1 BEFORE THE NEW YORK STATE LEGISLATURE:
SENATE STANDING COMMITTEE ON HEALTH;
2 SENATE STANDING COMMITTEE ON INVESTIGATIONS &
GOVERNMENT OPERATIONS;
3 ASSEMBLY STANDING COMMITTEE ON HEALTH;
ASSEMBLY STANDING COMMITTEE ON OVERSIGHT, ANALYSIS &
4 INVESTIGATION; and
ADMINISTRATIVE REGULATIONS REVIEW COMMISSION
5 ----------------------------------------------------
6 VIRTUAL JOINT PUBLIC HEARING:
7 COVID-19 AND HOSPITALS
8 ----------------------------------------------------
9 Date: August 12, 2020
Time: 10:00 a.m.
10
11 PRESIDING:
12 SENATOR GUSTAVO RIVERA
Chair, Senate Standing Committee on Health
13
SENATOR JAMES SKOUFIS
14 Chair, Senate Standing Committee on Investigations &
Government Operations
15
SENATOR SIMCHA FELDER
16 Chair, Administrative Regulations Review Commission
17 ASSEMBLYMEMBER RICHARD N. GOTTFRIED
Chair, Assembly Standing Committee on Health
18
ASSEMBLYMEMBER JOHN T. MCDONALD III
19 Chair, Assembly Standing Committee on Oversight,
Analysis & Investigation
20
ASSEMBLYMEMBER DAN QUART
21 Chair, Administrative Regulations Review Commission
22
23
24
25
2
1 SENATE MEMBERS PRESENT:
2 Senator George Borrello
3 Senator Pat Gallivan
4 Senator Pamela Helming
5 Senator Brad Hoylman
6 Senator Andrew J. Lanza
7 Senator Betty Little
8 Senator Monica Martinez
9 Senator Jen Metzger
10 Senator Thomas F. O'Mara
11 Senator Patty Ritchie
12 Senator James Tedisco
13
14 ASSEMBLYMEMBERS PRESENT:
15 Assemblymember Tom Abinanti
16 Assemblymember Jake Ashby
17 Assemblymember Charles Barron
18 Assemblymember Edward Braunstein
19 Assemblymember Marianne Buttenschon
20 Assemblymember Kevin Byrne
21 Assemblymember Kevin Cahill
22 Assemblymember Steve Cymbrowitz
23 Assemblymember Nathalia Fernandez
24 Assemblymember Andrew Garbarino
25 Assemblymember Aileen Gunther
3
1 ASSEMBLYMEMBERS PRESENT (continued):
2 Assemblymember Ellen Jaffee
3 Assemblymember Ron Kim
4 Assemblymember Brian Manktelow
5 Assemblymember Missy Miller
6 Assemblymember Steven Otis
7 Assemblymember Linda Rosenthal
8 Assemblymember John Salka
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
4
1
SPEAKERS: PAGE QUESTIONS
2
Howard Zucker 10 18
3 Commissioner
NYS Department of Health
4
Gareth Rhodes 10 18
5 Deputy Superintendent and
Special Counsel
6 NYS Department of Financial Services
7 James Malatras 10 18
President
8 Empire State College
9 Carlina Rivera 134 141
Chair, Committee on Hospitals
10 New York City Council
11 Bea Grause 163 173
President
12 Healthcare Association of NYS
13 Kenneth Raske 163 173
President
14 Greater NY Hospital Association
15 Veronica Turner-Biggs 220 236
Downstate Health Systems
16 Senior Executive Vice President
1199 SEIU, United Healthcare
17 Workers East
18 Ardela Moore [ph.] 220 236
1199 SEIU Member,
19 Environmental Service Worker
Garnet Health Medical Center
20
David Van de Carr 220 236
21 1199 SEIU Member,
Respiratory Therapist
22 Mount Sinai Morningside
23 Judy Sheridan-Gonzalez, RN 220 236
President
24 New York State Nurses Association
25
5
1
SPEAKERS (continued): PAGE QUESTIONS
2
Elisabeth Benjamin 288 309
3 Vice President, Health Initiatives
Community Service Society of New York
4
Anthony Feliciano 288 309
5 Director
Commission on the Public's Health System
6
Judy Wessler 288 309
7 Resident of New York, New York
8 Lois Uttley 288 309
Women's Health Program Director
9 Community Catalyst,
and
10 Coordinator
Community Voices for
11 Health System Accountability
12 David Pearlstein, MD 319 341
President and CEO
13 St. Barnabas Hospital
14 Bonnie Litvack, MD 319 341
Medical Society of the
15 State of New York
16 Carole Ann Moleti, DNP, MPH, CNM, 319 341
FNP-BC
17 Certified Nurse-Midwife
18 Patricia Burkhardt, CM, LM, DrPH 319 341
Treasurer
19 New York State Association of
Licensed Midwives
20
Ralph Palladino 351 366
21 Second Vice President
DC37 AFSCME
22
Debora Hayes 351 366
23 Upstate Area Director for
CWA District 1
24 Communication Workers of America
25
6
1
SPEAKERS (continued): PAGE QUESTIONS
2
Fred Kowal 351 366
3 Statewide President
United University Professors
4
Catherine Hanssens 378 392
5 Center for HIV Law and Policy
6 Jessica Barlow 378 392
Senior Staff Attorney
7 Disability Rights New York
8 Marcus Harazin 378 392
Coordinator, Patient Advocates Program
9 New York Statewide Senior Action Council
10 Erik Larsen, MD 410 425
Assistant Director of EMS &
11 Emergency Preparedness
White Plains Hospital
12
Miao Jenny Hua, MD, Ph.D. 410 425
13 New York, New York
14 Janet Mendez 410 425
Resident of
15 Morningside Heights, New York
16
17
18
19
20
21
22
23
24
25
7
1 SENATOR RIVERA: Good morning everyone.
2 Welcome to the third -- well, it is a first
3 of such hearings, but the third that we are doing on
4 the impact of COVID-19 on different sectors of the
5 health infrastructure of the state of New York.
6 Today we will be focusing on the impact on
7 hospitals.
8 Just would want to get a couple of very quick
9 procedural things out of the way, and we will get
10 right into the testimony.
11 We are joined today by my co-chairs in the
12 Senate Majority: Senator James Skoufis, chair of
13 Investigations, as well as chair of Administrative
14 Regulations Review, Senator Simcha Felder.
15 Also joined from the Majority by
16 Senator Brad Hoylman, Senator Jen Metzger, and
17 Senator Monica Martinez.
18 We're also joined from the Minority, we have
19 Senator Pat Gallivan, the ranker on the health
20 committee; ranker in -- and then we also have
21 Senator Patty Ritchie, Senator Jim Tedisco,
22 Senator Pam Helming, Senator George Borrello,
23 Senator Betty Little, Senator Lanza.
24 And with that, I will pass it off to my
25 Assembly colleague for some procedural matters, and
8
1 we will get right into the questioning.
2 ASSEMBLYMEMBER GOTTFRIED: Okay. You know,
3 before I do the procedural things, could our
4 Co-Chair John McDonald introduce the
5 assemblymembers who are in the hearing?
6 SENATOR RIVERA: And as he is still on mute,
7 I just saw that Senator Tom O'Mara, the ranking
8 member of the Investigations Committee has joined
9 us.
10 Apologies that I missed you, sir.
11 Go ahead, Assemblymember.
12 ASSEMBLYMEMBER MCDONALD: In order of how
13 they appear:
14 Aileen Gunther, Charles Barron,
15 Edward Braunstein, Ellen Jaffee, Jake Ashby,
16 John Salka, Kevin Cahill, Missy Miller, Ron Kim,
17 Steve Cymbrowitz, Tom Abinanti.
18 Obviously, Dan Quart is with us as well. I'm
19 sure he'll be speaking.
20 I see Ranker Brian Manktelow. Kevin Byrne.
21 And I believe that's it for now, but I know
22 more members will be joining us.
23 ASSEMBLYMEMBER GOTTFRIED: Did you read off
24 Ellen Jaffee?
25 ASSEMBLYMEMBER MCDONALD: I did read off
9
1 Ellen Jaffee.
2 ASSEMBLYMEMBER GOTTFRIED: Oh, okay.
3 Okay. Well, thank you.
4 I will just do some quick procedural points.
5 You know, this is going to be a long hearing,
6 and, so, every three hours or so we will take a
7 10-minute break for what the health committee calls
8 "ambulation and toileting."
9 And a safety reminder: Nobody should talk
10 while -- in the hearing while they are driving.
11 We will not be having opening remarks for
12 this hearing, in the interest of time.
13 Witness testimony will be limited to
14 5 minutes each.
15 Question-and-answer time will be limited to
16 5 minutes, per panel, for committee chairs and
17 ranking minority members, and -- committee chairs
18 and ranking members of the sponsoring committees,
19 and 3 minutes each for other committee members.
20 You know, we've had two days, about 21 hours,
21 of hearings on COVID-19 and nursing homes, adult
22 homes, and home care.
23 So, at this hearing, testimony and questions
24 will be limited to the topic of COVID-19 and
25 hospitals.
10
1 Committee -- excuse me.
2 Committee members may submit written
3 questions, whether on the long-term-care topic from
4 our previous hearings, or COVID and hospitals today,
5 may submit written questions to us, which we will
6 forward to the appropriate witness, asking that the
7 witness respond in writing within three weeks.
8 And last point is, that each of our
9 witnesses, I will ask them to swear or affirm that
10 the testimony that he or she is about to give is
11 true.
12 And that's it at my end.
13 SENATOR RIVERA: Thank you, Assemblymember.
14 A slight correction, however.
15 We have not done hearings for 21 hours.
16 We have done hearings for about 23 hours.
17 So, just thought I would make that small
18 correction.
19 Moving to our first panel, we are joined by
20 Commissioner Howard Zucker of the New York State
21 Department of Health.
22 He is accompanied by Jim Malatras, president
23 of the Empire State College, and, Gareth Rhodes,
24 deputy superintendent and special counsel for the
25 Department of Financial Services.
11
1 ASSEMBLYMEMBER GOTTFRIED: And do each of you
2 swear or affirm that the testimony you are about to
3 give is true?
4 COMM. HOWARD ZUCKER: I affirm.
5 GARETH RHODES: I affirm.
6 JAMES MALATRAS: I affirm.
7 ASSEMBLYMEMBER GOTTFRIED: Okay. Fire away.
8 COMM. HOWARD ZUCKER: Good morning, members
9 of the New York State Senate Committee on Health,
10 Investigations & Government Operations, and
11 Administrative Regulations Review Commission, and
12 Assembly Committee on Health; Oversight, Analysis,
13 and Investigation; and Administrative Regulations
14 Review Commission.
15 Thank you for the opportunity to speak before
16 you today.
17 This morning I want to talk about the central
18 role our hospitals played in this unprecedented
19 emergency.
20 As a physician and as an intensivist, I spent
21 decades working in these facilities, including two
22 of the New York City hospitals.
23 Intensivists care for critically-ill
24 patients, and in my case it was children. In that
25 position, that clock, that clock on the wall, is
12
1 working against you; it never stops for you to get
2 your bearings or to try something again.
3 That's exactly what happened on the scale
4 that was previously unimaginable when COVID-19
5 besieged New York hospitals.
6 From the arrival of the first
7 laboratory-confirmed cases in New York State on
8 March 1st, the number of cases rose exponentially,
9 with the number of cases doubling overnight on
10 March -- on both March 5th and on March 6th.
11 New York hospitals had long been preparing
12 for this.
13 Since 2009, New York State Department of
14 Health has regularly staged practice drills for H1N1
15 pandemic, influenzas.
16 We now know that our scenarios and our
17 exercises could not fully anticipate the symptoms
18 and bodily damage inflicted by COVID-19 or a
19 transmission pathway as devious as this disease.
20 Those drills also could not have fully
21 anticipated the enormity of the strain on our
22 health-care system and our public health systems
23 that a pandemic of this scope, swift onset, unique
24 nature, and infectiousness could bring; nor did we
25 predict in those drills that states would be
13
1 responding to such devastation without any
2 coordinated system of federal support, intervention,
3 and detection.
4 The first challenge we recognized as
5 New York's COVID-19 surge began, was that our
6 53,000 statewide licensed bed capacity needed to be
7 drastically and dramatically increased to meet a
8 demand that some statistical models had placed as
9 high as 140,000 beds.
10 These existing 53,000 licensed beds were
11 disbursed across a vast health-care system,
12 consisting of 23 public and 200 private hospitals,
13 each with their own operations, policies, and
14 systems.
15 On March 23rd, we issued a directive,
16 requiring each hospital to double its licensed bed
17 capacity.
18 New York hospitals rose to that challenge.
19 We directed hospitals statewide to cancel all
20 elective surgeries in order to make available as
21 many hospital beds as possible to treat COVID-19
22 patients.
23 Initially, models predicted significantly
24 larger inpatient facility needs.
25 The initial estimates were, that
14
1 New York State would need 140,000 hospital beds by
2 the end of April.
3 We worked with the Army Corps of Engineers,
4 the Department of Defense, and the National Guard to
5 erect and staff alternate care facilities, like the
6 Javits and "The Comfort."
7 1,095 patients were treated at the Javits
8 during the duration of its operations.
9 "The Comfort," where 182 patients were
10 treated, was operated by the U.S. Navy Medical
11 Corps, and they established the patient admissions'
12 criteria.
13 Javits and "The USNS Comfort" were originally
14 limited to non-COVID-19 patients, based on a
15 decision by the federal entities that were staffing
16 these alternative care sites.
17 But by April 3rd, in the case of Javits, and
18 on April 6th, on the Comfort, we had successfully
19 pushed to get them to accept COVID-19 patients.
20 That was adapting to the needs of the
21 hospitals increasingly stressed by the rapidly
22 growing COVID-19 patient census.
23 In addition, the State aggressively worked to
24 establish other alternative patient-care sites in
25 estimated high-impact areas, including The Brooklyn
15
1 Center at -- with 280 beds; the South Beach
2 Psychiatric Center in Staten Island, which is
3 managed by Northwell, with 260 beds; and additional
4 sites constructed, but never activated, included
5 SUNY Stony Brook, 1,028 beds; SUNY Old Westbury,
6 1,024 beds; and the Westchester Convention Center
7 with 110 beds.
8 Building this capacity was an extraordinary
9 effort, and we were ready to treat thousands of
10 additional COVID-19 patients if it became necessary.
11 Bending the curve was an even more remarkable
12 effort by New Yorkers that alleviated the need to
13 open these sites.
14 We began ordering PPE, ventilators, and other
15 supplies to be sure we could restock our hospitals
16 if the supply chain failed them.
17 We set up staffing portals, and asked for
18 health-care workers to sign up to help in the battle
19 against COVID-19.
20 And when the supply of those medications that
21 were needed to care for the most critically-ill
22 COVID-19 patients in ICUs ran low due to extreme
23 demand and supply-chain issues, the State identified
24 those hospitals with the most urgent needs, and
25 worked with the pharmaceutical wholesalers to ensure
16
1 that New York hospitals were prioritized, which
2 resulted in larger and more frequent distribution of
3 these medications into the state.
4 The governor issued executive orders to
5 expand scope of practice and limit restrictions so
6 that more health-care providers could provide care
7 to more people as the hospital emergency departments
8 and inpatient beds quickly filled.
9 However, these numbers and policy decisions
10 cannot effectively characterize the experience of
11 physicians and other health-care professionals
12 living through COVID-19 inside these hospitals.
13 At every hospital, in every ward, on every
14 floor, in every hallway, and on every gurney,
15 health-care workers were making critical
16 decisions --
17 SENATOR RIVERA: Commissioner?
18 COMM. HOWARD ZUCKER: -- focused solely --
19 SENATOR RIVERA: Commissioner, how much
20 longer do you have, sir?
21 COMM. HOWARD ZUCKER: Four pages. Three,
22 four minutes.
23 SENATOR RIVERA: Which is, definitely, you're
24 not going to be able do it all.
25 COMM. HOWARD ZUCKER: All right.
17
1 SENATOR RIVERA: If you could actually try to
2 conclude in the next 30 seconds, I'm giving you some
3 leniency with an extra minute.
4 COMM. HOWARD ZUCKER: All right, well, I will
5 tell you that -- well, let me finish this paragraph.
6 Perhaps 20 minutes after the first patient
7 was sick, they had to make another decision, and
8 another decision after that.
9 In the meantime, some hospitals that were
10 nearby, but were -- had no way to access it.
11 For instance, in the third week of March,
12 Elmhurst Hospital was inundated with patients at a
13 time when other hospitals had capacity, but there
14 was no system in place to immediately share the
15 load.
16 And we needed to create a way to make this
17 overtaxed system work efficiently, to save lives, to
18 improve patient outcomes, and to alleviate the
19 stress on front-line workers.
20 And in many other --
21 SENATOR RIVERA: Okay.
22 There's, obviously, the rest of your -- if
23 the rest of your testimony is the written testimony,
24 it is all -- will be on the record.
25
18
1 So we'll now move to questions.
2 Thank you for your testimony.
3 We'll lead off by the Senate, by
4 Senator James Skoufis.
5 SENATOR SKOUFIS: Thanks very much.
6 Good morning, everyone.
7 Thanks for your testimony, Commissioner.
8 And I do want to express my gratitude to each
9 of you, and the governor, and your team, for your
10 remarkable work over the past five months.
11 You know, there's a lot of Monday-morning
12 quarterbacking that happens, but I think very few
13 people have the full appreciation for just how
14 quickly things were changing, just how difficult
15 things were in hospitals and elsewhere.
16 And I do want to acknowledge that before
17 I get to my questions.
18 First, can you talk to me, I know it's coming
19 out in a couple of days, but, we talked, on page 128
20 of last year's budget bill, S1507-C, it's speaking
21 to a study that all of you were directed to -- to
22 engage with, looking at staffing in hospitals and
23 nursing homes and elsewhere.
24 It reads: That the department shall report
25 its findings and the recommendations to the
19
1 commissioner of the department of health
2 [indiscernible] present of the Senate and speaker of
3 the Assembly no later than December 31, 2019.
4 I appreciate that this study is being
5 released, I guess, in two days, but, make no
6 mistake, the department ignored the law.
7 And I think that's kindly putting it.
8 You could argue that the department is
9 breaking the law, in not issuing this report by
10 December of last year, which, no doubt, could have
11 informed us a bit more, leading into this pandemic.
12 Can you speak to, why, on August 14th, we
13 will be getting this report, and why we did not get
14 it on December 31st?
15 COMM. HOWARD ZUCKER: The report needed to be
16 reviewed further.
17 Obviously, in January, when this pandemic
18 started, or, in February, I should say, when it
19 really took off, and there were issues, we were
20 redirected to those issues.
21 The report is -- I've glanced at that
22 report -- well, I've read through the report, but
23 I wanted to look at that one more time. It's going
24 to come on August 14th, which is on Friday.
25 And I believe that the efforts of the
20
1 department to address the needs of the hospitals
2 were met, whether it's an issue of staffing or other
3 needs that they had.
4 But let's -- I'm happy to discuss the report
5 after it comes out.
6 SENATOR SKOUFIS: Okay, well, I --
7 [indiscernible] and I noted this last night in a
8 separate hearing: You know, this is a pretty
9 longstanding practice, when these types of
10 deadlines, via legislative directive, are often
11 ignored by agencies.
12 Quite frankly, we could have taken you to
13 court and compelled you all to release this far
14 sooner than August 14th.
15 That's on us, and we ought to be doing more
16 of that as a legal prerogative.
17 But I really do hope that your department,
18 and all the agencies, do a better job of not
19 ignoring the legislature when we ask you -- not ask
20 you, direct you to do something in statute.
21 If I could move on:
22 So PPE, no doubt, was an enormous challenge
23 that extended far beyond our state's boundaries, and
24 was, predominantly, a challenge that resulted from
25 the federal government not doing its job, one of
21
1 many instances over these past five months.
2 I know that [indiscernible] the governor just
3 announced a consortium, with seven other states,
4 moving forward in sort of a purchasing agreement, if
5 you will.
6 But what else can we do?
7 Knowing the federal government was just so
8 unprepared, making sure we had masks and gowns and
9 gloves for our hospital workers, what else can we
10 do?
11 Are we doing more to try and encourage
12 manufacturing of this kind of equipment in the
13 state?
14 What more can we do?
15 COMM. HOWARD ZUCKER: So, number one, the
16 governor has announced that there needs to be a
17 90-day supply of PPE available to the hospitals.
18 So we are addressing that.
19 We are also looking across the state, and
20 elsewhere, about, what one can do regarding
21 manufacturing more PPE, and making sure that we have
22 access, and we don't end up in a situation where we
23 have to call and compete against our fellow states
24 to get the equipment.
25 This was one of those situations where we
22
1 recognize the challenges that we face by not having
2 the ability to --
3 SENATOR SKOUFIS: I appreciate that. Thank
4 you.
5 And I just want to get in my last question.
6 And perhaps, Mr. Malatras, and thank you for being
7 here -- Dr. Malatras, sorry:
8 Are there any regrets that you have, looking
9 back?
10 Again, hindsight is 20/20.
11 Something you would do differently in
12 hospitals, knowing what you now know over the past
13 five months?
14 DR. JAMES MALATRAS: I think we're still
15 actively in the response at some level. It's not
16 the same, but we're preparing.
17 Thankfully, in New York, our infection rate
18 among one of the lowest in the nation. Our
19 hospitalizations are down.
20 But we are preparing, actually, for the fall.
21 And, also, as you see what the other states
22 are doing, we have about 40 or so states that are
23 actually increasing exponentially across the county,
24 [indiscernible] New York which is actively still
25 managing the cluster crisis that is still here.
23
1 So, we're still in active response.
2 We'll have time for retrospective
3 [indiscernible].
4 SENATOR SKOUFIS: Okay.
5 Thank you.
6 SENATOR RIVERA: Thank you, Senator.
7 Thank you, Mr. Malatras.
8 Assembly.
9 ASSEMBLYMEMBER MCDONALD: We will now go to
10 our health chair, Mr. Richard Gottfried.
11 ASSEMBLYMEMBER GOTTFRIED: Thank you.
12 Commissioner, I'd like to -- since our goal
13 here is learning for the future, long before you
14 became commissioner, but only a couple years before
15 I became health chair, New York started on a path of
16 dramatic reductions in hospital capacity.
17 At the same time, we have seen increasing
18 consolidations within -- within the hospital
19 industry. I think it's probably almost every
20 hospital is now part of some network headed by a
21 large academic medical center. A lot of the
22 reduction in capacity [inaudible]
23 community hospitals.
24 So my question is: Has -- have those trends,
25 reduction --
24
1 SENATOR RIVERA: Assemblymember, if I may
2 interrupt for one second, I want to make sure that
3 the time is rolling.
4 It is not rolling yet.
5 There you go.
6 I'm sorry.
7 Continue, Assemblymember.
8 ASSEMBLYMEMBER GOTTFRIED: Okay.
9 -- so have those reductions in capacity, and
10 particularly reductions in capacity of community
11 hospitals, and consolidation of hospital systems,
12 have we gone too far with those trends?
13 Do we need a course correction?
14 And is that one of -- have we learned that
15 from this epidemic?
16 COMM. HOWARD ZUCKER: I think the discussion
17 here is obviously about the pandemic, and the
18 hospitals are part of it.
19 I think what we have learned from the
20 pandemic, and are learning from the pandemic, as we
21 know, this is far from over, is that we have to look
22 at all parts of the hospital system, and figure out
23 how to make sure the needs of the patients are met.
24 I think this is a longer discussion about
25 health-care delivery, which I'd like to have with
25
1 you, regarding hospital inpatient needs, outpatient
2 needs, and where we're going, and would be happy to
3 discuss that.
4 But with regards to the pandemic, there are
5 many lessons we've learned regarding hospital
6 delivery, both inpatient and outpatient and hospital
7 services.
8 DR. JAMES MALATRAS: And, Chairman Gottfried,
9 if I may, because it builds on Chairman Skoufis's
10 question as well, I think part of it is, you need
11 different amounts of beds, or number of capacity, at
12 different times.
13 And what we learned with the current pandemic
14 is, you don't always need the same amount of beds at
15 normalcy, but you may need to ramp up exponentially,
16 given a crisis like we witnessed.
17 So what the "Surge & Flex" regulation that
18 the department of health just put out, requires
19 hospitals to be ready to increase their capacity by
20 at least 50 percent.
21 While you also need beds, you need staffing,
22 which is why we did the staffing portal, which
23 brought about 100,000 people into the system, as
24 needed.
25 And then the equipment to go along with it.
26
1 As we all know, ventilators, and other key PPE, were
2 key to this success.
3 So building that capacity also all works
4 together.
5 So I think there's a level of preparedness,
6 that we really focus on preparedness for future
7 response, to have the flexibility to quickly adapt
8 and grow, as needed, as well as, in addition to your
9 long term, do you have enough beds, generally?
10 I think the health-emergency thing also had
11 to be addressed, which we did do the "Surge & Flex"
12 regulation.
13 ASSEMBLYMEMBER GOTTFRIED: Thank you.
14 SENATOR RIVERA: Thank you, Assemblymember.
15 We'll follow up with Senator Felder,
16 recognized for 5 minutes.
17 SENATOR FELDER: Yeah, good morning.
18 I want to echo my colleague Senator Skoufis's
19 thanks and compliments for all the work that you've
20 done.
21 And I -- I -- I wanted to address the issue
22 of -- of having somebody, a family member or
23 somebody close to the patients, in the hospitals
24 during this time.
25 My own experience has been, over the years:
27
1 Thank God, I have a mother who is very
2 elderly. And I can't remember any time that she's
3 been hospitalized, and she has frequent miles in the
4 emergency room, unfortunately, that, unless somebody
5 was with her, I -- I -- I can't forecast, you know,
6 and say she'd be dead, God forbid, but, I think so,
7 because the nature of the emergency rooms are, that
8 they do their best. Things are just happening.
9 So during this time, I understand that a
10 pandemic is not a usual thing, obviously.
11 But, you know, when a loved one is
12 hospitalized, the family and friends, usually, at
13 least somebody stays at their bedside some portion
14 of the time, to make sure they get comfort, care,
15 and assistance that's really vital to the recovery,
16 besides, obviously, the medication.
17 It's clear that, this time, all the way
18 till -- I mean, I don't know, you know, exactly when
19 it stopped, but the guidance and the rules that the
20 hospitals implemented was not to allow anybody to
21 stay with their loved ones at any point of time.
22 And it really was intolerable that patients
23 languished alone, scared, and unable to communicate;
24 they couldn't communicate through their final days,
25 and family members had no way of knowing what was
28
1 going on until it was too late.
2 And I'm certain that we can do better.
3 And I'm just wondering whether you have, you
4 know, for the future, I'm not talking about the
5 past, I'm talking about for the future, is there
6 some plan to improve this policy, whether -- you
7 know, whether they have the abilities on iPads, or
8 even -- I don't have the answer. I'm sorry.
9 You know, usually, I don't like posing a
10 problem without an answer, but, I don't have a good
11 answer.
12 But I do know that, you know, I'm using my
13 mother again, that anytime she goes into the
14 emergency room, if there's no one there, she's not
15 coming out.
16 That's the story.
17 So, is there some commitment to being able to
18 have a family member?
19 I mean, the nurses, you know, they dressed up
20 entirely, you know, to make sure that there was
21 no -- no contagion, or whatever else.
22 I can't -- I -- I -- I know I'm speaking to
23 the converted when I say that a family member is a
24 critical part of taking care of the patients.
25 And it was -- it was horrible.
29
1 I can't say anything else.
2 I'm just asking for your help, and
3 commitment, to trying to do something, some way, for
4 future, God forbid, if something happens, so that
5 family members or close ones can be there.
6 They don't have to be there all day, but, at
7 some point during the day, so that they're there,
8 you know, really, at the worst times in a person's
9 life.
10 COMM. HOWARD ZUCKER: So I hear you on this.
11 Having been a patient, having been a relative
12 of a patient, and as a doctor, I can tell you
13 I really understand that situation.
14 But you have to remember where we were at
15 that moment in time, and we were trying to make sure
16 that this situation would not spread through a
17 hospital. We wanted to be sure that we protected
18 the patients.
19 We did have a visitation policy that was put
20 into place in May -- at the end of May to address
21 these concerns.
22 I absolutely understand where you're coming
23 from, and it is very tough for patients, but, we are
24 at a different point in time.
25 We have more supplies. We understand the
30
1 disease better. We have the "Surge & Flex" issues.
2 There are so many things we have done.
3 But back then, when it began, the goal was to
4 make sure that this was not going to spread
5 throughout the hospital where there are many
6 vulnerable patients, for all -- for many reasons.
7 So I hear you.
8 SENATOR FELDER: Thank you.
9 Thank you, Senator.
10 Assembly.
11 ASSEMBLYMEMBER MCDONALD: Thank you.
12 Our next speaker will be Assemblymember
13 Dan Quart.
14 ASSEMBLYMEMBER QUART: Good morning. Thank
15 you very much.
16 And thank you, Dr. Zucker, for your
17 statement and your testimony.
18 I am chair of the Assembly's Oversight
19 Committee on Regulations, so I'll start with my
20 questions in the area of regulations.
21 The department of health recently adopted
22 emergency regulations that require hospitals to
23 maintain a 90-day supply of PPE; 60-day supply,
24 nursing home.
25 I think Senator Skoufis mentioned that a
31
1 little in his questions.
2 However, this requirement is based on a
3 so-called "burn rate" taken specifically from
4 April 19th through April 27th.
5 And the CDC's, quote/unquote, contingency and
6 crisis guidelines that allowed treating two or three
7 or more patients without changing PPE.
8 On March 28th, Governor Cuomo stated that
9 New York State was concerned that these guidelines
10 were inadequate, and that, quote, Dr. Zucker is
11 looking at that. If we believe the CDC guidelines
12 do not protect health-care professionals, we will
13 put our own guidelines in place, quote/unquote, by
14 the governor.
15 A few days after that, DOH issued guidance,
16 with contingency and crisis recommendation, based on
17 CDC guidelines.
18 My question is:
19 Did department of health, did New York State,
20 review the CDC policies, and determine that they
21 were insufficient?
22 And, if there was some review, was that ever
23 made public; was the documentation of that review
24 made public?
25 COMM. HOWARD ZUCKER: Well, we review the
32
1 CDC guidelines on a regular basis with regards to
2 the PPE issue, a 90-day supply.
3 The reason we have a 90-day supply in place
4 is because, if we start to recognize that there is a
5 problem after 30 days, whether based on guidance
6 from the CDC or our own guidance, we will be able to
7 immediately adjust and make sure that we have enough
8 PPE.
9 I gather what -- the CDC guidance is just
10 one -- we follow that, but we also look internally.
11 And that's why the governor has said, let's
12 have enough PPE.
13 ASSEMBLYMEMBER QUART: Well, Dr. Zucker, I'll
14 just pick up on your answer.
15 You said "immediately adjust."
16 And I think that may, or very well may,
17 become relevant, because, as you're well aware,
18 Vice President Pence set forth that the CDC
19 guidelines could, or would, change.
20 So what is the mechanism that you've
21 implemented on changing guidelines, in light of any
22 change on CDC guidelines, or, change of
23 circumstances in the hospitals themselves?
24 COMM. HOWARD ZUCKER: Oh, that's what I'm
25 saying, with a 90-day supply, a 3-month supply is a
33
1 significant amount of PPE.
2 The issue here is that, if we start to see an
3 uptick in cases, we will adjust accordingly.
4 This is not sort of a, you know, on/off
5 switch.
6 If we start to see a little bit of a change,
7 or more of a change, then we will go back and look
8 at the guidance that we have, as well as any of the
9 recommendations the CDC have, and adjust it, to be
10 sure that we meet the demands of those in the
11 hospital.
12 ASSEMBLYMEMBER QUART: Well, you mentioned
13 sufficiency of PPE, so let's delve into that a
14 little bit, Dr. Zucker.
15 As the pandemic set forth, there seemed to be
16 a disconnect, at least from my perspective, between
17 hospital administrators, what they were telling you,
18 and nurses who were on the nightly news, saying,
19 very specifically, that there was not enough PPE
20 equipment within the hospitals.
21 And they referenced that, and memorialized
22 that, in the lawsuit, all those complaints, in April
23 of this year.
24 Did DOH have an acute awareness in real time
25 of the situation on hospital floors, maybe something
34
1 different than what hospital administrators were
2 telling you?
3 COMM. HOWARD ZUCKER: So a couple things on
4 that.
5 One is: Just because something is reported
6 doesn't mean those are the facts of what is actually
7 happening and what's reported on the news.
8 I actually have spoken to the hospital
9 administrators on a regular basis during the time
10 that was going on, but, not only talking to the
11 administrators, because you just raised that, I also
12 spoke to the physicians and the nurses in many of
13 the hospitals, and the leadership, and asked these
14 questions.
15 And there was, we provided 24 million pieces
16 of PPE, and there was available PPE to all those who
17 needed it.
18 Granted, there were different policies that
19 were put into place about how to preserve some of
20 the PPE equipment. But we were pushing also to get
21 more PPE.
22 I can tell you that, in those conversations
23 with those physicians and those nurses, they said,
24 we have the PPE that is needed.
25 If there was a problem, they should come back
35
1 to us and we make sure that it's available.
2 So I'm not -- sorry.
3 Go ahead.
4 ASSEMBLYMEMBER QUART: Since I only have a
5 couple seconds left, in response to your -- the last
6 part of your answer:
7 As you know, my colleague
8 Assemblymember Reyes passed legislation, Chapter 117
9 of the laws of 2020. It's, essentially, a
10 whistleblower protection for those who come forth
11 and make complaints that might be contrary to those
12 by administrators within the hospital.
13 Does DOH have any normal procedures in place,
14 if there's another wave, for whistleblowers coming
15 forth, taking in that information and processing it
16 and responding to it in a timely fashion?
17 COMM. HOWARD ZUCKER: Well, we always
18 respond.
19 If there's any concern, whether it's in a
20 hospital or any other Article 28 facility, and
21 someone brings it to our attention, we immediately
22 investigate that.
23 If someone had a concern, whether it was
24 during the previous months of this pandemic, or
25 going forward, we will investigate it and act
36
1 accordingly.
2 SENATOR RIVERA: Thank you, Commissioner.
3 Thank you, Assemblymember.
4 Next from the Senate, we have
5 Senator Gallivan recognized for 5 minutes.
6 SENATOR GALLIVAN: Thank you, Chairman.
7 Good morning to all the members of the panel.
8 Dr. Zucker, I want to talk a little bit
9 about the discharge and transfer of patients.
10 And we go back to Executive Order 202, which
11 the governor issued on March 7th, dealing with rapid
12 discharge, transfer, and receipt of patients.
13 Could you explain what that order did?
14 COMM. HOWARD ZUCKER: I'd like to know a
15 little bit more. I have to -- you know, there are a
16 lot of numbers on a lot of orders, so I need to find
17 out which one it is.
18 SENATOR GALLIVAN: So this deals with rapid
19 discharge, transfer, and receipt of such patients at
20 hospitals and nursing homes.
21 COMM. HOWARD ZUCKER: Well, patient -- I'm
22 not sure what you mean by "rapid transfer."
23 The fact is, if a patient is ready to move
24 from the hospital, and meets all the clinical
25 criteria, and -- then the patient can be
37
1 transferred.
2 We have many different guidance documents
3 that have been put into place over the course of
4 this pandemic.
5 I'm happy to review that particular document
6 and get back to you.
7 SENATOR GALLIVAN: Well, I'm not sure what
8 the governor meant by "rapid transfer" either, which
9 is why I asked the question.
10 COMM. HOWARD ZUCKER: Well, I will tell
11 you -- I just will tell you that, at that moment in
12 time, we were seeing, as I was going to mention in
13 my opening remarks, 140,000 potential cases.
14 And the goal was to make sure that people who
15 were better, and able to move, should be moved to
16 the appropriate facilities.
17 And that was just what we needed to do to
18 make sure we had enough beds for all the patients
19 who potentially could come in.
20 But I will go back and look.
21 SENATOR GALLIVAN: Are you able to talk about
22 the type of coordination that exists between
23 hospitals and nursing homes?
24 COMM. HOWARD ZUCKER: Sure.
25 Well, there's always coordination between
38
1 hospitals and between all other Article 28
2 facilities.
3 And so during this period of time, I mean,
4 we'll start with the hospital issue. The nursing
5 home issue we discussed last week.
6 But on the hospital issue, the governor had
7 said, right at the beginning of this, that we need
8 to level -- a level setting, to be sure that there
9 is a possibility to move a patient from one hospital
10 to another hospital, independent of whether they're
11 in the same system.
12 Many times patients move within the system,
13 but we also move them across systems, in an effort
14 to be sure that all patient needs were met.
15 And the same with any other needs of patients
16 from one facility to another.
17 SENATOR GALLIVAN: So there was another order
18 on May 10th, another executive order, and that
19 prohibited hospitals from discharging patients to a
20 nursing home, unless first certified by the nursing
21 home administrator that the facility could properly
22 care for the patient. And it required the hospitals
23 to perform a COVID test on the patients prior to
24 discharge.
25 How did that order come about?
39
1 COMM. HOWARD ZUCKER: So -- I mean -- well,
2 I'll answer that, but then I also want to mention
3 that we did -- we did discuss all of this the last
4 time I was here, when I discussed the nursing home
5 issue.
6 The May 10th issue is that we now had the
7 capability to do more testing. And so that was the
8 decision, to do testing before someone left the
9 hospital. That was what the purpose of the May 10th
10 order that was put forth.
11 But we have already discussed the issues of
12 the nursing homes, whether it's that issue or other
13 issues.
14 And I'm really here to talk about the
15 hospitals, and to focus on the hospitals' challenges
16 that they had during the time of this crisis, and
17 going forward as well.
18 SENATOR GALLIVAN: Do you have an idea of how
19 many patients were discharged [indiscernible]
20 hospitals, back into the nursing homes, during this
21 pandemic.
22 ASSEMBLYMEMBER GOTTFRIED: Senator, Senator,
23 excuse me, if I could interrupt.
24 We're really trying to focus in this hearing
25 on hospitals, and not nursing homes.
40
1 We did 23 hours on the topic of long-term
2 care.
3 I would ask that questions along this line,
4 send them to me and Senator Rivera in writing. We
5 will send them to the commissioner, and we will get
6 answers.
7 But we really need to focus today on --
8 strictly on hospitals.
9 SENATOR GALLIVAN: I'm focusing on the
10 process that hospitals were directed to follow in
11 order to discharge people back to nursing homes.
12 And I'd also like to know how many nursing
13 home patients were transferred to the hospital, when
14 they're in the hospital, and subsequently died of
15 coronavirus?
16 COMM. HOWARD ZUCKER: This is the issue that
17 I addressed a week and a half ago.
18 I said, I think we have litigated this issue,
19 and I said that I will provide you the information
20 once I have an opportunity to review it and I've
21 made sure all that data is accurate.
22 And I'm happy to do that, and I will do that.
23 But if there are specific questions regarding
24 the hospitals and those issues, I'm happy to answer
25 them.
41
1 SENATOR GALLIVAN: How many ventilators did
2 the State obtain from upstate hospitals and transfer
3 to downstate hospitals?
4 COMM. HOWARD ZUCKER: I have to look at the
5 exact number.
6 On the ventilators, I know that the issue was
7 to be sure there were enough ventilators available
8 to all of the patients that needed them.
9 We looked at this issue when we started on
10 the challenges that we faced.
11 We were concerned that we were going to end
12 up, where the potential for splitting ventilators,
13 and what would be needed; BiPAP machines being
14 converted to ventilators.
15 And I can take a look and see if I have that
16 number with me.
17 Give me a second, if I have it here.
18 SENATOR RIVERA: I'll give you a couple more
19 seconds since there was a period there when the time
20 kept running.
21 COMM. HOWARD ZUCKER: So the department --
22 the department deployed 2600 ventilators to
23 hospitals.
24 And the exact number from upstate, I'd have
25 to look that one up. I don't have that exact
42
1 number.
2 SENATOR GALLIVAN: The very last question
3 also has to do with [indiscernible cross-talking].
4 SENATOR RIVERA: Very quickly, please.
5 SENATOR GALLIVAN: Was anybody without a
6 ventilator that needed one?
7 COMM. HOWARD ZUCKER: No.
8 SENATOR GALLIVAN: All right. Thank you.
9 COMM. HOWARD ZUCKER: In fact, even during
10 our peak, when there were 4449 patients intubated,
11 it's an unbelievable amount of patients intubated,
12 they all, who needed a ventilator, got a ventilator.
13 And, now, there are only 60 people in the
14 state of New York ventilated.
15 We went from 4500, essentially, down to 60.
16 SENATOR RIVERA: Thank you, Commissioner.
17 SENATOR GALLIVAN: Thank you.
18 SENATOR RIVERA: Thank you, Commissioner.
19 Assembly.
20 DR. JAMES MALATRAS: [Indiscernible]
21 30 seconds more, because I think the ventilator
22 point is a really important point.
23 SENATOR RIVERA: However, we will have to --
24 but we will have to go to the next -- let's go to
25 the Assembly.
43
1 You'll have an opportunity, I'm sure, to
2 answer it at a future date.
3 ASSEMBLYMEMBER MCDONALD: The Assembly will
4 recognize me.
5 And, Dr. Zucker, Dr. Malatras, and
6 Dr. Gareth, thank you for being with us.
7 Executive orders, obviously, there was plenty
8 of them issued.
9 Of course, we don't hear too much about the
10 ones that are working. We only hear about the ones
11 that people aren't happy about.
12 I'm kind of curious, from a professional
13 standpoint, you know, obviously, the governor was
14 very direct about trying to recruit doctors and
15 nurses that were retired to come back in. We
16 allowed medical students to start to practice.
17 Was that a significant help to the hospital
18 systems during this process?
19 Was there a lot of participation from those
20 retired professionals, and, obviously, were many of
21 the young professionals able to start?
22 COMM. HOWARD ZUCKER: So we did many -- we
23 did many things to address this.
24 We had volunteers, we had 95,000 volunteers,
25 available. And 15,000 of those came from other
44
1 areas, came from upstate and in the state, as well
2 as elsewhere, to help out in the downstate area.
3 We had some of the medical students -- or,
4 medical students graduate early, to bring them in.
5 This was all helpful.
6 When you have a system which is so stressed
7 during this kind of a crisis, which is completely
8 unprecedented, you need to utilize all the resources
9 you have, and one of the major resources is human
10 resources.
11 So they were extremely helpful.
12 If your question is, were they helpful and
13 beneficial? Absolutely.
14 DR. JAMES MALATRAS: We had 30,000
15 volunteers, 30,000 from out of state.
16 I think we had nearly three or four hundred
17 of the facilities access our portal and use those
18 volunteers.
19 And it was, as the Commissioner said,
20 absolutely essential.
21 And where it was helpful was, staffing
22 agencies exist in the world, but there's fees and
23 other things.
24 But the State's mechanism, [indiscernible]
25 quickly and expeditiously done without the overhead
45
1 and the fees, and those types of things.
2 So it was used quite regularly by the
3 hospitals, nursing homes, and other facilities.
4 ASSEMBLYMEMBER MCDONALD: So I'm going to
5 speak for upstate for a little bit.
6 And we understood during -- as the crisis was
7 unfolding, capacity in the hospitals in downstate
8 were a big issue.
9 And, obviously, it was big news up here when
10 the first ambulance showed up, and -- from patients
11 from New York City were here at Albany Med.
12 Do we have any idea of how many patients were
13 transported from downstate to upstate during the
14 course of the pandemic?
15 COMM. HOWARD ZUCKER: There were transfers
16 that we facilitated through ambulances and -- as
17 well as working with FEMA. There was a handful that
18 did go from downstate to upstate.
19 But the goal, as the governor mentioned, was
20 to see how to move patients within the system that
21 they have, and to move them. And we were able to do
22 that.
23 And why would you take someone and move them
24 upstate if you don't have to?
25 I'm going to speak now as a clinician.
46
1 The worst thing you could possibly do --
2 everyone thinks you put someone in the back of an
3 ambulance and just move them, and it's no big deal.
4 But, in reality, that is extremely dangerous
5 to move somebody. You're putting them in, if
6 they're intubated, the tube slips, something
7 happens, you don't have the resources to help them,
8 you don't have the medications, you don't have the
9 backup systems that are available, the support
10 there.
11 So you don't move people unless you really
12 need to move them. And if there's a way to move
13 them locally, you do it that way.
14 And that's the smartest thing you can
15 possibly do, and that's why we didn't move them all
16 [indiscernible].
17 ASSEMBLYMEMBER MCDONALD: I agree with you
18 100 percent.
19 And that's the comments I was saying to
20 people: They weren't move them unless they truly
21 had to move them.
22 I think, and this is just to be noted,
23 obviously, with the restrictions on non-emergent
24 processes, a lot of our upstate hospitals lost a lot
25 of opportunity to continue to serve their
47
1 constituents. And a lot of these upstate hospitals
2 have been left out in regards to support.
3 And I think that's something we need to be
4 very mindful of, because I've heard from all of our
5 upstate hospitals that they are bleeding
6 tremendously, financially.
7 Actually, Dr. Malatras, I know you wanted
8 to mention something about ventilators, so I'm going
9 to give you 30 seconds to say that.
10 DR. JAMES MALATRAS: We kept very close data
11 analytics on every ventilator in the state of
12 New York, to make sure every hospital had the
13 ventilators they needed.
14 And the most important one that we
15 [indiscernible], of course, [indiscernible] system
16 in New York City, which had the largest impact
17 [indiscernible] at COVID. And we knew, exactly to
18 the date, how many excess ventilators they had.
19 So whether it was downstate or upstate, we
20 made sure, in the spirit of cooperation and
21 collegiality of the hospitals systems working
22 together, that no hospital was left without the
23 necessary ventilators and other materials they
24 needed. And worked quite well.
25 The Upstate Health Association hospitals
48
1 worked really well together with the downstate
2 facilities.
3 So that process, where everyone always had
4 the ventilators they needed. But, we were pushing,
5 of course, for more ventilators because there was a
6 dramatic need across the entire [indiscernible].
7 ASSEMBLYMEMBER MCDONALD: Thank you.
8 I'll just make a closing comment, and,
9 Dr. Zucker, really, it's not for you; it's probably
10 for the others who are listening.
11 PPE, it's very clear, after 23 hours of
12 hearings, we need to be able to, New York State,
13 provide for our own.
14 We need to find a way to do it in a
15 cost-effective manner.
16 What's not being discussed is the cost to
17 these hospitals. And upstate and downstate are
18 enduring, buying this PPE from China.
19 Thank you.
20 SENATOR RIVERA: Thank you, Assemblymember.
21 Now recognize Senator O'Mara for 5 minutes.
22 SENATOR O'MARA: Thank you, Chairman.
23 Good morning, gentlemen. Thanks for being
24 here.
25 I want to credit the State and their response
49
1 to ramping up hospital beds that were needed.
2 I think an outstanding job was done in regards to
3 that.
4 And we had a great outpouring of health-care
5 workers that came to New York, to help us, from
6 across Upstate New York, from states across the
7 country, frankly, to come in. And I thought it was
8 very well done.
9 I was disappointed that the health-care
10 workers being paid in New York City were hit with
11 our high income taxes, which was reported upon, and
12 certainly shocked them, and opened their eyes to the
13 real state of taxation in New York.
14 But I'd to like to ask you gentlemen: Is
15 there anything being done to help those health-care
16 workers that got slammed with the extra taxes,
17 recoup those?
18 COMM. HOWARD ZUCKER: That is something we
19 will -- we can look into and get back to you on.
20 SENATOR O'MARA: All right.
21 With the beds that were ramped up in the
22 hospitals, what was the peak occupancy during the
23 height of this, and when was that?
24 COMM. HOWARD ZUCKER: Sure.
25 So, on April 12th, there were 18,825 patients
50
1 in the hospital.
2 Now we have in the 500 range of patients in
3 the hospital.
4 At that time, we had over 5,000 individuals
5 in the ICU, and we had, as I mentioned, 4449 people
6 intubated. And now we have, down, 60 people
7 intubated.
8 We have come down that curve amazingly well.
9 And when you look at other parts of the
10 country, and I get calls, and I speak with other
11 health commissioners, they ask, on a regular basis:
12 How did New York do it, and what do we need to do?
13 This was a true collaborative effort across
14 the entire health system to make this happen.
15 SENATOR O'MARA: And you still are not
16 prepared today to tell us how many deaths occurred
17 in hospitals from patients transferred from nursing
18 homes?
19 COMM. HOWARD ZUCKER: As I mentioned in the
20 last hearing that I did, that I'm working on making
21 sure that some of those numbers are not
22 double-counted. And I promised to get back to you
23 on that.
24 SENATOR O'MARA: Will you agree to appear
25 before these committees again in the future once
51
1 that information is available?
2 COMM. HOWARD ZUCKER: We will be able to
3 provide you that information as you need it, and we
4 can discuss it at that point.
5 SENATOR O'MARA: With regards to the order to
6 send hospital patients back to nursing homes,
7 Upstate New York hospitals didn't have the occupancy
8 problems that New York City hospitals had.
9 And in New York City, shortly after that
10 order, we had the "USS Comfort," the Jacob -- the
11 Javits Center, and the Good Samaritan Hospital in
12 Central Park.
13 Why were those facilities not utilized as
14 overflow for these COVID patients to go back to
15 [indiscernible] stay in the hospital?
16 And why couldn't they stay in upstate
17 hospitals where there wasn't full occupancy?
18 COMM. HOWARD ZUCKER: So let me see if
19 I understand your question, because you broke up a
20 little bit in there.
21 As I understand what you're asking is: Why
22 could some of the -- why did patients go to the
23 Javits and the "Comfort" versus going to upstate
24 facilities?
25 Is that what you're asking?
52
1 SENATOR O'MARA: No.
2 Why did nursing home patients that you were
3 eager to open hospital beds for, rather than
4 returning them to their nursing home, why didn't
5 they go to the Javits Center or the "USS Comfort" or
6 the Good Samaritan Hospital in Central Park?
7 [Indiscernible] same token, why did upstate
8 hospitals that didn't have an occupancy problem, why
9 didn't they remain in the hospitals?
10 COMM. HOWARD ZUCKER: So, you know, as we
11 mentioned before, that we've gone through this in
12 the nursing home hearing, but let me just reiterate:
13 That hospital -- the Javits and the "Comfort" were
14 designed for certain purposes.
15 And the fact is, that an individual who
16 needs -- a resident of a nursing home needs care, a
17 certain type of care, was not going to be provided
18 at a Javits or a "Comfort." That's not what they
19 were designed for.
20 But I discussed this all last week, the exact
21 issues there.
22 And regarding upstate, there was -- there
23 were appropriate care that needed to be provided at
24 the hospital. And they go back to their -- their
25 nursing homes, then they return there.
53
1 GARETH RHODES: If I could say something as
2 well, the Javits Center, for example, the restrooms
3 that were there were not in the individual rooms.
4 They were provided on the -- in a trailer of a large
5 semi-truck, a vendor that came in.
6 The Javits Center was not an appropriate
7 place for a patient or a resident who had dementia,
8 for example.
9 That we -- every one of these transfer
10 decisions was based on the individual patient, what
11 their individual patient's needs are.
12 And [indiscernible] find -- you never want to
13 put a patient in a facility that isn't able to
14 provide the proper, the adequate, care.
15 COMM. HOWARD ZUCKER: You know, Senator, the
16 other issue here is that, regarding upstate, we
17 understood -- when this began, and this was
18 happening in New York City, we did not know how this
19 was going to spread.
20 Was this going to stay in that area? a
21 handful of counties? Was it going to get worse?
22 Look what has happened across the country
23 now.
24 And so we need to be prepared.
25 And this is why the governor canceled
54
1 elective surgeries and made sure that we had the
2 availability of --
3 SENATOR RIVERA: Thank you, Commissioner.
4 Thank you, Commissioner.
5 Assembly.
6 ASSEMBLYMEMBER MCDONALD: I want to recognize
7 some assemblymembers that have joined us:
8 Linda Rosenthal, Marianne Buttenschon,
9 Nathalia Fernandez. I think I already mentioned
10 Steve Cymbrowitz. And I think Andrew Garbarino
11 might be, I'm getting a second.
12 And we will now move on to Assemblymember
13 Ron Kim for 3 minutes.
14 ASSEMBLYMEMBER KIM: Thank you for joining us
15 today, Commissioner Zucker and Dr. Malatras.
16 Due to my limited time, I have a few
17 questions to which I appreciate a yes-or-no
18 response.
19 Would you agree that, when we hit the peak of
20 the COVID mountain, we were in full triage mode and
21 didn't know how to fully prevent the spread of COVID
22 or arrange the best care for COVID patients?
23 COMM. HOWARD ZUCKER: See, this is where
24 I can't answer yes or no, because these things are
25 not --
55
1 ASSEMBLYMEMBER KIM: That's fine, that's
2 fine.
3 Would you agree that, during these panic
4 times, hospitals were [indiscernible] for direction
5 and guidance from this administration, and that
6 every policy decision played a key role in the way
7 health-care facilities treat, diagnose, and arrange
8 care for COVID patients?
9 COMM. HOWARD ZUCKER: They were looking for
10 guidance from so many different sources, and we were
11 one of them, the government. And we were a key
12 role -- played a key role in this, obviously.
13 ASSEMBLYMEMBER KIM: Fair enough.
14 Is it possible, then, under these
15 circumstances, state policies could have led to
16 unintended consequences and outcomes?
17 COMM. HOWARD ZUCKER: There's always the
18 potential for something that one does not anticipate
19 is going to happen. But it's not like a policy is
20 put into place, expecting an unintend -- an outcome
21 that was not --
22 ASSEMBLYMEMBER KIM: But it's certainly
23 possible.
24 That's why it's called "unintended."
25 COMM. HOWARD ZUCKER: [Indiscernible]
56
1 pandemic, where you don't have all the facts,
2 anything is possible.
3 GARETH RHODES: State policies
4 [indiscernible cross-talking] --
5 ASSEMBLYMEMBER KIM: Sure.
6 GARETH RHODES: -- when you have --
7 [Multiple parties cross-talking.]
8 ASSEMBLYMEMBER KIM: So, Commissioner Zucker,
9 are you aware of any hospitals complaining to your
10 department that nursing homes were intentionally
11 transferring dying COVID residents to hospitals at
12 around the same time states stopped counting these
13 transfer deaths?
14 COMM. HOWARD ZUCKER: You know, this goes
15 back to the question I keep -- or, the statement
16 I keep making.
17 But, again, no, we do not have any reports
18 that were brought into -- into, at least to me or to
19 the department, about this.
20 But we have, as I said, litigated the nursing
21 home issue for, you know, multiple hours in the
22 past.
23 ASSEMBLYMEMBER KIM: Okay, that's fine.
24 My last question, Commissioner Zucker: Is
25 the department of health investigating any transfers
57
1 of COVID patients between hospitals and other
2 health-care facilities, and, vice versa, from
3 March 25th to now, that could have led to
4 mistreatments and misdiagnosis of these patients or
5 to spread of COVID to others?
6 COMM. HOWARD ZUCKER: So let me answer that
7 by saying that we are in the middle of a pandemic.
8 After there is an event, whether it was when
9 we looked at the measles issue, or whether there was
10 the H1N1 situation back in 2009, even though it was
11 before my time, you do an after-action items report,
12 and you look at all the things that have transpired.
13 We are in the middle of this, we are still
14 managing it.
15 I know that the hearing is going on, but
16 I can tell you that my team is sitting in the
17 offices until 2:30 in the morning the other day,
18 working [indiscernible cross-talking] --
19 ASSEMBLYMEMBER KIM: If we're in the middle
20 of it, and we're all going to take a victory lap
21 [indiscernible cross-talking] --
22 COMM. HOWARD ZUCKER: -- [indiscernible
23 cross-talking] --
24 ASSEMBLYMEMBER KIM: -- as if this was -- you
25 know -- thank you.
58
1 SENATOR RIVERA: Thank you, Assemblymember.
2 Thank you, Commissioner.
3 I'll recognize myself for 5 minutes.
4 Thank you all for being here today.
5 I want to focus on safety-net hospitals,
6 particularly since what we're talking about here, we
7 all recognize, and it has been said by many of my
8 colleagues, that there are a lot of things that we
9 did not know about this disease, and when we're
10 talking about the peak of it all, we're talking
11 about the first three weeks of April, really, where,
12 like -- when -- when things were extremely bad.
13 I want to talk about safety nets, and I want
14 to focus on, we all were in a moment of triage.
15 And I want to talk about how -- I want you to
16 be on the record about how the State calibrated,
17 particularly because, if we're talking about, for
18 example, there's a story on April 3rd of this year,
19 that spoke specifically about something that we
20 all -- that we all knew, and at that moment it was
21 very clear, people of color and people who were
22 served by safety-net hospitals were being struck far
23 worse than anybody else.
24 Right?
25 And so the next three weeks, from April, were
59
1 key in -- in being able to control this.
2 I wanted to talk -- I want you to talk about
3 how the State calibrated the resources to go to
4 safety-net hospitals; I want to talk about how that
5 is happening, because, when there is -- as we're
6 still in the first wave, but when the second one
7 hits, or when the other bump hits, we're still going
8 to get worse -- we're still going to get hit worse
9 in places like The Bronx, and other places that have
10 safety-net hospitals.
11 So I want you to talk about how the State
12 calibrated resources for those institutions, please.
13 COMM. HOWARD ZUCKER: So there's a couple of
14 parts to that.
15 One is, the issue of the need to be sure that
16 the resources are available, to whether it's -- you
17 named The Bronx, you pick the area, it doesn't
18 specifically matter, where there are individuals who
19 are more challenged by this, put it that way.
20 And we realized this -- by looking at some of
21 these ZIP Codes, we realized that the antibody
22 levels were higher in certain areas of the state.
23 And I bring up The Bronx because it was
24 higher, and it's your area.
25 SENATOR RIVERA: Yes, sir.
60
1 COMM. HOWARD ZUCKER: And we realized
2 [inaudible] realized that the individuals that live
3 in that area were also those who ended up in the
4 hospitals in that area, and were affected.
5 We have reached out to all the hospitals. We
6 are trying to be sure that the resources are
7 available, both all the things we mentioned -- the
8 PPE, the staffing, the equipment -- to be sure that,
9 if there is an uptick, or if there is a, you know,
10 surge, and, hopefully, it doesn't happen, that those
11 hospitals who provide the care to those communities
12 have what they need.
13 And this is an ongoing discussion with
14 those -- the leadership of those hospitals, as well
15 as the associations.
16 And --
17 SENATOR RIVERA: And I want to -- I just want
18 to be on the record that it's just -- and that is --
19 and that is good.
20 But I just want to make sure that we're on
21 the record, saying, that it's not just -- certainly,
22 the resources that are needed during triage times,
23 I'm very -- that is very good, that that focus is on
24 there.
25 But there has to be some commitment from the
61
1 State, to make sure that we stabilize institutions
2 which are safety-net institutions to begin with.
3 They were in crisis before the crisis.
4 And I know that you recognize this, but
5 I want to make sure that there is a recognition on
6 the record from the administration that there needs
7 to be a commitment, to making sure these
8 institutions are maintained, because, in times like
9 crisis -- in time of crises, these are the
10 communities that get hit worse.
11 We're not just talking about safety-net
12 institutions in The Bronx. Certainly, safety-net
13 institutions all across the state.
14 So I just want to make sure there's a
15 commitment on the record, that it's not just about
16 the resources that are needed doing triage --
17 Which I am very, very, thank you for that.
18 -- but it has to be a long-term commitment,
19 to making sure that these institutions can continue
20 to thrive because, after the crisis is gone, there
21 is still crisis there, because, as I said, there was
22 a crisis before the crisis.
23 COMM. HOWARD ZUCKER: Well, I think there's a
24 key point here, and someone asked me the question:
25 What did we learn from -- so far from this pandemic?
62
1 SENATOR RIVERA: Did you recalibrate -- did
2 you recalibrate?
3 That's what I'm talking about.
4 COMM. HOWARD ZUCKER: Right, right.
5 And I think one of the things we learned,
6 I mentioned this before, is that it showed the
7 health disparities that exist in society, and we
8 need to address them, and we are addressing them.
9 And I will mention that there's -- for the
10 financially-distressed hospitals, there is a billion
11 dollars -- a little over a billion dollars of the
12 $4 billion that came in that was going to those
13 hospitals.
14 And we also transferred -- that we
15 transferred patients from some of these safety-net
16 hospitals during the -- the point of the surge to
17 other facilities, to make sure that those patients'
18 needs were met during that time.
19 I know that's retrospective.
20 And I know what you're asking about, looking
21 prospectively, and we are.
22 SENATOR RIVERA: And just one -- I just want
23 to make sure that we were -- again, that there's a
24 recalibration when necessary. That we put the
25 resources where are most necessary.
63
1 And if we recognize, as has been -- as the
2 data speaks for itself, that it is Brown and Black
3 communities, poor and working-class communities,
4 that are get -- that got hit worse by the crisis,
5 that those institutions which are safety-net
6 institutions, for those communities, get the
7 resources that they require, that they need, during
8 this crisis.
9 COMM. HOWARD ZUCKER: I hear you
10 [indiscernible cross-talking] --
11 SENATOR RIVERA: I just want to make sure
12 that it's on the record.
13 Thank you.
14 Assembly.
15 ASSEMBLYMEMBER MCDONALD: Senator, I will
16 recognize now the ranker for health in the Assembly,
17 Kevin Byrne, for 5 minutes.
18 ASSEMBLYMEMBER BYRNE: Thank you, Chair.
19 Thank you, Commissioner, for being here.
20 I know it's 11:00.
21 How much time do we have with you left?
22 Because I just want to be as quick as possible.
23 COMM. HOWARD ZUCKER: I have two hours --
24 ASSEMBLYMEMBER BYRNE: I know you're a busy
25 guy, you've got an important job, but, what are we
64
1 looking at?
2 COMM. HOWARD ZUCKER: I think I have
3 two hours, so I have one more hour left.
4 ASSEMBLYMEMBER BYRNE: Okay.
5 So I'm going to try to keep plowing through.
6 I hope my colleagues get to ask all the
7 questions they want.
8 I'm glad you talked about hospital capacity.
9 That was something where I expected we were going to
10 hear a lot about.
11 And when the governor and you, and we had
12 those -- plenty of those press briefings (frozen
13 video).
14 SENATOR RIVERA: Assemblymember Byrne,
15 I think we're frozen.
16 Freeze the time, please.
17 Let's see if he comes back.
18 Assemblymember Byrne, we'll give you a couple
19 more seconds.
20 We will come back to Assemblymember Byrne.
21 SENATOR TEDISCO: Senator? Senator?
22 It's Jim Tedisco.
23 Could I have 3 minutes at some point?
24 SENATOR RIVERA: Sir, we will get to you,
25 Senator Tedisco, yes. Hold on a second.
65
1 So will -- do you have another assemblymember
2 on deck?
3 ASSEMBLYMEMBER MCDONALD: Yes, we do.
4 Ranker Brian Manktelow.
5 SENATOR RIVERA: Got you.
6 We will return to Assemblymember Byrne.
7 Thank you.
8 ASSEMBLYMEMBER MANKTELOW: [Inaudible.]
9 SENATOR RIVERA: We can't hear you,
10 Assemblymember.
11 It seems that technical -- all right.
12 So I'm going to go --
13 ASSEMBLYMEMBER MCDONALD: Let's go on to --
14 SENATOR RIVERA: [Indiscernible
15 cross-talking] let's go to Senator --
16 ASSEMBLYMEMBER MCDONALD: Okay.
17 SENATOR RIVERA: -- let's go to
18 Senator Metzger.
19 Recognize Senator Metzger for 3 minutes,
20 please.
21 SENATOR METZGER: Thank you, Mr. Chairman.
22 And thank you for joining us today,
23 Commissioner.
24 I also want to express my appreciation to you
25 and your staff during this unprecedented crisis.
66
1 As Senator Skoufis said, you know, the facts
2 on the ground were really changing minute to minute.
3 The crisis took an enormous toll on hospital
4 workers; the incredible physical and mental stress
5 that they endured during this crisis.
6 And I want to ask:
7 What is being done to make sure that they get
8 the support and help they need?
9 And whether you're considering, you know,
10 mental health and care for these workers and
11 planning for a future surge?
12 That's one question.
13 I'll get all my questions out.
14 I -- turning to PPE:
15 I know at least one hospital in my district
16 is having a hard time obtaining the necessary masks,
17 a 90-day supply, specifically small N95 masks, which
18 was a problem throughout the most challenging part
19 of this crisis.
20 So I would like to, you know, hear what you
21 recommend on that score.
22 And I also have a rural hospital that has a
23 serious problem with having sufficient storage for
24 90 days of PPE.
25 And I imagine this is a difficulty for other
67
1 hospitals as well.
2 And want to know if you have recommendations
3 for addressing that, or if this has come up, and how
4 they can address that?
5 Thank you.
6 COMM. HOWARD ZUCKER: So on the mental-health
7 issue, we do have a COVID mental-health hotline that
8 is available, which has been available since the --
9 pretty much, the beginning of this pandemic.
10 I've also spoken to the office of mental
11 health about some of these issues.
12 And I have to tell you, Senator, I've
13 actually spoken to my colleagues in the hospitals,
14 and some of the things that you hear, I personally
15 heard from nurses and doctors, and the challenges
16 that we read, that unfortunately tragic story about
17 the doctor at Columbia who committed suicide.
18 So, I hear you.
19 And I think it's a really important issue,
20 and it is being addressed, and will be addressed
21 going forward.
22 Regarding the PPE -- Jim, do you want --
23 DR. JAMES MALATRAS: No, we understand that
24 many of the facilities have challenges, but we think
25 it's really important, as many of your colleagues
68
1 have noted, the issues on PPE.
2 And that's why we're working with the
3 health-care associations, to make sure every
4 hospital has what they need to build it up.
5 And I just wanted to go back to one point,
6 because it was raised about health-care facilities.
7 Even during the crisis, when we did hear
8 about some challenges in individual hospitals, the
9 governor required that each facility give a nurse an
10 N95 each day. Right?
11 So we did adjust that policy when we heard
12 from, you know, the nurses, the heartbeat of health
13 care to us.
14 So when we heard those challenges, we worked
15 very closely with those folks.
16 And on the PPE, many of us at the table
17 today, we, literally, took calls from individual
18 hospitals for help on the PPE side.
19 So, we were actively engaged at the whole
20 time.
21 SENATOR METZGER: Sorry, but, time is up, but
22 the storage is a big issue, so I hope you can
23 address that at a later time.
24 Thank you.
25 SENATOR RIVERA: Thank you, Senator.
69
1 Now we'll try Assemblymember Byrne.
2 Is he back?
3 If you -- well, if you have somebody in the
4 Assembly --
5 ASSEMBLYMEMBER MCDONALD: Yep, we will --
6 I don't see Byrne or Manktelow, so we'll go to
7 Assemblymember Kevin Cahill.
8 SENATOR RIVERA: Thank you.
9 ASSEMBLYMEMBER MCDONALD: 3 minutes.
10 ASSEMBLYMEMBER CAHILL: Hello, Commissioner,
11 and Gareth and Jim. It's good to see so many of my
12 homies here today on the screen.
13 Gareth is a Kingston resident, and, Jim, of
14 course, hails from the great village of Ellenville.
15 Commissioner, thank you once again for
16 joining us.
17 I would like to talk for a few moments about
18 the rest of health care, not specifically COVID.
19 But, we can start by talking about the fact
20 that many health facilities around the state,
21 including here in the Hudson Valley, were designated
22 as COVID centers. And, as a result of that, the
23 hospitals that were conducting business in other
24 areas had to discontinue that.
25 So here in our community, that meant that our
70
1 well-respected and much-needed psychiatric inpatient
2 care center was moved to another community. And the
3 people that rely on that no longer had that
4 available to them in this community, and that
5 created incredible dislocation for those families.
6 And I'm sure similar compromises occurred in
7 other communities, where facilities were, for all
8 intents and purposes, commandeered to be on reserve.
9 And, by the way, I'm not questioning that
10 decision. I think it was a good decision.
11 What should be -- what [sic] should we
12 reasonably anticipate that that decision will be
13 revisited; what will the result be?
14 And my second question in that regard is:
15 What impact does this have on the long-term
16 certificate of need?
17 For example, the Hudson Valley Health
18 Alliance hospitals have a new certificate for 170-so
19 beds, down from about 500 combined in the previous
20 iteration.
21 And one-third of those beds were dedicated to
22 the psychiatric unit, and now that psychiatric unit
23 has largely been moved to another city.
24 When can we expect those facilities to be
25 restored?
71
1 And when will the department of health once
2 again be re -- be enforcing certificates of need?
3 COMM. HOWARD ZUCKER: So on the issue of the
4 behavioral-health issues, we're working with the
5 office of mental health to address that, to make
6 sure the facilities are -- that meet the needs of
7 the community are able to be up and operational
8 again.
9 I can't speak specifically about the
10 certificate of need.
11 As they come in, we will look at them, and
12 see where we are.
13 I think one of the things that has happened,
14 there's a sense that, that because our numbers are
15 so low in New York State, that this has gone and it
16 has passed.
17 But, we are constantly addressing the
18 potential of an uptick of cases. And we have to be
19 sure that we keep the buffer in place, to be sure
20 that we meet any of those challenges that may come
21 to us in the fall.
22 So I don't want to say we're not going to do
23 this.
24 Sorry?
25 ASSEMBLYMEMBER CAHILL: Sorry, before I run
72
1 out of time, I recognize that we have to deal with
2 an emergency with emergency measures.
3 My concern is the longer term, and restoring
4 those services, those needed services, to our
5 community.
6 COMM. HOWARD ZUCKER: I got it, and it stays
7 on the radar, and we'll make sure that that doesn't
8 get dropped.
9 ASSEMBLYMEMBER CAHILL: Thank you.
10 SENATOR RIVERA: Thank you, Assemblymember.
11 Thank you, Commissioner.
12 Next we have, recognize Senator Brad Hoylman
13 for 3 minutes.
14 SENATOR HOYLMAN: Good morning.
15 Thank you, Commissioner.
16 Thank you, Jim and Gareth.
17 And from my constituents, I just wanted to
18 really thank you for all your work.
19 I had two quick questions.
20 One: We know that, back in April, the
21 organization Samaritan's Purse, led by that
22 notoriously homophobic pastor, Franklin Graham,
23 opened up a field hospital in Central Park through a
24 partnership with Mount Sinai.
25 You know, he has a long history of homophobic
73
1 and transphobic comments.
2 He called LGBT activists "immoral." He said
3 that being gay or trans is detestable. He claimed
4 that Satan was behind the fight for equal rights.
5 He also required employees to sign a
6 statement of faith, which, essentially, reaffirmed
7 their homophobic views, before working in the field
8 hospital.
9 And Samaritan's hospital continued to work at
10 that location, really, until May 5th, meaning, that
11 they operated for more than a month.
12 In your review that you're planning on
13 taking, will you commit to looking at how the
14 decision-making was made to allow what, by most
15 accounts, is a disreputable organization, to set up
16 an encampment on public property in Central Park?
17 COMM. HOWARD ZUCKER: So regarding how that
18 was set up, this was an agreement between the
19 hospital and that organization. Obviously, the
20 State was not involved in that at all.
21 So I just want to be on the record about
22 that.
23 But as we move forward, and as we look at all
24 the issues after this pandemic is over, we will
25 address all of them, including the issues of a field
74
1 hospital, and the relationships and how it was set
2 up.
3 I'm happy to do that.
4 SENATOR HOYLMAN: Thank you, because it --
5 I think for the LGBTQIA community, it has, you know,
6 left a bitter taste in our mouths, that an
7 organization was using this as, essentially, a paid,
8 you know, advertisement for proselytizing its
9 homophobic views.
10 And then, secondly, I just wanted to follow
11 up on health-care workers who are at the center of
12 this pandemic.
13 We still don't have a sense, as policymakers,
14 how many were infected or died.
15 Will you be releasing that data at some
16 point, with specific numbers on infection for
17 mortality, so we can move forward on protecting them
18 should, God forbid, we endure another wave of the
19 pandemic?
20 COMM. HOWARD ZUCKER: So I think there's two
21 parts to that.
22 One is, that, yes, we're always looking at
23 these numbers, and as I have mentioned previously,
24 to get the accurate numbers, and exactly what
25 happened.
75
1 And I -- you know, I really feel for all the
2 health-care workers.
3 One of my colleagues died; one of the doctors
4 I worked with died in one of the downstate
5 hospitals. And there are others across the country
6 that I've heard about, and others that were in the
7 ICU that we know about.
8 So we will look at those numbers, and to make
9 sure, going forward, that we address that.
10 So I have to say that -- oh, sorry. Time's
11 up.
12 SENATOR RIVERA: Thank you, Commissioner.
13 Yep, yep.
14 SENATOR HOYLMAN: Thank you for your good
15 work.
16 Thank you --
17 ASSEMBLYMEMBER MCDONALD: The Assembly --
18 SENATOR HOYLMAN: Thank you for
19 [indiscernible cross-talking] --
20 ASSEMBLYMEMBER MCDONALD: The Assembly now
21 recognizes again, Member Kevin Byrne.
22 Welcome back.
23 SENATOR RIVERA: Second at bat.
24 ASSEMBLYMEMBER BYRNE: Thank you, and
25 apologies for the disruption. Lost power for a
76
1 little bit.
2 But, Commissioner, again, thanks for being
3 here.
4 I want to try to be as effective and
5 efficient with my time as possible.
6 We talk about flattening the curve,
7 flattening the curve. We talked about reducing
8 density.
9 It was almost a mantra in the governor's
10 daily press briefings.
11 Something we also heard the governor and the
12 administration talk about a lot was increasing
13 hospital capacity.
14 You spoke about it in your testimony today.
15 I don't hear a lot of discussion about that
16 now, since, quite frankly, we've successfully
17 reduced the infection rate. We've -- we're in a
18 better position now than we were, perhaps, in March,
19 April, May.
20 But, increasing hospital capacity, I believe
21 there would be benefits for that, not just during a
22 pandemic, but, perhaps, before and after a pandemic.
23 In fact, some folks have phrased increasing
24 hospital capacity as "raising the ceiling."
25 So we're flattening the curve, we're raising
77
1 the ceiling.
2 The Mercatus Center, which is a more
3 market-based group, came out with their Hope 2020
4 report. It was a pre-release. It was not
5 peer-reviewed yet. But they do rankings for states
6 across the country, based on a bunch of different
7 factors. And it's based on health-care openness,
8 access, transparency.
9 And they, sadly, rank us pretty low on this
10 bar.
11 And I'm not doing -- I'm not saying that as a
12 criticism, but my point being, I think there's a lot
13 of room for us to improve, I think there's always
14 room to improve, to increase access to care.
15 And the governor has had some sweeping
16 powers, with these disaster powers, with directives,
17 suspending state laws, as a means to increase access
18 to hospital capacity.
19 Which ones of those did you find to be the
20 most effective?
21 Which ones are still in effect today?
22 You talked about hospitals doubling capacity.
23 When did that expire?
24 And, what lessons have you learned with these
25 directives, that we can continue, post pandemic, and
78
1 in preparation for a second surge?
2 COMM. HOWARD ZUCKER: That's a very pat
3 question. I'll answer part of that. I know Jim has
4 some comments as well.
5 First, the increase in capacity, this is
6 still in effect. We are 64 -- we increased it by
7 64 percent. We had 27,000 beds that we increased
8 during the surge.
9 There are many lessons that we have learned
10 from this pandemic.
11 There are many lessons, going forward, that
12 address the whole health-care system, you raised,
13 not just about a pandemic, but, you're right. We
14 could have a terrible flu season one year, or we
15 could have other problems that can occur. And we
16 have addressed it.
17 So the concept of how to surge and flex is
18 something that we have now developed, put into
19 place, and we will be able to activate it whenever
20 is necessary in the future.
21 The concept of how to move patients from one
22 hospital to another, and activating this
23 care-coordinating system, could be up and running
24 again.
25 The concept of how to develop other
79
1 facilities, and what we would need to do, has
2 already been worked through. The blueprint is
3 there, we just need to implement it again.
4 So that's part of it.
5 I know Jim had some other points you wanted
6 to raise?
7 ASSEMBLYMEMBER BYRNE: For either of you,
8 just because there's limited time, if there's
9 specific regulations that were suspended through the
10 governor, that you found to be effective, that
11 perhaps we should consider, moving forward, if
12 there's any specific things that you can cite, that
13 would be helpful too.
14 DR. JAMES MALATRAS: We are looking through
15 those regulatory pieces right now, Assemblyman.
16 And we want to also note that we're tracking
17 hospital capacity very closely right now on our
18 dashboard, which everyone in the public is
19 following.
20 We have about 30 percent of our hospital beds
21 available in the state right now, including about
22 40 percent of our ICUs.
23 So we're looking at that not only statewide,
24 but regionally, so we know what [indiscernible]
25 happen.
80
1 I think the important regulation you asked
2 about, which we've memorialized it, it was
3 originally done in an emergency context, but we put
4 it into a regulatory context, is the Surge & Flex,
5 so we can quickly adapt and have more beds.
6 So we are watching right now, very closely,
7 how many hospital beds are not only in each
8 individual hospital, but also how many are
9 regionwide, so we are -- we are concerned about that
10 as well one. We're noting those things very
11 closely.
12 And one of the requirements we had to begin
13 reopening, as we all know, is that hospitals had to
14 have a 30 percent of their beds available so we
15 wouldn't run into this problem again.
16 So this is working on multiple levels, and
17 it's something that we're monitoring very closely.
18 ASSEMBLYMEMBER BYRNE: Okay, thank you.
19 Well, I would help that we can again keep
20 this conversation going not just in the middle of an
21 emergency or a pandemic as the way to increase
22 access.
23 Often in the legislature we talk about
24 insurance, but there's also, again, raising that
25 ceiling, increasing access through other means.
81
1 Also, one quick question about ventilators.
2 You talked about everyone that needed a
3 ventilator got one.
4 There was conversations about using bag-valve
5 masks, about using BiPAP machines, about using
6 splitters.
7 Were any of those technologies used?
8 COMM. HOWARD ZUCKER: The BiPAP machines were
9 used, but part of it was, not because there wasn't a
10 ventilator. It was because it was a therapy that
11 was more beneficial to that patient at that time, to
12 use it that way.
13 We did not need to do any manual ventilation
14 with a bag and a valve, but we were ready, we were
15 ready. And the same with the splitting, we were
16 ready for that.
17 SENATOR RIVERA: Thank you, Commissioner.
18 Thank you, Assemblymember.
19 Now I'll recognize Senator Pam Helming for
20 3 minutes.
21 SENATOR HELMING: Thank you, Senator Rivera.
22 And thank you, Commissioner, Mr. Rhodes,
23 and Dr. Malatras, for your testimony today.
24 I want to talk for a moment about our small
25 rural hospitals.
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1 As we all know, our small rural hospitals are
2 absolutely critical for meeting the medical needs of
3 people living outside of the large metropolitan
4 areas.
5 These hospitals in our communities, they're
6 also major employers, and they do so many other
7 positive things for our communities.
8 Before the COVID-19 outbreak, many of these
9 rural sole community providers, and, as
10 Senator Rivera has already talked about, our
11 safety-net acute-care facilities, they were facing
12 significant financial challenges.
13 And as we all know, these hospitals, they've
14 been operating on incredibly thin margins for the
15 past several years.
16 Now with additional burdens associated with
17 the last [indiscernible], due to the mandate to
18 cancel elective surgeries, on top of all the
19 investments that they had to make to prepare for the
20 pandemic, these hospitals are experiencing
21 significant financial challenges.
22 So, Commissioner, I was wondering if you
23 could speak to the efforts being made on the part of
24 the State to stabilize and save our rural hospitals.
25 I know you mentioned the $1 billion of
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1 federal funds that had been distributed.
2 But, from what I'm hearing, that's not going
3 to be enough to do the job.
4 These hospitals are looking that there may be
5 a second surge, their elective surgeries may be
6 canceled.
7 So if you can just speak to what's being done
8 to help our rural community hospitals?
9 COMM. HOWARD ZUCKER: Sure.
10 So you know that we have incredible
11 commitment to the rural hospitals, and we have an
12 entire team in the department working on this exact
13 issue, even before the pandemic, to make sure that
14 the hospitals -- the needs of those hospitals are
15 met.
16 This is a challenge, and I understand this is
17 a complex issue.
18 And we will make sure that we do everything
19 to protect, as best as we can, the hospitals in the
20 areas that had the elective surgeries canceled, and,
21 obviously, fortunately so, didn't end up with the
22 challenges of a lot of COVID patients there.
23 But I recognize this was a hit to the
24 hospitals at -- on a financial level, and we are
25 looking at this in the bigger picture of rural
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1 health.
2 So I hear your concerns, and we'll address it
3 as we move forward.
4 SENATOR HELMING: Thank you.
5 I'm looking -- I look forward to more
6 specific details.
7 COMM. HOWARD ZUCKER: Sure.
8 SENATOR HELMING: Also, I just want to
9 comment, that when we talk about health disparities,
10 I often hear of it in terms of, you know, we have
11 problems in our Black and Brown communities.
12 We need to make improvements, and
13 I 100 percent support that.
14 But I also feel that our rural communities
15 need -- the issues there need to be addressed with
16 the working poor.
17 We need to have equal access. We need access
18 to tests.
19 I know there have been so many conversations
20 about the PPE.
21 I am telling you that I have heard from
22 hospitals, despite what you heard, and I've sent
23 letters as late as mid-May, requesting PPE for these
24 those hospitals, gowns, masks, and more, and it
25 didn't happen.
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1 It didn't happen.
2 COMM. HOWARD ZUCKER: And I hear you --
3 I know time's up.
4 I hear you about the health disparities, and
5 it crosses many different areas.
6 I see the time.
7 SENATOR RIVERA: Thank you, Commissioner.
8 Assembly.
9 ASSEMBLYMEMBER MCDONALD: We will now hear
10 from Assemblymember Ranker Brian Manktelow.
11 ASSEMBLYMEMBER MANKTELOW: Good morning.
12 Can you hear me?
13 ASSEMBLYMEMBER MCDONALD: Yes, we can.
14 ASSEMBLYMEMBER MANKTELOW: Perfect.
15 Commissioner, just a couple of questions in
16 regards to ventilators.
17 At the start of the pandemic, when we first
18 realized we had to have ventilators, how many
19 ventilators did New York State have at that point?
20 COMM. HOWARD ZUCKER: We had -- I have to get
21 you the exact number of the ventilators we had at
22 that point. I have to look that one up. I don't
23 have that right off the top of my head.
24 But I knew that we needed more.
25 ASSEMBLYMEMBER MANKTELOW: Can you
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1 ballpark -- can you just ballpark it?
2 COMM. HOWARD ZUCKER: [Indiscernible]
3 thousands of ventilators. And we had to -- you have
4 to remember, some of the ventilators that we had in
5 the state were already provided to the hospitals.
6 And so we needed to find out where -- where,
7 and which hospitals, that there were ventilators
8 from the State.
9 But also the hospitals, if you're asking the
10 bigger question of, "how many ventilators?" when we
11 started to look for ventilators, you start to find
12 out that a hospital's ambulatory surgery center have
13 ventilators. Every anesthesia machine is,
14 basically, a ventilator; you have ventilators there.
15 Office-space surgery practices sometimes have --
16 many times have ventilators.
17 So we needed to figure out how many there
18 were out there, and that was part of the effort to
19 get those numbers and to figure those out.
20 DR. JAMES MALATRAS: Early on, Assemblyman,
21 the governor [inaudible] because it was a major
22 concern of ours. But we thought the need would be
23 upwards of 40,000 ventilators.
24 We started, I think, in the system, before we
25 started working with folks, with about 2500 to
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1 3,000 ventilators, early on.
2 ASSEMBLYMEMBER MANKTELOW: All right.
3 How many do we have right now -- do you
4 know? -- on hand?
5 COMM. HOWARD ZUCKER: I can get you the exact
6 number of how many we have on hand.
7 ASSEMBLYMEMBER MANKTELOW: The ones that we
8 do have on hand, are they being stockpiled in case
9 we have a second wave?
10 COMM. HOWARD ZUCKER: We do have hundreds of
11 ventilators in the stockpile right now.
12 We also have -- are finding out which ones we
13 have given out, and how to bring those back if
14 they're no longer needed.
15 We also have ventilators that were out there,
16 that now need to be brought back and serviced,
17 because once they're used they need to be serviced.
18 There's a -- we have spoken with our federal
19 partners about that as well.
20 So we are looking at all of these issues to
21 make sure they're available.
22 We deployed 2600 ventilators during -- as
23 I mentioned before, during the pandemic.
24 ASSEMBLYMEMBER MANKTELOW: All right. So the
25 hospitals and facilities that gave up their
88
1 ventilators, they will be getting them back?
2 COMM. HOWARD ZUCKER: Oh, yes, right, they'll
3 get [indiscernible cross-talking] --
4 DR. JAMES MALATRAS: To be clear,
5 Assemblyman, every hospital that did give or loaned
6 a ventilator have been given their ventilators back.
7 That is not in [indiscernible].
8 Our number of intubated patients are so low
9 in the state of New York right now, those have all
10 have been returned.
11 No hospital has given -- no hospital has any
12 ventilators on loan right now.
13 ASSEMBLYMEMBER MANKTELOW: Oh, okay.
14 Perfect.
15 And when -- I know we reached out to the
16 federal government to get ventilators from the
17 federal government.
18 How many did we get from them? Do you know?
19 COMM. HOWARD ZUCKER: So we received
20 ventilators from -- we had 2,000 ventilators that
21 I believe -- I have to check the exact number.
22 I think it was several thousand ventilators.
23 But I will get you the exact number of how
24 many came from the feds.
25 ASSEMBLYMEMBER MANKTELOW: Okay.
89
1 And did we -- did some of them that came, did
2 we use some of those?
3 COMM. HOWARD ZUCKER: Ventilators were used,
4 they went out into the hospitals and to the
5 communities, yes.
6 ASSEMBLYMEMBER MANKTELOW: All right.
7 So were those ventilators -- those
8 ventilators were definitely helpful, then, to our
9 residents in New York, by getting them
10 [indiscernible] --
11 COMM. HOWARD ZUCKER: All ventilators were
12 helpful.
13 And as I mentioned it, ventilators need to
14 come back to get serviced. And so they were brought
15 back and sent back for service to the facilities --
16 to the [indiscernible cross-talking] --
17 ASSEMBLYMEMBER MANKTELOW: So, Commissioner,
18 we're replacing and we're buying ventilators right
19 now.
20 What are we paying for those ventilators
21 today, compared to a year ago?
22 COMM. HOWARD ZUCKER: I have to look at those
23 numbers.
24 ASSEMBLYMEMBER MANKTELOW: And I'm sure
25 there's a spike in cost. There's going to have to
90
1 be.
2 And if it's astronomical and really out of
3 line, is that a place where our attorney general
4 could look into that for us?
5 COMM. HOWARD ZUCKER: Well, we need to
6 look -- I mean, this is where it goes back to what
7 I was saying before, that we need to be sure that we
8 have enough supply.
9 And this was the whole purpose of making sure
10 that we have enough PPE. This is why the governor
11 said 90-day supply. This is why the governor said
12 about a Surge & Flex, and about all the supplies
13 that we need.
14 We need to be sure, that if something were to
15 happen again in the autumn, or subsequent months
16 after that, that we have what we need, and we do not
17 repeat the exercise that we just went through in the
18 spring.
19 And so that's why we're making sure we have
20 all the supplies that we would want.
21 DR. JAMES MALATRAS: [Indiscernible], we hear
22 you.
23 That's why we are entering into the
24 multi-state consortium. We've been working on those
25 things.
91
1 So I think the governor mentioned at some
2 of our briefings, and so you heard, there were
3 ventilators that cost at around ten to
4 fifteen thousand dollars per ventilator.
5 And at the height of the crisis, largely
6 because supply chain is from China, they were
7 charging upwards of $70,000 per ventilator, not just
8 for New York, but, virtually, every state that
9 wanted it.
10 So, you're right, that's something, at the
11 time, where we were dealing with an emergency
12 crisis.
13 Moving forward, having a multi-state
14 consortium working to build that stockpile now is
15 really important so we can keep that at a lower
16 cost.
17 And if there is price gouging, and other
18 things, I'm sure the attorney general will be
19 involved.
20 ASSEMBLYMEMBER MANKTELOW: So my last
21 question, then:
22 You know, we --
23 SENATOR RIVERA: Very quickly, please, since
24 your time has expired.
25 ASSEMBLYMEMBER MANKTELOW: All right. I'll
92
1 ask it later on.
2 I just keep hearing about the second wave.
3 I just want to know where -- where are we
4 getting those numbers, or where is that thought
5 coming from, that we're going have a second wave
6 this fall?
7 That's all.
8 COMM. HOWARD ZUCKER: Well, can I answer
9 that?
10 SENATOR RIVERA: Very quickly, very quickly,
11 please.
12 COMM. HOWARD ZUCKER: Bottom line is, if you
13 look across the country, you see these spikes in
14 Florida, Arizona, California, and you just look at
15 the nation.
16 The concern is that, not so much the mutated
17 virus potential, these individuals coming back into
18 New York.
19 That's why we do this unbelievable
20 contact-tracing program, to make sure, whenever
21 there's a case in the state, we jump on it and we
22 make sure we address it immediately.
23 SENATOR RIVERA: Thank you, Commissioner.
24 Now we'll recognize Senator Jim Tedisco for
25 3 minutes.
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1 SENATOR TEDISCO: Hello?
2 SENATOR RIVERA: Yep. Go ahead, sir.
3 SENATOR TEDISCO: Hi, Commissioner.
4 COMM. HOWARD ZUCKER: How are you?
5 SENATOR TEDISCO: Good. How are you?
6 Good.
7 I believe there was a requirement over the
8 last five months of this crisis, that every hospital
9 would interact on a daily basis by telephone, and
10 report to the department of health, to someone
11 there, about the situation in their hospitals.
12 And I presume, although we beat it back very
13 good, this virus, that that probably continues, to
14 understand the PPEs, what their need is, number of
15 deaths, number of COVID patients.
16 Now, you suggest you have done a holistic
17 investigation of the crisis in our health-care
18 facilities, and had it peer-reviewed from the
19 outside.
20 But it kind of defies logic to suggest that
21 you can come to a conclusion without the real
22 starting point, and that's the real number of
23 individuals who died in nursing homes, or, went to a
24 hospital, were sick, and died.
25 My question to you is: Wouldn't it be simple
94
1 just to have, in that discussion over the phone
2 every day, or to call the hospitals, I believe
3 there's -- how many? -- 365 hospitals in the state
4 of New York, and to ask them, either on that call,
5 or the ensuing call the next day or the day after,
6 what's the report on how many individuals died from
7 COVID that came from a nursing home into your
8 hospital?
9 What would be the difficulty?
10 Because you've just done a holistic report,
11 you've said. But you did the report, came to a
12 conclusion that it was the staff that caused that
13 wildfire, without even having the real number
14 [indiscernible cross-talking] --
15 SENATOR RIVERA: Senator -- Senator --
16 SENATOR TEDISCO: -- [indiscernible
17 cross-talking] --
18 SENATOR RIVERA: -- if I may interrupt --
19 SENATOR TEDISCO: -- [indiscernible
20 cross-talking] --
21 SENATOR RIVERA: -- Senator, I'm sorry.
22 Could you please pause, pause a minute.
23 So, Senator, as we stated multiple times, we
24 already had all this -- all this time that we were
25 talking about nursing homes.
95
1 Please focus on hospitals.
2 SENATOR TEDISCO: Yeah.
3 SENATOR RIVERA: Un-pause.
4 SENATOR TEDISCO: Okay.
5 Yeah, on those hospitals, are those calls
6 ensuing?
7 COMM. HOWARD ZUCKER: There are calls reg --
8 well, two parts.
9 There are calls regularly with the hospital
10 leadership on many different issues.
11 We also have a HERDS survey that comes out,
12 to find out information from the hospitals, over
13 150 data points of information that comes in.
14 We did this for 130 days, and it's
15 continuing. That was -- and we continue to get this
16 information.
17 As Senator Rivera mentioned, we have already
18 spoken about the issues of the nursing homes.
19 And I mentioned that I need to look at the
20 numbers and the data, and I'm happy to report back
21 to the leadership when that's ready.
22 SENATOR TEDISCO: So you could ask them on a
23 daily basis, any question from DOH that you wish to
24 ask them, and they could give you an answer?
25 COMM. HOWARD ZUCKER: I think that, you know,
96
1 sometimes we don't feel like the answer is very
2 simple to get it, yes or no. But a lot of these
3 answers are not that simple, and you need to look at
4 some of this data and to try to tease it out.
5 And that's why, you know, someone sends a
6 piece of information in, doesn't mean that it's --
7 it hasn't been looked at in the bigger picture.
8 And that's what we need to do.
9 Sometimes things are double-counted, sometime
10 things come from -- it's inaccurate, and we need to
11 go through it.
12 And that's what we usually do, on all
13 information.
14 SENATOR TEDISCO: Thank you.
15 SENATOR RIVERA: Thank you, Senator.
16 Assembly.
17 ASSEMBLYMEMBER MCDONALD: We will now move
18 into Assemblymember Edward Braunstein for 3 minutes.
19 It's a rapid-fire round, guys, and gals.
20 ASSEMBLYMEMBER BRAUNSTEIN: Good morning,
21 Commissioner.
22 During the daily briefings at the height of
23 the crisis, I recall the governor mentioning working
24 to coordinate cooperation between hospital systems.
25 As you said earlier, it's common for patients
97
1 to be transferred within a hospital system, but not
2 between hospital systems.
3 Can you just talk about some of the
4 challenges you faced with that?
5 And, what changes are in place for potential
6 surge and flex should we see a second wave?
7 COMM. HOWARD ZUCKER: I think that there's a
8 natural initial tendency to sort of feel, like, well
9 you know, we have our system and we are comfortable
10 within it.
11 But when the governor addressed all the
12 hospital leadership, and there are many calls to
13 speak with all of the leaderships of all the
14 hospitals, and particularly the major ones
15 downstate, or the major systems downstate, there was
16 an absolute collegiality on the part of the
17 leadership to say, we are in an unprecedented
18 situation, and we need to work with everyone. And
19 whatever you need, New York State government, we are
20 here to help.
21 And they did.
22 And that is why our numbers are the way they
23 are, and that is why the system -- the hospital
24 system rose to the occasion and helped out.
25 Now, as you just mentioned, the ability to
98
1 move within a system was the first thing that people
2 wanted to do, but we did move between systems. We
3 did move across -- all across the affected areas.
4 And I think that that was attributed to the
5 commitment of all the doctors, the nurses, the whole
6 health-care system, and all the leadership
7 downstate -- or, for all over, but that was where it
8 was affected the most.
9 ASSEMBLYMEMBER BRAUNSTEIN: So should we face
10 another potential second wave and encounter the
11 situation again, are there concrete plans in place
12 to facilitate those transfers, or is it just going
13 to be, we're going to call everybody together and
14 have like a voluntary system?
15 COMM. HOWARD ZUCKER: This is why the
16 governor has put forth the whole Surge & Flex plans,
17 and all the -- this is one part of the many pillars
18 of how to move forward from where we are, and
19 continue to sort of operationalize exactly what we
20 learned and did during the first part of this
21 pandemic, to be sure that we do not have to repeat
22 what we did before, and to put it into place.
23 And that's what we're doing.
24 And the hospitals recognize that, and they're
25 on board.
99
1 DR. JAMES MALATRAS: Assemblyman, this is
2 mem -- this will be memorialized -- it is
3 memorialized in the regulation that was just issued.
4 So all of those component pieces will be
5 included, so you can better manage from the various
6 hospitals systems.
7 And part of what went into that was the data
8 analytics, so you knew exactly where the hospital
9 capacity was of each hospital, so you could address
10 that need.
11 So all of those things that happened during
12 the crisis is now memorialized in the regulation
13 that will be ready for the fall, or any other
14 [indiscernible], if it not COVID-19, whatever other
15 infectious disease or pandemic may arise.
16 ASSEMBLYMEMBER BRAUNSTEIN: Great.
17 Thank you.
18 SENATOR RIVERA: Thank you, Assemblymember.
19 Now recognize Senator Alessandra Biaggi for
20 3 minutes.
21 SENATOR BIAGGI: Thank you, Mr. Chair.
22 And good morning, everybody.
23 My questions are predominantly for
24 Commissioner Zucker, and they relate to an area of
25 District 34.
100
1 So, Mount Vernon is a majority -- minority
2 city located in Westchester County, which I'm sure
3 you already know.
4 In 2010, Mount Vernon, New York, had
5 approximately 60,000 people living in it.
6 Today it's estimated to be 100,000, and we
7 will have confirmation of that after census comes
8 back.
9 Are you, Dr. Zucker, familiar with
10 Montefiore's plans to close Mount Vernon Hospital?
11 COMM. HOWARD ZUCKER: I am -- I know that
12 Montefiore has looked at many of the different
13 hospitals.
14 I am not specifically aware of what their
15 plans are regarding that hospital at this point in
16 time.
17 SENATOR BIAGGI: So Mount Vernon --
18 Montefiore has plans to close Mount Vernon Hospital.
19 And during the pandemic, the hospital had
20 been operating at what's being considered limited
21 capacity, despite the fact that Mount Vernon has had
22 the second-highest number of cases in Westchester.
23 18 nurses were laid off from their ICU unit
24 during the pandemic, and Montefiore, most recently,
25 reinstated them because of our outcry.
101
1 On March 17th, myself, as well as several of
2 my other colleagues, including Senator Bailey, had
3 sent a letter to Governor Cuomo, requesting that the
4 capacity at the hospital be fully utilized, really,
5 to ensure, not only that Mount Vernon residents
6 could have access to the hospital, but also because
7 what we were hearing from nurses, was that, because
8 there was not room in Mount Vernon Hospital because
9 certain floors were blocked off, that in the transit
10 from Mount Vernon Hospital to other hospitals in
11 The Bronx, patients died.
12 And so, you know, at that time,
13 New York State, of course, was scrambling to expand
14 hospital capacity, making sure everybody could get a
15 bed.
16 But my question most directly is: Do you
17 think it is appropriate for hospitals to be closing,
18 especially in communities of color, and especially
19 in communities with such great need, as
20 Mount Vernon, in these areas that have been highest
21 hit with COVID, and, historically have comorbidities
22 that have increased the likelihood that someone will
23 not only become very ill, but also die?
24 COMM. HOWARD ZUCKER: Well, I think
25 I answered that question when Senator Rivera asked
102
1 me about the need to be -- the efforts --
2 SENATOR BIAGGI: But I'm specifically talking
3 about Mount Vernon Hospital.
4 COMM. HOWARD ZUCKER: Well, I can't comment
5 specifically on Mount Vernon without having more of
6 the facts, and to talk to the system -- the
7 Montefiore system.
8 So I'm not going to comment about that,
9 nor --
10 SENATOR BIAGGI: [Indiscernible] that the
11 hospital is in a city that has incredible need.
12 It's in the middle of a pandemic, as you've said.
13 And, this is a community that cannot continue to
14 sustain a low level of standard of care, when,
15 historically, communities of color have received low
16 standards of care.
17 So will you, as the commissioner, take a
18 stand, and take a comment, and take a position, on
19 the closure of Mount Vernon Hospital?
20 COMM. HOWARD ZUCKER: As all of these
21 hospital issues and closures do come through the
22 department, they go to the public-health policy
23 council, when asked any of these kinds of decisions
24 need to be made.
25 And when it's brought to my attention, I will
103
1 clearly review it and make a decision, and work with
2 them when it goes for a vote at the specific meeting
3 of PHHPC meeting.
4 And, obviously, this pandemic has made people
5 look at things in a new light.
6 SENATOR RIVERA: Thank you, Commissioner.
7 Thank you, Senator.
8 Assembly.
9 ASSEMBLYMEMBER MCDONALD: Assembly would be,
10 Member Tom Abinanti, for 3 minutes.
11 ASSEMBLYMEMBER ABINATI: There you go.
12 Okay.
13 Good morning, gentlemen. Thank you for
14 joining us.
15 Commissioner, you keep saying: I have to
16 look at this, and I'll get back to you. I have to
17 look at this, and I'll get back to you.
18 A week and a half go ago we asked you for
19 information, similar to what was asked today, like,
20 the source of admissions to the hospitals/where did
21 they come from, and what were the outcomes?
22 When will you have looked at this
23 information?
24 When will you give it to us?
25 And where do you suggest we discuss it?
104
1 COMM. HOWARD ZUCKER: So I think there's a
2 couple things here.
3 As I've said multiple times, and I think it's
4 worth repeating, we are in the middle of a pandemic.
5 We have spent the course of the past 10 days,
6 and just so you know --
7 ASSEMBLYMEMBER ABINATI: And so you're
8 suggesting that, when it's over, then we'll have
9 this conversation.
10 So we'll have to wait maybe six months before
11 you tell us the source of the admissions?
12 COMM. HOWARD ZUCKER: No, Assemblyman --
13 ASSEMBLYMEMBER ABINATI: [Indiscernible] you
14 just have to look at it.
15 COMM. HOWARD ZUCKER: Assemblyman, there was
16 an ask about this staffing study, and I said I would
17 have it to you on Friday, and I am reviewing it.
18 But I think it's worth raising the fact that,
19 in the course of the past 10 days, the department
20 has been working, literally, into the middle of the
21 night, and I can tell you that, on some of the other
22 issues that have been raised.
23 There's an issue
24 [indiscernible cross-talking] --
25 ASSEMBLYMEMBER ABINATI: Commissioner, you
105
1 have the source of the admissions. It's simple
2 numbers. All you have to do is release them.
3 When and where are we going to get those
4 numbers?
5 I want to know how many came from nursing
6 homes.
7 I want to know how many came from group
8 homes.
9 I want to know how many came from the
10 different congregate care?
11 COMM. HOWARD ZUCKER: Assemblyman,
12 I understand -- I understand that the numbers are
13 what you want. And I understand that.
14 But I also know that you want to be sure that
15 there is someone who has looked, and be sure that
16 they are accurate, and that there's no
17 double-counting.
18 And that's what I'm going to do.
19 But [indiscernible cross-talking] --
20 ASSEMBLYMEMBER ABINATI: [Indiscernible
21 cross-talking], but you don't have an answer.
22 I've only got a minute and a half left.
23 The visitation policy, has that changed?
24 Can you now visit hospitals as before the
25 pandemic?
106
1 COMM. HOWARD ZUCKER: There are 207 hospitals
2 that have provided visitation policies to us.
3 There's over 120, I believe, that have already
4 opened up. That number may even be higher.
5 We want to be sure --
6 ASSEMBLYMEMBER ABINATI: What I'm concerned
7 about -- all right, Commissioner, what I'm concerned
8 about is, during the height of the pandemic, you had
9 non-verbal people, kids with disabilities, who were
10 dependent on their parents and their caregivers at
11 their institutions, at their homes, at their
12 schools.
13 And they were brought into the hospitals, and
14 the people upon whom they were dependent could not
15 come in and translate for them what their needs
16 were.
17 That's true, isn't it?
18 COMM. HOWARD ZUCKER: I understand, actually,
19 all the hospitals have visitation now.
20 I just was thinking about this for a second.
21 All the hospitals have visitation --
22 ASSEMBLYMEMBER ABINATI: But in the future,
23 will you work out a plan, please, so that we don't
24 end up with the trauma being worse than the
25 situation that people -- you're worried about?
107
1 COMM. HOWARD ZUCKER: I understand that, and
2 I recognize that, and believe me, as a pediatrician,
3 I am well aware of some of the challenges that those
4 who have -- who have disabilities have, and the
5 concerns.
6 So I recognize that.
7 But I'm balancing that with the risk of
8 infections --
9 ASSEMBLYMEMBER ABINATI: The last question --
10 COMM. HOWARD ZUCKER: -- and the risk to
11 those individuals --
12 ASSEMBLYMEMBER ABINATI: -- How many
13 people --
14 SENATOR RIVERA: Actually, your time has
15 expired --
16 ASSEMBLYMEMBER ABINATI: -- basically, what
17 we're saying is --
18 SENATOR RIVERA: -- your time has expired,
19 Assemblymember.
20 ASSEMBLYMEMBER ABINATI: -- the nurse, whose
21 kid's in the hospital, she --
22 SENATOR RIVERA: Assemblymember, your time
23 has expired.
24 Apologies.
25 COMM. HOWARD ZUCKER: I just -- Senator, can
108
1 I just mention that, the developmentally-disabled
2 community, they are allowed to have a support person
3 there.
4 So the expanded visitation is another story.
5 But there is the ability to have a support
6 person there at this point.
7 SENATOR RIVERA: There are currently no
8 members of the Senate set up to ask questions.
9 Back to the Assembly.
10 ASSEMBLYMEMBER MCDONALD: Member
11 Linda Rosenthal, 3 minutes.
12 ASSEMBLYMEMBER ROSENTHAL: Okay.
13 Hi.
14 Hi, Commissioner, and thank you for being
15 here.
16 As the chair of the Assembly Committee on
17 Alcoholism and Drug Abuse, I was told by different
18 individuals that hospitals in their area had
19 temporarily closed the hospital inpatient
20 substance-use disorder treatment programs, and were
21 turning individuals away who came in seeking
22 treatment.
23 The abrupt changes to normal treatment
24 regimens from -- because of COVID, combined with the
25 day-to-day interruptions that all of us are facing,
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1 have placed many struggling with addiction at a much
2 greater risk of overdose, and making easy access to
3 treatment even more critical right now.
4 As you know, withdrawal is a painful process,
5 but, if left untreated, it could also be
6 life-threatening. And there's often a very small
7 window of opportunity for an individual to enter a
8 treatment program. When they are turned away, it
9 can have disastrous consequences.
10 So I've been trying to get this information
11 from different agencies, and I have been
12 unsuccessful, which is why I'm asking you right now:
13 How many hospitals around the state
14 temporarily closed their inpatient treatment
15 programs as a result of the COVID-19 pandemic?
16 And what steps were taken to ensure that
17 those who could not begin treatment or care at those
18 hospitals had referrals to other programs?
19 And were those patients tracked, and do we
20 know if they received treatment at other programs?
21 And, going forward, how will the department
22 ensure that there's availability of substance-use
23 disorder treatment during emergencies like this that
24 may occur in the future?
25 COMM. HOWARD ZUCKER: So, a couple things.
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1 This is primarily a question for OASAS,
2 because [indiscernible cross-talking] --
3 ASSEMBLYMEMBER ROSENTHAL: No, no, no.
4 Let me interrupt.
5 I asked OASAS and DOH, both, on the phone,
6 and they each did this (indication). And that's why
7 I'm going to you.
8 COMM. HOWARD ZUCKER: All right, so
9 Assemblywoman, what I will do -- I can't give you
10 the number on this.
11 But what I will do is, I will find out
12 exactly what -- I will work with OASAS on this.
13 Some hospitals have developed some inpatient
14 detox programs. It's about 100 of those hospitals.
15 I can't give you the exact names of which ones they
16 are. But that's the amount that are out there right
17 now.
18 I can sit down and talk to OASAS about that
19 and get a little bit more detail.
20 No one -- though, I can tell you that no one
21 has gone without services, that I'm aware of.
22 I'm sure you've heard stories, but I am not
23 aware of any.
24 But if there are specific cases, we can sit
25 down and talk about that, and I will try to figure
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1 out how to address it.
2 ASSEMBLYMEMBER ROSENTHAL: Okay.
3 I mean --
4 COMM. HOWARD ZUCKER: And if I have to go
5 back to [indiscernible cross-talking] --
6 ASSEMBLYMEMBER ROSENTHAL: I mean -- okay.
7 Thank you.
8 We know that because of all the withholding,
9 that substance-use programs across the state have
10 been severely damaged. And I'm very concerned about
11 that.
12 And I know Co-Chair Rivera is as well. I see
13 him nodding.
14 But hospitals did repurpose rooms, and
15 I understand that they needed everything.
16 SENATOR RIVERA: Your time's ups.
17 ASSEMBLYMEMBER ROSENTHAL: But where did they
18 go?
19 Okay.
20 Thank you.
21 ASSEMBLYMEMBER BYRNE: Point of order,
22 Chairpersons, I just noticed that we have limited
23 time here with the Commissioner, and we haven't been
24 rotating Majority and Minority members for
25 testimony.
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1 Several of the Assembly Minority Conference
2 have had their hand raised for -- from the very
3 beginning.
4 They were not able to answer [sic] questions
5 of the commissioner at previous hearings.
6 And I would appreciate it if we could get
7 back on track and alternate those speakers, please.
8 ASSEMBLYMEMBER MCDONALD: Okay.
9 Anything in the Senate?
10 SENATOR RIVERA: No, sir.
11 We will go with Missy Miller.
12 ASSEMBLYMEMBER MILLER: Hi. Thank you so
13 much.
14 Good morning, everybody.
15 I just want to know, and I apologize if
16 I missed it before, but, just back to PPE:
17 There seemed to be a terrible disconnect
18 between what hospital administrators, what hospitals
19 were saying they had, and what staff, doctors,
20 nurses, on the front lines, treating these patients,
21 were actually able to get.
22 I know -- you know, with an underlying
23 condition, like Oliver, he, unfortunately, had
24 several admissions during this period.
25 And each time we were there, the nurses, and
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1 even the doctors, were saying that they had to reuse
2 PPE. They didn't have enough masks.
3 The regulations were different each
4 admission. They didn't -- they were very confused.
5 They didn't know whether they were supposed to be
6 masking, shielding, full garb.
7 You know, so there was a lot of confusion,
8 and mostly disconnect, between the people/the staff
9 actually working, the nursing supervisors who were
10 providing and giving out, and, you know, telling
11 them what the actual to-date regulation was for PPE,
12 and what the hospital administrators were actually
13 saying.
14 So, has that been corrected?
15 Is that something that, moving forward, won't
16 happen anymore?
17 Is there an oversight to that?
18 COMM. HOWARD ZUCKER: So the hospitals need
19 to report to the state how much PPE they had on
20 hand. This was a daily part of our HERDS survey.
21 And, in addition, they had to tell us what their
22 burn rate was.
23 If there was a need that was not being met,
24 we were available to provide that.
25 They went to the County, went from the County
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1 to the hospital, but we were working on those
2 issues.
3 That's one part of the answer.
4 The other part is that, when you asked about
5 the face shields versus masks, you have to remember
6 that, as this was evolving, we were learning more
7 about this.
8 This is one of the challenges of, whether
9 it's a pandemic or just a new virus, is we did not
10 know all the information, not because we didn't
11 know, no one knew.
12 And as [indiscernible cross-talking] --
13 ASSEMBLYMEMBER MILLER: Of course, right, it
14 was unknown.
15 But, there was that disconnect between
16 hospitals reporting to the State or OEM, what they
17 had, saying they had.
18 I was, myself, calling hospitals, saying: Do
19 you have PPE? Are you in need?
20 No, no, no.
21 And then we would show up, and, boom, the
22 nurses are saying, uh, this is ridiculous. I have
23 to go wash this off. I have to reuse this.
24 Why was that disconnect there, from what
25 they're reporting, that their burning through?
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1 Was it because they were so nervous of
2 running out, that they weren't supplying their
3 front-line workers with what they actually needed?
4 COMM. HOWARD ZUCKER: I'm happy to talk with
5 the hospitals --
6 ASSEMBLYMEMBER MILLER: I reported it several
7 times on the governor's update calls.
8 I said -- you know, after each admission, I'd
9 say, this is crazy. Why is there this disconnect?
10 And so they were aware of this disconnect.
11 COMM. HOWARD ZUCKER: Well, the State did
12 give out 24 million pieces of PPE.
13 And if there was a concern, we did respond
14 accordingly.
15 I hear what you're saying about what you saw
16 with Oliver on the front line in the hospital. And
17 I'm happy to get back to you and talk about the
18 specifics.
19 But I can tell you that, going forward, this
20 is part of why the governor has put in place the
21 90-day amount of PPE [indiscernible
22 cross-talking] --
23 SENATOR RIVERA: Thank you, Commissioner.
24 COMM. HOWARD ZUCKER: -- so, and that's why
25 we have them.
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1 SENATOR RIVERA: Thank you, Commissioner.
2 Thank you, Assemblymember.
3 ASSEMBLYMEMBER MCDONALD: Still the Assembly,
4 Member Ellen Jaffee.
5 ASSEMBLYMEMBER JAFFEE: Thank you.
6 Thank you, Commissioner.
7 What I wanted to get a sense of was the --
8 how will our youth have been impacted by COVID?
9 And are those numbers --
10 SENATOR RIVERA: Assemblymember, if could you
11 turn on your camera, please?
12 ASSEMBLYMEMBER JAFFEE: I'm sorry.
13 I'm sorry. I thought --
14 SENATOR RIVERA: Thank you.
15 ASSEMBLYMEMBER JAFFEE: Thank you.
16 In terms of the -- I was just wondering, the
17 number of our youth that have been impacted by
18 COVID?
19 And are those numbers increasing?
20 Have they, you know, control -- been under
21 control?
22 And the ages of our youth that are -- really
23 have, you know, suffered through this?
24 COMM. HOWARD ZUCKER: Sure.
25 So, fortunately, you know, this virus has not
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1 impacted the younger population the way other
2 viruses actually have.
3 The percentage of kids who have been affected
4 is down in the 1 percent range, or -- or, in some
5 places, even lower.
6 We monitor this very closely.
7 I have to tell you, sort of as a
8 pediatrician, I am sort of trying to figure out why?
9 And there's a lot of thoughts about that, and
10 there's a lot of scientists out there looking at
11 this.
12 Perhaps, initially, there may be some
13 [indiscernible] activity from the immunizations they
14 get, which would be beneficial, and that would help.
15 There's maybe other reasons as well, just the
16 immune system, of how a kid's immune system is
17 versus adults.
18 But one challenge we have seen, and New York
19 was the first state to really jump on this, was the
20 issue of the multisystem inflammatory syndrome in
21 children.
22 We have seen 245 cases of that in the state.
23 And we have, unfortunately, lost two children to
24 that. This was an infection -- or, inflammation,
25 I should say, that occurred about four weeks after
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1 they got sick.
2 We addressed this. We are monitoring it.
3 We were the first state to really look at
4 this and monitor this.
5 I have spoken to my fellow commissioners
6 around the country about this. Many states don't
7 even report this.
8 We look at many different aspects of
9 pediatric care, including the psychosocial impacts
10 of children who are sort of living through a
11 pandemic, and may not be able to sort of grapple
12 with the impact of this, and understand what is
13 happening.
14 So we are addressing that as well.
15 But -- and we monitor what happens to all the
16 kids, and whether they have other medical
17 conditions.
18 The vast majority of the children who have
19 died, and it's only been a handful, have had other
20 medical conditions as well.
21 And I'd be happy -- I know your time is
22 short, so I'd be happy to share more with you
23 afterwards.
24 ASSEMBLYMEMBER JAFFEE: Thank you.
25 Just one of the reasons I'm asking that
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1 question is, because we are moving forward -- I'm a
2 former teacher -- moving forward to the possibility
3 of opening our schools at this point.
4 And there has been very real concern raised
5 about the impact of the COVID on our youth.
6 And I was wondering the numbers at this
7 particular point, of whether it is something of a
8 very real concern.
9 Are they having the -- are they -- is it
10 under control in terms of, the youth are not falling
11 into that as much, the numbers are not as great
12 as --
13 SENATOR RIVERA: Thank you, Assemblymember.
14 ASSEMBLYMEMBER JAFFEE: I'm finished.
15 SENATOR RIVERA: Your time has expired.
16 ASSEMBLYMEMBER MCDONALD: Next up is
17 Assemblymember Garbarino.
18 Assemblymember Garbarino?
19 ASSEMBLYMEMBER GARBARINO: Thank you,
20 Chairman.
21 Dr. Zucker, thank you very much.
22 I also -- I just want to say, your office was
23 very helpful during the uptick.
24 A lot of the calls that we had, dealing with
25 your staff, they were very helpful in helping some
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1 of my constituents' problems.
2 So I do want to say thank you, because I know
3 you're probably getting called from every member of
4 the legislature.
5 But I specifically want to ask questions
6 about what your thoughts, being the head of the DOH,
7 was to the federal support that we received during
8 the peak?
9 You know, the field hospitals, the hospital
10 ship, the ventilators, the PPE, did you -- was it
11 enough, did we get enough, from the federal
12 government that we needed?
13 COMM. HOWARD ZUCKER: I think that there are
14 multiple parts to the answer -- parts of an
15 answer -- the answer has multiple parts, I'll put it
16 that way.
17 The first part is about Javits and "Comfort."
18 So we worked with the federal government to
19 get Javits and "Comfort" in place. The governor
20 asked that these be converted to COVID-positive
21 facilities because, initially, they weren't not.
22 That provided the ability to care for
23 1,095 patients at Javits, and 282 at the "Comfort."
24 So that was helpful for us, to be able to
25 work with FEMA and others on that issue.
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1 There have been challenges in sort of the
2 last of national leadership and coordination on this
3 issue.
4 I have worked and spoken with everyone, from
5 the CDC director, to FDA commissioner, and to
6 members of the HHS leadership, about things when we
7 needed some dialysis machines. They were able to
8 provide it.
9 But I think the issue is about leadership at
10 a federal level.
11 And if that was there up front, I think
12 things would have been different.
13 But, absent, you know, the federal
14 leadership, we, as a state, have really led the
15 charge. And you can see this with the numbers that
16 we now have, less than 1 percent even positive in
17 the state.
18 ASSEMBLYMEMBER GARBARINO: Well -- now, are
19 you -- with the possibility of a second wave, are
20 you currently in discussions with HHS or the
21 Army Corps or FEMA or CDC about what to do, what
22 we need, from the federal government?
23 Has that -- have -- are [indiscernible]?
24 COMM. HOWARD ZUCKER: So I think the way we
25 broke down Javits was, so that we can get this up
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1 and operational again within 72 hours.
2 That was why the way it's packaged, and ready
3 to move forward.
4 We have conversations with -- I've had
5 conversations with HHS, if there are certain needs.
6 There were dialysis machines that were needed, and
7 they were able to provide those to us.
8 This is a constant dialogue.
9 And the same with issues with the CDC.
10 And, you know, there are always challenges,
11 and there are always things that we -- we would like
12 others to do and help us better.
13 But I think -- I think those conversations
14 between, you know, public health officials on a
15 regular basis.
16 We're talking with HHS about the Strategic
17 National Stockpile as well, because that's where
18 there's supplies.
19 I was a little surprised, you know, at what
20 wasn't there. But, you know, who expected, you
21 know, some of the challenges that we faced.
22 But we met those challenges at a state level.
23 SENATOR RIVERA: Thank you, Assemblymember.
24 Thank you, Commissioner.
25 Next?
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1 You're muted, Assemblymember.
2 ASSEMBLYMEMBER MCDONALD: Next up is
3 Aileen Gunther.
4 SENATOR RIVERA: Recognized for...?
5 ASSEMBLYMEMBER MCDONALD: 3 minutes.
6 SENATOR RIVERA: There you go.
7 ASSEMBLYMEMBER GUNTHER: Am I there?
8 Hi.
9 Hi, everybody.
10 So I'm going to be quick because I only have
11 3 minutes.
12 So I want to quote from a guidance issued by
13 the DOH on March 28th.
14 "Entities may allow health-care personnel
15 with confirmed or suspected COVID-19, whether
16 health-care providers or other facility staff, to
17 work if all of the following conditions are met."
18 The first condition on the list is: The
19 furloughing of such HCP would result in staff
20 shortages that would adversely impact operation.
21 Second is, that: They isolate for seven days
22 and have no symptoms for 72 hours.
23 This is despite the fact that we know
24 asymptomatic people can spread COVID.
25 I would note, there is no requirement for the
124
1 HCP to show negative results.
2 DOH even goes on to say, that: The HCP
3 experiencing mild symptoms can go back to work as
4 long as they wear a face mask.
5 So we have health-care personnel who are
6 potentially COVID-positive going to the hospitals.
7 This is despite all the knowledge we had at
8 that point.
9 This guidance was not issued back in February
10 when we knew very little about the virus.
11 This was issued late March, when already --
12 when already knew that asymptomatic people could
13 carry COVID.
14 COMM. HOWARD ZUCKER: So there's a couple --
15 ASSEMBLYMEMBER GUNTHER: I just want to
16 finish, I want to finish, because this is important
17 to me.
18 So -- so, as was stated, Wadsworth had
19 developed at that point, by late February.
20 Why wouldn't DOH require a negative test
21 result from a health-care personnel who had tested
22 positive?
23 If it is truly due to staffing shortages, and
24 I'm going to repeat, staffing shortages, what is the
25 State doing to ensure that all health-care
125
1 facilities, due to what you say might be a second
2 wave, have enough personnel to not have to send
3 staff who are sick back to work?
4 Do you believe statewide staffing ratios are
5 needed to ensure this doesn't happen?
6 And I will say, as a registered nurse, I also
7 was the infectious disease nurse in the hospital,
8 president of APIC in the Mid-Hudson region. And we
9 know about transmission.
10 And I think that I have begged and begged for
11 safe staffing.
12 And, you know what?
13 There are -- it would be so fiscally
14 responsible to do it, because we're paying plenty of
15 overtime at this point.
16 And for the safety of our patients, whether
17 it be long-term care or acute care, you know what?
18 Nurses are the backbone of health care.
19 We really get little to no -- we have been
20 picketing on the streets. We have been crying for
21 it for year after year after year.
22 After this COVID pandemic, isn't it time to
23 reconsider safe staffing, to be able to go into
24 these acute-care facilities and long-term care
25 facilities?
126
1 I'm emotionally distressed by the lack, or
2 the inactivity, of the governor, and of all
3 [indiscernible cross-talking] --
4 SENATOR RIVERA: Thank you, Assemblymember.
5 Your time has expired now.
6 COMM. HOWARD ZUCKER: So let me -- let unpack
7 that -- the question, because of some key points.
8 Number one --
9 Yeah, I'll do it quickly.
10 -- because there's a fact that's inaccurate
11 there.
12 The asymptomatic spread was not as known back
13 then. In fact, it was June 9th that the WHO put
14 out a statement that asymptomatic spread can occur.
15 I'm just sharing with you the facts on this.
16 And these are CDC guidelines.
17 The previous -- your esteemed colleague, the
18 previous speaker, mentioned about working with the
19 federal government.
20 So I worked with the CDC on many of these
21 things, and we took the guidance from the CDC
22 regarding, I don't want to repeat some of the parts
23 that you mentioned, about those
24 [indiscernible cross-talking] --
25 SENATOR RIVERA: We only have -- we only have
127
1 a few more members to [indiscernible] questions, so
2 let me go ahead and do that.
3 ASSEMBLYMEMBER MCDONALD: We have two members
4 left, and that'll be it for Dr. Zucker.
5 And we'll go to John Salka.
6 SENATOR RIVERA: Recognized for...?
7 ASSEMBLYMEMBER MCDONALD: 3 minutes.
8 SENATOR RIVERA: Thank you.
9 ASSEMBLYMEMBER MCDONALD: 3 minutes.
10 ASSEMBLYMEMBER SALKA: Yeah, first of all,
11 thank you, Commissioner, for being here today.
12 And this is a bit of a clinical question.
13 We understand that it's -- it can be
14 considered kind of any port in storm right now with
15 the ventilators that we have available.
16 But as I have been a respiratory therapist
17 for 30 years, I understand that treating the
18 pulmonary implications of the COVID virus is an
19 extremely complicated clinical picture.
20 Are you confident that the equipment that we
21 have available right now will give long-term
22 clinical outcomes that will be something that the
23 patient would actually get the best care they could?
24 I know that they -- when they were talking
25 about splitting ventilators, that sent a chill up my
128
1 spine.
2 So my question is: In fact, are you
3 satisfied with the best clinical guidelines that are
4 being offered right now in the care of these
5 patients, and confident that we won't have a major
6 number of people that will be suffering from
7 long-term consequences of inappropriate care -- what
8 could possibly be inappropriate care?
9 COMM. HOWARD ZUCKER: So, first, I don't
10 think it's inappropriate care because, at that point
11 in time, you have the clinical information. And you
12 have to make a decision based on that clinical
13 information you have.
14 I have lived my life, prior to being in
15 government, making those kind of decisions.
16 So I think that we provide -- when someone
17 has respiratory failure, provide ventilatory
18 support.
19 As we learn more about this virus, we learn
20 different ways with -- of managing these respiratory
21 [indiscernible]. If there are other ways of
22 managing respiratory failure, you can address it.
23 And we learned that, and that's when we
24 learned how to care for more and more COVID
25 patients.
129
1 Long term, I can't predict the future.
2 We talk about the respiratory issues, but we
3 don't know whether the other impact -- other systems
4 that may be impacted by this virus.
5 This was an article in the cardiology
6 journals the other day about the cardiac
7 implications from coronavirus.
8 So we are looking; the scientists are
9 looking, the doctors are looking, the researchers
10 are looking, and we will figure this out.
11 But it is too early to make a prediction
12 about what -- or, to make predictions. But it's too
13 early give you an answer about what will be some of
14 the potential long-term effects.
15 But I do not believe that this was
16 inappropriate care.
17 It was the care that needed to be provided at
18 that moment in time, based on the information we
19 had.
20 It goes back to [indiscernible], which is,
21 basically, you get more information; and then we
22 have more information, you make a different
23 decision.
24 And that's exactly what we were doing.
25 ASSEMBLYMEMBER SALKA: No, I understand,
130
1 we're all on a learning curve at this point right
2 now.
3 I talked to fellow therapists and clinicians,
4 and it was kind of, in some respects, a hit-and-miss
5 thing on how we treated these patients.
6 But I just want to make sure that, when we
7 look at a ventilator, and we spend fifteen or
8 twenty thousand dollars on that ventilator, that
9 it's a piece of equipment that is properly able to
10 manage that complicated clinical picture.
11 COMM. HOWARD ZUCKER: May I add --
12 ASSEMBLYMEMBER SALKA: I want to
13 [indiscernible].
14 COMM. HOWARD ZUCKER: May I add just one
15 thing, is that, we talk about this regarding this
16 pandemic and COVID-19.
17 But as others in the legislature mentioned,
18 what about a different kind of illness, or a
19 different virus, or a different bacteria?
20 So we want to be prepared, if a ventilator
21 supportive -- can support them during their acute
22 phase of their illness.
23 So we need to look at the big picture.
24 ASSEMBLYMEMBER SALKA: Thank you,
25 [indiscernible].
131
1 SENATOR RIVERA: Thank you, Assemblymember.
2 ASSEMBLYMEMBER MCDONALD: Last, but not
3 least, our colleague Jake Ashby.
4 SENATOR RIVERA: Recognized for 3 minutes.
5 ASSEMBLYMEMBER ASHBY: Thank you,
6 Mr. Chairman.
7 Commissioner Zucker, was your department
8 denied any equipment or resources requested by the
9 federal government?
10 And, was the White House helpful with what it
11 did deliver?
12 COMM. HOWARD ZUCKER: So this goes back to
13 what we were talking about before, regarding
14 supplies and asks for equipment that -- ventilators
15 or dialysis machines.
16 But when we asked for the Javits Center and
17 for the "Comfort," we worked with them to get that
18 set up.
19 I'm not sure exactly your -- the specific
20 questions.
21 When I spoke with CDC about certain things,
22 we got information.
23 But this is a much more complex process than
24 just a yes-or-no answer.
25 ASSEMBLYMEMBER ASHBY: Were you ever
132
1 denied -- was your department ever denied resources
2 by the federal government?
3 OFF-CAMERA SPEAKER: We had asked for more
4 ventilators at one point.
5 COMM. HOWARD ZUCKER: Ventilators, yes.
6 ASSEMBLYMEMBER ASHBY: Okay?
7 OFF-CAMERA SPEAKER: But [indiscernible] the
8 federal government only had 10,000. They did not
9 give us our full request.
10 ASSEMBLYMEMBER ASHBY: Anything else?
11 OFF-CAMERA SPEAKER: That is the one that
12 [indiscernible].
13 OFF-CAMERA SPEAKER: That's the one.
14 ASSEMBLYMEMBER ASHBY: Okay.
15 So other than the ventilators, resources that
16 the federal government provided that you requested,
17 they were helpful?
18 COMM. HOWARD ZUCKER: I guess you could bring
19 up the issue that, testing, because it ended up
20 being that our Wadsworth lab created the test.
21 And when we said we needed more testing, it
22 wasn't there.
23 So that is a problem.
24 And if we had that, and if we had more tests,
25 we probably would have figured this -- you know,
133
1 what was going on a little bit sooner.
2 So I think that, you know, when someone said,
3 "well, what would you have liked from the
4 government?" I would have liked more testing from
5 them, and be able to go forward.
6 ASSEMBLYMEMBER ASHBY: Okay.
7 Yeah, Wadsworth is in my district as well, so
8 I'm fully aware of that.
9 But with the ventilators, we didn't end up
10 using all of the ventilators as well, though;
11 correct?
12 COMM. HOWARD ZUCKER: The ventilators that
13 the federal government gave us went out to the
14 hospitals, yes.
15 ASSEMBLYMEMBER ASHBY: Okay.
16 Thank you.
17 DR. JAMES MALATRAS: Just one more point, on
18 the larger question, Assemblyman, of federal need,
19 which would be, I think many of the questions were
20 raised by many of your colleagues on rural
21 health-care facilities, urban health-care
22 facilities, other things.
23 Federal funding for state and local
24 government hospitals and education are critically
25 important as we go forward in the latest -- in the
134
1 next funding round.
2 ASSEMBLYMEMBER ASHBY: Appreciate it.
3 SENATOR RIVERA: All righty.
4 Thank you, Assemblymember.
5 Thank you, Commissioner.
6 Thank you, Mr. Malatras and Mr. Rhodes.
7 That concludes your section.
8 We will now move on to -- oh, one thing that
9 I wanted to say on the record for every member, both
10 for -- regarding the first two hearings on nursing
11 homes, and this one as well, if there are questions
12 that you still feel that the commissioner or the
13 administration should answer, please get those
14 questions to both the chairperson -- to
15 Chairman Gottfried or myself in the next few days,
16 as we put a document together to get to the
17 administration.
18 Thank you for that.
19 We will move on to Panel 2.
20 That will be Carlina Rivera --
21 Not my cousin. I know you all were thinking
22 it.
23 -- chair of the Committee on Hospitals from
24 the New York City Council.
25 ASSEMBLYMEMBER GOTTFRIED: Okay.
135
1 Thank you.
2 And welcome, Councilmember.
3 In addition to chairing the Council Committee
4 on Hospitals, your district also overlaps a little
5 bit with mine.
6 So, do you swear or affirm that the testimony
7 you're about to give is true?
8 CARLINA RIVERA: I do.
9 ASSEMBLYMEMBER GOTTFRIED: Okay.
10 CARLINA RIVERA: Thank you, and good
11 afternoon.
12 Hello, my name is Carlina Rivera.
13 I am a member of the New York City Council,
14 and I am chair of the council's Committee on
15 Hospitals.
16 I want to thank the committee chairs for
17 giving me the opportunity to provide testimony at
18 today's hearing.
19 And, of course, to all of your colleagues for
20 their very thoughtful and passionate questions to
21 the previous panelists, our leaders in the state
22 department.
23 As Hospitals' chair, I saw just as all you
24 did, the disaster of the COVID-19 pandemic's worst
25 days unfold right before my eyes in communities
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1 across our state.
2 My team and I spent late nights and countless
3 hour on the phone this spring with hospital
4 administrators, front-line workers, and advocates.
5 And while I'm thankful that our state's new
6 COVID case counts are at record lows, thanks to the
7 hard work of so many health-care workers and
8 everyday New Yorkers, I'm also thankful that we are
9 holding a state hearing today to examine the one
10 hard truth we still have not solved.
11 Simply put, our initial massive failure in
12 responding to the pandemic, which resulted in a
13 COVID-19 death rate that no other state has matched
14 to this date, could have been lessened if the
15 unequal systems that have been in our hospitals for
16 decades were addressed through legislative and
17 regulatory changes at the state level.
18 There is no doubt that, due to lack of
19 support from the federal government and the Trump
20 administration, New York was forced to go it alone
21 without the federal resources one would normally
22 expect during a pandemic of this magnitude.
23 And there were certainly challenges none of
24 us could have foreseen, but these basic inequities
25 in public and private hospital financing, and
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1 workplace protections and resources, and in where
2 patients can afford to receive care, played an
3 outsized role in preventing thousands of patient
4 deaths in New York State hospitals.
5 I know you have already heard from and
6 questioned our state health commissioner,
7 Dr. Howard Zucker, which I was watching his
8 testimony before hearing my own.
9 I know Dr. Zucker defended the response from
10 the State and hospitals, and I respect his efforts
11 during a rapidly evolving crisis.
12 I also know he left many questions
13 unanswered, and only committed to explore some ideas
14 on how his agency could better prepare for a second
15 wave.
16 But I prefer to focus in my testimony on what
17 you, our state legislators, can potentially do to
18 help us compel the State and hospitals to act now to
19 prevent a future COVID-19 surge, and permanently
20 address the inequities in our health-care system.
21 I just want to make sure -- all right.
22 I'm going to try to breeze through this as
23 quick as I can, considering the timing.
24 For the remainder, I just want to note a
25 couple of legislative actions that I think are
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1 certainly possible, and that I know that you both
2 respective chairs have explored in the past.
3 So, mandate resource pooling and fair
4 distribution of PPE and medical supplies across all
5 hospitals and medical facilities, with contracting
6 done through the State or another centralized entity
7 that can maximize purchasing power.
8 Institute a more concrete and transparent
9 systemwide emergency response plan, not just in name
10 only, with clear and public organizational
11 frameworks, chains of command outlining roles
12 between the state, local municipalities, hospitals,
13 and hospital associations, and more express
14 directives on how to handle COVID-19 patent care
15 during the surge with limited resources.
16 Ensure any plan also includes requirements
17 for and streamlining of rules for proactive
18 out-of-system patient transfers so that public
19 hospitals or those that are not part of a major
20 network are not overwhelmed at any point during a
21 second surge.
22 Ensure that visitation and patient advocacy
23 policies reflect not only the safety of front-line
24 workers, but also the need for mental support and a
25 voice for patients and families.
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1 Require all hospitals and medical facilities
2 to proactively work with contract tracing teams by
3 sharing an equal load in testing responsibilities,
4 as well as requiring testing for anyone who visits a
5 hospital or outpatient facility for any level of
6 care or for a long period of time.
7 Temporarily halt the closure of any hospital
8 facilities that were slated to occur through the
9 certificate-of-need process.
10 Require more stringent reporting on access to
11 hospital emergency rooms and beds for under- or
12 uninsured patients.
13 Require hospitals to provide data and
14 reporting on their surge capacity, and how it is
15 being maintained, both structurally and in terms of
16 workforce.
17 Ensure all COVID-19 data is transparent and
18 accurately measures impacts to the hardest-hit
19 communities.
20 Mandate that hospitals provide real
21 mental-health and supportive resources to front-line
22 workers beyond this one-size-fits-all approach.
23 And pass new revenue generators, such as the
24 pied-á-terre tax, a wealth tax, and the closure of
25 corporate loopholes, to restore Medicaid cuts passed
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1 in the fiscal year 2021 state budget, starting with
2 cuts that most acutely affect enhanced safety-net
3 hospitals.
4 And in the long term, the State must pass
5 legislation to restore the state's community
6 planning process for hospitals and health-care
7 facilities that existed through the 1980s, and
8 integrate it into a more modernized
9 certificate-of-need process that is more patient
10 representation and public input, as well as a health
11 equity impact assessment.
12 Pass strong --
13 SENATOR RIVERA: Thank you, Councilmember.
14 You have -- if you have, like, one last
15 thought?
16 CARLINA RIVERA: Sure.
17 I mean, we've mentioned:
18 State staffing.
19 Expanding on reforms to the way Medicaid
20 reimbursement and indigent-care funds are
21 distributed to safety-net hospitals.
22 Mandate nation-leading training and
23 instruction on implicit bias.
24 And, of course, I guess I'll end with,
25 passing the New York Health Act --
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1 SENATOR RIVERA: Got you.
2 CARLINA RIVERA: -- which I fully, fully
3 support.
4 SENATOR RIVERA: Thank you.
5 CARLINA RIVERA: We all know that it has a
6 lot to do with systemic racism.
7 And I want you all to know that, while my
8 committee does have oversight authority to question
9 and examine New York City's public and voluntary
10 hospital systems --
11 SENATOR RIVERA: Thank you, Councilmember.
12 CARLINA RIVERA: -- you all have the ultimate
13 authority.
14 SENATOR RIVERA: We have to wrap up because
15 we'll move to questions --
16 CARLINA RIVERA: Sure.
17 SENATOR RIVERA: -- because we have a long
18 hearing.
19 First, we'll be led off by the Assembly.
20 ASSEMBLYMEMBER MCDONALD: And that will be
21 led off by Chair Gottfried.
22 ASSEMBLYMEMBER GOTTFRIED: Thank you.
23 I guess Senator Rivera forgot the rule that
24 we give extra time to anyone who says they favor the
25 New York Health Act.
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1 But I have a question.
2 CARLINA RIVERA: I'm very in favor of it.
3 ASSEMBLYMEMBER GOTTFRIED: Councilmember, you
4 talked about the need for rules on transfers of
5 patients from one hospital system to another,
6 essentially, to avoid dumping of patients from one
7 system to another.
8 Is that something that we just need to be
9 mindful might happen and we want to avoid it, or do
10 you think that was happening during the peak months?
11 CARLINA RIVERA: I think in the immediate,
12 patient transfers and resource pooling was probably
13 one of the biggest failures during the pandemic.
14 I think patients were most often transferred
15 only when they were in emergency situations and the
16 hospital had reached critical capacity.
17 I think Dr. Zucker is absolutely correct in
18 saying that patient transfers in these situations
19 can be very, very dangerous.
20 But where we could have done better is with
21 ambulances, for example, which often did not get
22 diverted to less-busy hospitals unless a hospital
23 hit max capacity.
24 And this was standard operating procedure
25 prior to the pandemic, and usually only affected our
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1 busiest public hospitals, such as Elmhurst.
2 And I think, secondly, hospitals could have
3 been more active in, certainly, managing patient
4 populations and transferring lower-risk patients
5 sooner.
6 However, hospitals are often not ready or
7 willing to do this beyond their own networks.
8 And -- because, as I heard from
9 administrators and advocates, they had concerns
10 about how insurance and medical records would be
11 handled in these cases.
12 And I think that what we saw during the
13 pandemic, which I have said many, many times, is
14 that there was supposed to be this one network of
15 everyone working together. And I certainly think
16 that was more in theory than in practice.
17 And, you know, this just meant that patients
18 were often rushed to other hospitals when they were
19 already critically sick, resulting in many
20 unnecessary deaths during transfers, or, in cramped
21 conditions in overstretched hospitals.
22 And I think, in terms of resource pooling, we
23 all know the problem here.
24 Supply chain management is best solved
25 through consolidation.
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1 And that simply did not happen at the scale
2 that it should have. And hospitals were desperate,
3 they were scrambling, to get the best supplies that
4 they could have gotten for their workers and
5 patients.
6 And the State should have stepped in,
7 probably fully taken over supply chain and
8 contracting, and then removed that additional work,
9 since they were already overwhelmed.
10 ASSEMBLYMEMBER GOTTFRIED: Thank you.
11 SENATOR RIVERA: I'll recognize myself for
12 5 minutes.
13 You know, I thought that Dick was going to
14 say that we give everybody whose last name is Rivera
15 a couple -- a little bit more time.
16 But -- so thank you for joining us,
17 Councilmember.
18 I wanted to focus a little bit on the
19 disconnect that exists. And I want, from your
20 perspective, as you've been looking at it, the
21 disconnect that might have existed between the State
22 and the City, in how -- because we know most
23 hospitals are in the city of New York. Certainly,
24 most public hospitals are in the city of New York.
25 And we have been consistently talking about
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1 some of the disconnect that has existed in many
2 policy areas, not just in health care, between the
3 State's -- the State and the City's administration.
4 And, unfortunately, sometimes the people get
5 stuck in the middle are the folks that are hurt.
6 Those are the folks that I want to talk
7 about.
8 So if you could talk a little bit about, from
9 your perspective, as you looked at hospitals in the
10 city, what about that disconnect that might have
11 existed between the State's administration and
12 guidance, and the City's efforts, and how that clash
13 might have led to us not functioning as effective as
14 possible.
15 CARLINA RIVERA: That's a great question.
16 I mean, you know, we always -- hindsight is
17 always 20/20 -- right? -- on how we could have
18 worked together a lot better.
19 First, I just want to say that I don't
20 think -- I don't think any hospitals were
21 particularly at fault. I think every hospital did
22 their best to handle the crisis.
23 I think the issues of inequity here that
24 accelerated this crisis are much more systemic.
25 And while the state department of health did
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1 heroic work to stand up to a massive response, I do
2 think that they're at fault for not being as
3 transparent about their response during the first
4 wave, and even today at this hearing.
5 I also think that we could put blame on -- we
6 should be putting blame on a number of interest
7 groups that have worked to block legislation to
8 address decades of hospital deregulation.
9 Certainly, we all know that the
10 Greater New York Hospital Association has a very
11 close relationship with the State. And, in fact,
12 they played a very important role in the active
13 coordination of care.
14 I think we'd all be well-served by taking a
15 careful look at that relationship, and how they can,
16 I guess, be more transparent and better support the
17 public system.
18 In terms of who bore the brunt, I mean, we
19 all know that it was communities of color that bore
20 the brunt of these deaths.
21 It's because many New York immigrants,
22 New Yorkers of color, a public hospital emergency
23 room is, unfortunately, their only option for
24 primary care or treatment.
25 And that just isn't a smart way to provide
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1 care, from a safety perspective, from a financial
2 perspective, and even from a care perspective.
3 So as private hospitals have retreated from
4 communities of color, or consolidated into large
5 networks, for many New Yorkers there isn't even an
6 option nearby to receive treatment, and that's
7 before you even get into insurance.
8 So in terms of how they're working together,
9 you know, what I've witnessed, and, again, in my
10 capacity as chair of Hospitals, and the oversight
11 that I can implement, or I guess practice, over
12 specifically Health and Hospitals, which is the city
13 system, you know, they're struggling even now after
14 the height of the pandemic.
15 You know, you have a public hospital system
16 handling the city's entire testing regime.
17 Even I've heard from numerous advocates and
18 administrators that private hospitals have actively
19 opposed calls to become more involved in community
20 testing.
21 But we're just not seeing from the State that
22 level of transparency, and even in response to some
23 of your questions over these last few weeks.
24 And I think when it comes to, certainly, who
25 is, I guess, underserved, I think a lot of the
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1 policy proposals that you have, particularly around
2 the certificate-of-need process and enhanced
3 safety-net investments, that would go a long way to
4 helping rural communities, as well as the
5 communities of color that are concentrated in the
6 city.
7 So there's a lot there, I think, that we
8 desire in terms of how we can work a little bit
9 better together.
10 I was hoping the pandemic would -- you know,
11 when I saw that kind of dais of the governor and the
12 Greater New York Hospital Association, you know,
13 I was really hoping that Dr. Katz of H&H would be
14 there, and there would be more unity.
15 But it seemed to be a lot of the same old.
16 And I'm hoping that some of your legislative
17 and budgetary action will make a difference,
18 finally.
19 SENATOR RIVERA: Thank you, Councilmember.
20 That is all for me.
21 Back to the Assembly.
22 ASSEMBLYMEMBER MCDONALD: At this time -- at
23 this time I do not see any other -- oh, excuse me.
24 Dan Quart.
25 SENATOR RIVERA: Dan Quart.
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1 ASSEMBLYMEMBER MCDONALD: 5 minutes, please.
2 ASSEMBLYMEMBER QUART: Councilmember, how are
3 you?
4 CARLINA RIVERA: I'm doing well.
5 How you doing?
6 ASSEMBLYMEMBER QUART: I'm doing well.
7 Good to see you again.
8 I have one question, but it concerns budgets.
9 And I think you have a unique perspective,
10 both on your professional experience before you were
11 elected as a councilmember, and now as chair in the
12 city council.
13 Obviously, we're all very familiar with the
14 difficulties of the state budget, and the
15 limitations, and so much depending on federal
16 resources being given to us.
17 But I think maybe, if you could talk to the
18 committee members, and -- about, theoretically,
19 let's say, a 20 percent budget cut to hospitals, and
20 it could be worse, or, hopefully, not as bad.
21 But in real terms, from your perspective,
22 from the council's perspective, as chair of the
23 Hospitals, what would a budget cut of 20 percent,
24 what would that mean in real terms to our city
25 hospitals, the level care to especially communities
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1 of color that will bear the brunt?
2 I think if you can speak a little about what
3 that would look like, so we go from theoretical to
4 what that reality would be.
5 CARLINA RIVERA: Well, I think the cuts would
6 be devastating.
7 And I will tell you that, coming out of a
8 very long budget negotiation process around the city
9 budget, I mean, I guess it was long -- it was more
10 intense, so it seemed much longer -- and seeing how
11 we had to face the fiscal realities of our state and
12 city budget crisis, and making those cuts across the
13 board to countless initiatives, you know, from
14 housing protections, to geriatric mental health,
15 that was really, really hard to do.
16 But we realized that, you know, right now,
17 we're in a situation where that kind of financial --
18 those decisions have to be made.
19 I think when it comes to our hospital system,
20 we certainly -- that should be the last thing on the
21 table that -- in terms of cuts.
22 We have seen, in terms of the indigent-care
23 pool, and how that formula for charity dollars
24 hasn't worked for a very, very long time, we see our
25 city hospitals already struggling.
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1 And I will tell that you, pre-pandemic, you
2 know, my relationship with the hospital system was
3 really important.
4 And they would come to me asking for all
5 types of funding asks.
6 And I'll give you an example.
7 I was thinking about this as I was listening
8 to testimony.
9 They would come to me and ask for things like
10 funding for EKG machines, the renovation of a
11 nurse's station, trauma slots, even work on the
12 facade of some of the busiest hospitals in New York
13 City.
14 And I just thought, you know, these are
15 things that should be funded by the City and State,
16 no question.
17 You know, these are our important places --
18 these are some of the most important places in the
19 city.
20 Everyone needs quality health care, it's a
21 human right.
22 But I will tell you, in terms of -- if
23 I could just mention, in terms of City and State
24 coordination, to kind of answer your question, and
25 also Chair Rivera, you know, we need to institute a
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1 more concrete and transparent systemwide emergency
2 response plan, not just in name only, with clear and
3 public organizational framework, chains of command,
4 outlining roles between the State and local
5 municipalities, hospitals, hospital associations.
6 I mentioned this in my testimony.
7 But it really needs to be really, really
8 outlined and worked through.
9 And I think that that formula, and the fact
10 that we don't have enough consumer representation on
11 some of these boards that are making some of the
12 most important decisions in terms of certificate of
13 need, that should all change.
14 But a 20 percent cut would be catastrophic,
15 considering how our communities of color,
16 specifically with those underlying conditions, we
17 always knew that they deserved more funding.
18 And to cut those services now I think would
19 be such a disservice to every New Yorker, because we
20 see similarities in other cities and towns and
21 villages all over New York State.
22 I hope that answers some of your questions,
23 Assemblymember.
24 ASSEMBLYMEMBER QUART: It does.
25 Thank you, Councilmember.
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1 SENATOR SKOUFIS: Now -- Senator Rivera had
2 to step away for a few moments, so I'll take over on
3 the Senate side, while he -- until he comes back.
4 The only other senator we have so far is
5 Senator Hoylman, for 3 minutes.
6 SENATOR HOYLMAN: Hello. Good morning.
7 Good morning, Councilmember.
8 We share a large part of our district
9 together, as well as proximity to New York's great
10 public hospital, Bellevue.
11 And I wanted to ask you what you knew about
12 the fact that Bellevue was left stranded without
13 PPE. And you and me and other elected officials and
14 volunteers helped bring face masks and gowns.
15 But at the same time, we were hearing that
16 the private hospitals had access to donors, to
17 members of their boards of directors, that,
18 literally, flew private jets to China to pick up PPE
19 for their administrators and staff.
20 Can you confirm that that was the case, as
21 far as you know?
22 And what is your level of outrage at the fact
23 that there was this incredible disparity between our
24 public and private hospitals at the beginning of the
25 pandemic?
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1 CARLINA RIVERA: Well, I think some of my
2 rightful outrage -- thank you for the question --
3 was because, as often as I checked in with our
4 hospital leaders, you know, I -- of course,
5 Northwell, Mount Sinai health systems, every system
6 is important, and we all should be working together.
7 My main concern was with Health and Hospitals
8 because of what was going on in Elmhurst and
9 Woodhull and Lincoln, and some of these areas that
10 were really, really inundated.
11 They would always tell me that they had
12 adequate PPE, but, how we define "adequate" really
13 was left to the discretion of some of those hospital
14 leaders, and some of the, you know, bureaucrats
15 inside the system.
16 And I found it, you know, wholly unacceptable
17 from what we saw, and, you know, what we were trying
18 to work on.
19 And I know the State could certainly expedite
20 this, is our whistleblower protections, because a
21 lot of the people that were inside these hospital
22 systems, if it wasn't for the media, we wouldn't
23 have had a clear picture of how exactly dire the
24 circumstances were.
25 You know, one thing that I did not get to say
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1 in my testimony because of time constraints, was,
2 you know, one thing I think the State can do, is to
3 require the state department of health to review the
4 non-profit status of any hospitals that engage in
5 operations that are more in line with for-profit
6 entities, like -- such as, the provision of
7 ten-figure salaries to executives, massive
8 advertising budgets, and a primary focus on
9 increasing net revenues through increased market
10 share, expansion of the most lucrative patient and
11 health services over necessary, but expensive,
12 low-cost considerations for the local community.
13 So I think we should really take a hard look
14 at that when we saw those disparities there, while
15 we're all struggling to figure out, you know, how
16 to, you know, expand on reforms to the way Medicaid
17 reimbursement and indigent-care funds are
18 distributed to safety-net hospitals.
19 I agree with you, I saw places like Bellevue,
20 but really more like Queens Hospital and places in
21 the outer boroughs, communities of color
22 specifically, that were really, really struggling
23 with everyday PPE.
24 And did it feel good to make those donations?
25 Absolutely.
156
1 But, it was tragic that it came to that, and
2 we couldn't rely on the federal government.
3 And considering the position we're in now,
4 I just think cuts to the system right now would be
5 devastating.
6 And I'm hoping that perhaps the State could
7 look at some of these hospitals that are really
8 operating in this really -- this corporate structure
9 that doesn't seem to be the best definition of
10 "public service."
11 SENATOR HOYLMAN: Thank you.
12 SENATOR SKOUFIS: Does the Assembly have
13 anyone else?
14 ASSEMBLYMEMBER MCDONALD: We do.
15 We have Assemblymember Ron Kim, for
16 3 minutes.
17 ASSEMBLYMEMBER KIM: Well, thank you,
18 Chairman Quart [sic].
19 Councilmember, it's good to see you, and
20 thank you for testifying, and your expertise in this
21 space.
22 Just to continue the conversation about
23 financing, and the distribution of funds to the
24 hospitals:
25 It's my understanding that we received some
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1 federal stimulus money for New York City hospitals.
2 Do you have a better understanding of how
3 that money was distributed; who were the ones that
4 benefited?
5 And did the communities of color in the
6 outer-borough hospitals, did they receive a fair
7 share of this federal funding?
8 CARLINA RIVERA: Thank you for this question.
9 I will say that I -- I'm expecting that
10 they -- there is not necessarily a fair-share
11 formula right now in place on how these moneys are
12 distributed to our hospital systems.
13 What I would also add, is that my number-one
14 challenge since I became chair of Hospitals was
15 really getting the kind of data and information,
16 specifically on -- in terms of the finances for
17 these hospital systems, not just in time for a
18 hearing to ask thoughtful questions of hospital
19 executives, but just generally.
20 It's very, very difficult to get some of this
21 information on finances from our hospital system,
22 including Health and Hospitals, which I have direct
23 oversight over in my chair capacity.
24 So while that type of transparency and
25 accountability has been increasingly difficult, I've
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1 found maybe somewhat of an improvement lately under
2 the tenure of Dr. Katz.
3 But, really, I don't have an idea of how that
4 money was distributed, specifically to answer your
5 question.
6 And I find that, as elected leaders, we
7 certainly deserve that information, because I do not
8 think that they received a fair share.
9 ASSEMBLYMEMBER KIM: And is that a topic that
10 you would be perhaps willing to explore in the city
11 council at another oversight hearing, perhaps?
12 CARLINA RIVERA: Absolutely.
13 You know, I've held a number of budget
14 hearings just to extract this information.
15 You know, and just to give you a quick
16 example, we've even been forced to FOIL some
17 information in the past, which I find ridiculous.
18 But I would certainly love to host another
19 hearing, and share another hearing on this
20 particular topic. And would be happy to have you
21 testify, or even take your questions directly to
22 some of these executives.
23 ASSEMBLYMEMBER KIM: Thank you so much,
24 Councilmember.
25 ASSEMBLYMEMBER MCDONALD: Senator, unless you
159
1 have anybody, we do have Tom Abinanti from the
2 Assembly, for 3 minutes.
3 ASSEMBLYMEMBER ABINATI: Thank you for
4 joining us today.
5 I share your frustration, as a legislator,
6 who is not be always able to get the administration
7 to answer and provide the information that they
8 should.
9 I just want to ask you, if you want to
10 comment at all --
11 I'm sorry I didn't hear all of your
12 testimony. I had another conference call going on
13 at the same time.
14 -- I'm very concerned about the inability of
15 loved ones to see patients in hospitals and other
16 care facilities.
17 Do you have any comments on that?
18 Have you had any complaints about that?
19 Do you face that at all?
20 I'm particularly concerned about people with
21 special needs who get pushed into a hospital, and
22 then they lose contact with the world because
23 they're totally confused.
24 We have had the same kind problem with senior
25 citizens.
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1 Any comments on that?
2 CARLINA RIVERA: Absolutely.
3 You know, we -- under the, I guess, some of
4 the guidance of state legislators, we also put
5 forward a letter, asking for our hospital system to
6 consider something like compassionate-care helpers,
7 which is, especially during COVID-19 and the
8 pandemic, we saw people just being isolated with no
9 advocacy.
10 So trying to put some sort of familial
11 support in the room, someone who can maybe speak the
12 same language, who is culturally humble and
13 understands that some things are harder to express,
14 advocate for or talk through.
15 And so we've certainly been trying to push
16 for a system that allows, again, that familial
17 support with these people who are very, very sick.
18 It's happened with our senior citizens,
19 people who speak English as a second language,
20 people particularly with special needs, and
21 certainly our immigrant community.
22 So when we put forward that letter, and a
23 pilot program was implemented in Health and
24 Hospitals that I believe will potentially become
25 permanent.
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1 It was also looking at some of the guidance,
2 I believe the letter was penned by Lentol in the
3 State House.
4 So, we certainly want to continue that
5 advocacy.
6 I mean, I know I even heard from faith-based
7 and clergy leaders, that they were the only people
8 in the room many times, trying to help that person
9 FaceTime a loved one, which is very, very
10 heartbreaking.
11 So we want to make sure that that situation
12 doesn't happen again in the case of a second wave,
13 or just, you know, throughout the health-services
14 system, ongoing.
15 ASSEMBLYMEMBER ABINATI: Yeah, I had wanted
16 to ask the commissioner, and didn't -- ran out of
17 time because of our limitations here, about, if he
18 had any numbers to show transmission to patients of
19 COVID from visitors.
20 When we're talking about nursing homes, there
21 apparently was, according to the nursing home
22 industry, they only had one documented case where a
23 visitor transmitted COVID to a resident.
24 And I was wondering if there were any numbers
25 with respect to patients getting COVID while they
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1 were in the hospital, and then whether it came from
2 a visitor or somebody on staff.
3 But I don't know that there are any of those
4 numbers out there without, you know, FOILing them,
5 basically.
6 CARLINA RIVERA: Well, thank you for bringing
7 that up.
8 I mean, I've been concerned by the state
9 department of health's lack of transparency and
10 response, certainly to your questions around this
11 over the past few weeks and in your previous
12 hearing.
13 I think the data behind nursing home
14 transfers, particularly to hospitals, and deaths,
15 must be publically released for an independent
16 review.
17 And I think this is -- also, this is an issue
18 that has particularly affected maternal mortality
19 during this crisis.
20 And I want to thank the chairs again for
21 bringing that issue to the forefront and bringing
22 more awareness around it.
23 But I certainly would be interested in that
24 data.
25 I plan to request it. I guess if I have to
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1 FOIL it, I will.
2 And I will certainly be doing a follow-up
3 hearing in my capacity as the chair of Hospitals.
4 We have a couple planned for September.
5 And I would look forward to any testimony,
6 questions, or concerns you have that I might be able
7 to address in the chambers [inaudible].
8 ASSEMBLYMEMBER ABINATI: Thank you.
9 SENATOR SKOUFIS: Anyone else on the Assembly
10 side?
11 ASSEMBLYMEMBER MCDONALD: We're good to go.
12 SENATOR SKOUFIS: Okay.
13 Thank you very much, Assembly --
14 Councilmember.
15 I apologize.
16 Thanks for being here, and your testimony.
17 CARLINA RIVERA: Thanks, everyone.
18 Thank you for your work.
19 ASSEMBLYMEMBER MCDONALD: Thank you.
20 SENATOR SKOUFIS: The next panel that we have
21 is the Healthcare Association of New York State,
22 Bea Grause, president, as well as, Kenneth Raske,
23 who is the president of Greater New York Hospital
24 Association.
25 ASSEMBLYMEMBER GOTTFRIED: Okay. So not to
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1 put any pressure our next few witnesses, just to
2 give people notice --
3 UNKNOWN SPEAKER: Here's the contact info for
4 Arthur Webb.
5 ASSEMBLYMEMBER GOTTFRIED: -- after this
6 panel we will be taking a 10-minute break.
7 But for right now, Bea Grause and Ken Raske,
8 do you both swear or affirm that the testimony
9 you're about to give is true?
10 BEA GRAUSE: Yes.
11 KENNETH RASKE: I do.
12 ASSEMBLYMEMBER GOTTFRIED: Okay. Fire away.
13 BEA GRAUSE: Okay, great. I'll kick it off.
14 Good morning, Chairman Rivera and Gottfried,
15 and to your legislative colleagues.
16 I'm Bea Grause, president of the
17 Healthcare Association of New York State.
18 We represent non-profit and public hospitals,
19 health systems, and continuing-care providers
20 throughout the great state of New York.
21 Thank you for this opportunity.
22 And thank you, the legislature, for your
23 partnership, and thank Governor Cuomo and
24 Commissioner Zucker for their leadership during this
25 incredibly trying time.
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1 But most importantly, I have to thank the
2 health-care workers who have put their patients
3 above all.
4 This pandemic showed the incredible
5 resilience of all New Yorkers, but also of the
6 health-care delivery system.
7 Given the right tools, we demonstrated that
8 we can handle any crisis that comes our way.
9 Every hospital in our state stepped up,
10 urban, rural, large, and small.
11 Everyone faced daunting challenges; shortage
12 of ventilators, PPE, testing kits, ICU and inpatient
13 bed capacity, but all rose to the occasion.
14 They shared services, staff, and supplies,
15 partnered to expand testing in their communities,
16 developed best practices for care delivery, and
17 maximized opportunities, such as telehealth.
18 As the statewide Healthcare Association,
19 HANYS served as a central resource to help hospitals
20 and the State meet the needs of every New York
21 community; it was truly a team effort.
22 Thanks to decisive actions by the governor,
23 the commissioner, and other state leaders,
24 health-care providers were granted flexibility to
25 respond effectively to this crisis.
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1 In light of the successes shown by the
2 temporary modification of laws, regulations, and
3 guidelines, on behalf of my membership, I am asking
4 the State to make some of these changes, such as
5 telehealth, permanent, so that the benefits can be
6 carried forward for all patients in a post-COVID
7 era.
8 We're committed to working with state
9 government and all health-care stakeholders to
10 ensure health-care services remain available to all
11 New Yorkers long after this crisis ends.
12 Our hospitals continue to face very real
13 financial challenges, and we need your continued
14 support.
15 Hospitals and health systems across New York
16 State have incurred major expenses fighting on the
17 front line against COVID-19.
18 An analysis completed for HANYS by
19 Kaufman Hall estimates that, through April 2021,
20 hospitals across the state will have suffered
21 between twenty and twenty-five billion in losses and
22 new expenses; a staggering fiscal impact.
23 While federal funding from the CARES Act has
24 no doubt been helpful, the approximately 9 billion
25 in federal support received through July by New York
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1 hospitals is just a drop in the bucket compared to
2 the financial destruction COVID-19 has left in its
3 wake.
4 New York's hospitals are all not-for-profit
5 and have the lowest operating margins in the
6 country.
7 This shortfall will only exacerbate their
8 already precarious financial situation.
9 Meanwhile, the COVID-19 pandemic has turned
10 what began as a fiscal incertainty earlier this year
11 into a full-blown fiscal crisis in New York.
12 The 2021 enacted state budget contained
13 2.2 billion in health-care cuts.
14 This deficit has grown exponentially since
15 the COVID pandemic.
16 HANYS and all of our members appreciate the
17 governor's calls on the federal government to do its
18 part and provide the State with necessary funds.
19 Without this federal support, our health-care
20 providers could face additional deep cuts at the
21 state level.
22 Additional provider cuts are unthinkable.
23 We cannot let that happen.
24 I want to thank the legislature once more for
25 acknowledging the challenges our hospitals have
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1 faced, and continue to face.
2 Your work during this pandemic has helped
3 support New York's health-care institutions and the
4 dedicated professionals who serve in them.
5 I want to conclude my remarks by expressing
6 again my utmost appreciation to our health-care
7 workers: nurses, doctors, other direct-care
8 providers, and all those who provide essential
9 services, from food service and laundry, to
10 housekeeping and administration.
11 Their sacrifices have changed -- have saved
12 countless lives, and provided compassionate care to
13 those in need and their families.
14 We should all applaud and honor the work, and
15 I know we do.
16 Thank you very much.
17 SENATOR SKOUFIS: Thank you.
18 Mr. Raske.
19 KENNETH RASKE: Well, thank you very much,
20 Mr. Chairman.
21 And thank you, Bea.
22 It's always a pleasure to testify before such
23 a distinguished legislature that we have in New York
24 State.
25 The Greater New York Hospital Association
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1 represents institutions throughout New York State,
2 many in Connecticut, and many in New Jersey, and
3 even as far away as Rhode Island.
4 The common ingredient is, they're all large,
5 complicated facilities.
6 The outline of my presentation has been sent
7 to you. It's mostly a slide presentation. It's
8 separated into two parts:
9 The surge, the largest deployment of
10 health-care resources in the history of the
11 United States.
12 So I want you to know that we're bearing
13 witness on something that is immensely historic in
14 the health-care industry.
15 And the second part, which I'll quickly go
16 through, is the economic consequences, some of which
17 my colleague Bea touched upon.
18 If I could turn you to Panel 5 in the
19 presentation that we have sent to you, you will see
20 the rolling average of the surge in New York.
21 And I compared it for you to what you're
22 hearing and reading about in Florida, Texas, and
23 California.
24 And what you're going see -- what you see, if
25 you take a look at that chart, is that, obviously,
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1 our impact was earlier on, and, therefore, was
2 leading the nation in terms of what we had to find
3 out about this.
4 But as you can see, it's now ramping up in
5 these other parts, but it's not ramping up to the
6 degree that it has in New York.
7 In fact, New York's history here on hospital
8 utilization is actually, substantially, and perhaps
9 more than twice as bad, as it is in Texas, Florida,
10 and California, states which are significantly
11 larger than us.
12 The next panel deals with the coordination
13 among the institutions.
14 Ladies and gentlemen, I have to tell you,
15 I've spent a lot of time in this industry.
16 I have never seen more coordination between
17 hospitals -- among hospitals and with state
18 government.
19 I particularly want to single out state
20 government.
21 Although we've work with government at all
22 levels, state government was spectacular.
23 The leadership of some of the people that you
24 had earlier was amazing.
25 The governor was in a command-and-control
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1 environment.
2 This is under wartime conditions, and we
3 needed a commander-in-chief, and he distinguished
4 the people of the great state of New York with a
5 great deal of aplomb and accomplishment.
6 And I'm proud to be a citizen under him.
7 With respect to the other issues that we
8 have, what you did in order to accomplish this, was
9 to turn the hospital system upside down and inside
10 out.
11 We put beds -- hospital beds in cafeterias.
12 We put them in lobbies. We put them in places we
13 never even dreamed of ever having beds.
14 All of that was done.
15 And Bea's comments about the hospital
16 workers, they are the heros, and I'll never, never
17 forget that, because they put their lives on the
18 line.
19 Let me now turn you to the question of the
20 economics, and we can drill down substantially into
21 this.
22 If you can turn to, I believe it's Panel 18
23 in this presentation, you're going to see, here's
24 the problem:
25 We cut our volume, deliberately, by
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1 eliminating elective surgeries and ambulatory
2 activity.
3 Why?
4 Because we had to move those resources over
5 to the inpatient side.
6 So there was a super-big revenue loss as a
7 result of that.
8 Coupled with that now is, will the patients
9 return?
10 I want you to understand, that a lot of
11 volume has disappeared.
12 It has -- people have moved out of state.
13 The attitudes about going to a hospital have
14 been affected.
15 So we're seeing a decrease in the volume and,
16 therefore, the revenue function.
17 Also included in that, is that the payer mix
18 has changed, and it is becoming more problematic for
19 our institutions.
20 Fewer commercial payments as a result.
21 The transfer to Medicaid because people
22 became unemployed.
23 Again, Medicaid is a underpayer, so, as a
24 result, putting enormous fiscal pressure on our
25 institutions.
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1 And then the prospect that you've been
2 talking about of Medicaid cuts, well, certainly,
3 that is a reality in Washington that state and local
4 financing may not come through.
5 Needed financing that we're lobbying for may
6 not come through.
7 So that is on the horizon.
8 If it wasn't for the federal government,
9 which I know has been chastised here a number of
10 times throughout the morning, the federal government
11 has really stepped up to the plate, initially.
12 It is not going to carry the day totally on
13 this issue, but the great work of Senator Schumer,
14 the fantastic work of the delegation -- the House
15 delegation is absolutely amazing.
16 But here's the bottom line: Every hospital
17 in New York State's going to lose money this year.
18 The question is, how much?
19 Thank you.
20 SENATOR SKOUFIS: Thank you.
21 And we'll kick it off with the Assembly.
22 Assemblyman McDonald.
23 ASSEMBLYMEMBER MCDONALD: Exactly.
24 We'll start with our chair,
25 Chairman Gottfried.
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1 ASSEMBLYMEMBER GOTTFRIED: Yeah, thank you.
2 I have a question for -- well, two questions
3 for either, or both, Bea or Ken.
4 On the question of visiting, and concern
5 about visitors exposing patients to, whatever, seems
6 to me this is not -- while COVID is unprecedented,
7 hospitals have dealt with widespread outbreaks of
8 contagious diseases before, like every flu season.
9 And while flu is not as fatal, or -- and
10 generally not as serious as COVID-19, for many
11 patients it can be a real problem, and yet hospitals
12 don't eliminate visitation during flu season.
13 What kinds of procedures do hospitals
14 generally use to protect patients from infection by
15 visitors and, vice versa, to protect visitors from
16 infection by patients?
17 And what can we learn about that?
18 And, secondly, not so much a question as just
19 a comment:
20 When we talk about the need for Medicaid
21 stepping in to protect our hospitals, and all other
22 financing issues, people really need to recognize
23 that that means taxes, and it means taxing, not the
24 people who work on the floors in your hospitals, but
25 taxing the people who are on your boards of
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1 trustees.
2 But, as a question, I go back to the
3 visitation-and-infection question.
4 BEA GRAUSE: Sure.
5 This is Bea. I'll take a crack at it.
6 And I think, certainly, protecting patients,
7 health-care workers, and visitors is always a top
8 priority, and always has been.
9 You know, that said, I think this pandemic,
10 we are still piloting in the state. Hospitals are
11 still operating under the visitation pilots that
12 were started probably about two months ago. And --
13 you know, and I think we're learning a lot.
14 So we may see some changes.
15 You know, for example, now, if you're going
16 to visit -- and I visited a patient at Albany
17 Medical Center recently. And I think you have to
18 get your temperature taken, you have to attest that
19 you haven't been exposed to patients that have had
20 COVID.
21 So I think that there may be more screening,
22 and, certainly, you have to wear masks and good
23 handwashing. And those practices will not change.
24 But, they may wind up becoming more broad-based,
25 I think, as we learn how to operate in what I'm now
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1 calling a "chronically COVID world."
2 And -- and, again, but I think the goal is
3 the same: It's to protect patients, protect
4 health-care workers, and protect visitors who come
5 into the hospital.
6 KENNETH RASKE: Mr. Chairman, I'll dovetail
7 on that question on visitation.
8 Yes, we did the demo, which was limited
9 visitation, and now have expanded that, and
10 encourage all the hospitals to do the expanded
11 visitation, per the demo that was referenced by Bea
12 in her remarks.
13 So it's limited, but it has the ingredients
14 for the compassion that everybody is looking for in
15 that kind of question.
16 And that's something that is going on
17 currently.
18 With respect to tax policy, I'm not an expert
19 in tax policy, but I can tell you this: That, right
20 now, we are lobbying, ferociously, in Washington for
21 the state and local relief for all the
22 municipalities and states across the United States.
23 Speaker Pelosi addressed our board last week,
24 and we had that privilege of having her join us.
25 And it was something that she and our -- and
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1 Leader Schumer are working diligently on trying to
2 achieve.
3 That will provide the stabilization,
4 hopefully, if it is accomplished for New York State
5 budget.
6 Going forward, I worry about the state of
7 New York, and the prospects on the economy, and
8 continued unemployment.
9 I'm all over this city, I'm all over the
10 downstate area, and I am deeply concerned about the
11 level of employment and the economic recovery.
12 So we're all going to have our hands full,
13 and we're all going to have to row together, in
14 order to pull this state out of what could be a very
15 dire situation economically, post-COVID, as we go
16 forward.
17 ASSEMBLYMEMBER GOTTFRIED: Thank you.
18 SENATOR RIVERA: Assemblymember.
19 And thank you, Senator Skoufis, for kind of
20 pinch-hitting there for me in a bit.
21 I'll actually recognize myself for 5 minutes.
22 Thank you both for being here.
23 I want to ask a similar question, the one
24 I asked Councilmember Rivera, and that is about the
25 disconnect that sometimes exists between the
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1 administration at the state level and the
2 administration at the city level, and how, you know,
3 with all the caveats that we recognize, that they
4 were difficult times, that we were all under triage,
5 et cetera, I want to get your perspective on whether
6 that sometimes clashing communication styles, to be
7 very soft about it, actually might have impacted the
8 services that were actually provided in the city and
9 the hospitals -- the services the hospitals provided
10 to keep people healthy and safe during those times.
11 See if I can get your comments on that,
12 please.
13 KENNETH RASKE: Bea, you want me to start on
14 this one?
15 BEA GRAUSE: Sure. Go ahead. You start, and
16 I'll follow.
17 KENNETH RASKE: Thank you for the question,
18 it's an important question.
19 I could honestly tell you that the level of
20 coordination -- I just touched on it very, very
21 briefly in my oral remarks -- but the amount of
22 coordination between the hospitals, me,
23 specifically, and city hall and state government was
24 a mess.
25 Every day during the week I would be on with
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1 city hall.
2 We had an 8 a.m. call with the deputy mayor
3 in charge of health care, and that is day in and day
4 out.
5 And then we would coordinate what we would
6 know and what they would know, and then what the
7 state government was doing.
8 So I know it wasn't visible to anybody,
9 because it was just one person here, and another
10 person downtown, and another set of persons in
11 Albany, but the level of coordination was
12 astronomical.
13 And what were the subjects?
14 The subjects ranged everywhere, from PPE, to
15 drug shortages.
16 You know, we were talking about ventilators.
17 Ladies and gentlemen, there was a real
18 problem on the drugs that would put -- sedate a
19 patient to go onto a ventilator.
20 So these were wide-ranging subjects that were
21 broached by everybody.
22 And I have to tell you, you know, we were
23 trying to write up lessons learned on all of this,
24 and we have, and that's actually attached, some of
25 it, to our testimony. But the level of coordination
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1 has been phenomenal.
2 And it -- sure, it's a little makeshift, and
3 not necessarily visible to everybody.
4 SENATOR RIVERA: I want to make sure that
5 I give Bea an opportunity as well.
6 And, just, there is -- because there was,
7 particularly, as it refers to guidance, there was --
8 there were -- it seemed that, maybe -- as you said,
9 maybe we weren't seeing it, but to us, many of us on
10 the outside, it looked at times that the
11 administrations were clashing. And that whether it
12 was the mayors -- and this is no secret. Obviously,
13 there have been some, as I said, communication
14 styles might differ, or what have you.
15 But my concern, again, because these hearings
16 are about two things: they're about accountability
17 and forward-looking policy.
18 So how can we best -- so, Bea, I certainly
19 want to get your input here.
20 BEA GRAUSE: Sure. Yes.
21 SENATOR RIVERA: But just to be clear, so
22 what we're looking for is, like, how can we best
23 make sure that this coordination actually functions,
24 to not -- you know, to make sure that people are --
25 you know, are healthy and safe.
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1 Go ahead, Bea.
2 BEA GRAUSE: Yes.
3 Yeah, and I think to build off of what Ken
4 said, we've worked together on lessons learned. And
5 we've been working with the administration and the
6 department of health on -- you know, on the planning
7 for PPE in the fall surge; a lot of that.
8 And we're very forward-looking at this point.
9 You know, and I think in response to the
10 clashing, you know, I think it's important to put it
11 in context.
12 You know, during the two-plus months, from
13 March through May, it was all hands on deck all the
14 time.
15 And, was it perfect communication?
16 I think there was a lot of clarification and
17 redundancy sometimes, or maybe gaps in
18 communication.
19 So there was a lot of phone calling and a lot
20 of back -- you know, checking.
21 And I think that's part of the lessons
22 learned, as we go forward, and think about how to be
23 better prepared, to make sure that we're really
24 clear on communication at the local, state, city,
25 and state -- and state regional level.
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1 So I think -- again, I think there was
2 tremendous, tremendous effort, dedication,
3 collaboration, as Ken said. And -- but we can
4 always do better.
5 And I think that's really what the focus is
6 now.
7 SENATOR RIVERA: Thank you.
8 And in the last 20 seconds I'll just say,
9 just like -- as I said to the commissioner, I want
10 to make sure that there's -- and I know from you
11 folks there's a commitment.
12 I want to make sure that safety-net
13 hospitals, that are the ones that serve the folks
14 that are most at risk, that were most at risk before
15 the crisis, there were some of them in crisis before
16 the crisis, they still are there. Now they're in an
17 even worse situation.
18 Let's make sure we commit all ourselves to
19 make sure that we provide, so that they can continue
20 to exist and serve those communities.
21 BEA GRAUSE: We need federal funding.
22 SENATOR RIVERA: And we need more revenue
23 from the state.
24 [Indiscernible cross-talking.]
25 SENATOR RIVERA: We need more revenue from
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1 the state.
2 BEA GRAUSE: Yep.
3 My time has expired.
4 Assembly.
5 ASSEMBLYMEMBER MCDONALD: My time is on.
6 I will elect to speak for 5 minutes.
7 And, Ken and Bea, thank you both for your
8 testimony, and thank you for your shout-out for all
9 those who are on the front lines caring for
10 individuals.
11 Bea, I guess this question is more directed
12 towards you.
13 You had mentioned appropriately about the
14 fact that we're looking at an exposure of
15 $25 billion, and $9 billion was provided by the
16 federal government.
17 I should know, but I don't, how that was
18 distributed.
19 Do you have any idea how it was distributed
20 amongst your member organizations?
21 BEA GRAUSE: Yes. But it -- you know, and we
22 can certainly provide that to you offline. It's
23 quite complicated, actually.
24 There have been -- oh, gosh, I would say
25 six tranches of distribution in the fund. There's
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1 $52 billion remaining in the fund.
2 But there were hotspot distributions, rural
3 distributions, safety-net distributions, and all
4 formula-driven, somewhat in a black box, I guess
5 I would say, from HHS, in terms of how they made
6 those calculations.
7 But they have done that over time, and are
8 continuing to do that.
9 And, obviously, in the legislation that's
10 pending now before Congress, we are hoping that they
11 add to the Provider Relief Fund so that there are
12 additional dollars to come to New York.
13 ASSEMBLYMEMBER MCDONALD: As you know, and
14 probably as part of your testimony that's written,
15 that I haven't reviewed yet, many members,
16 particularly in the upstate, are lamenting the fact
17 that they feel that there wasn't enough support for
18 them.
19 As you know, with the hospital capacity, our
20 bed-capacity rules, a lot of elective surgeries,
21 which really weren't elective, they were necessary,
22 were put off to the back burner, and lost revenue,
23 which is critical when you look at the operations.
24 And that's my comment.
25 Thank you very much.
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1 Back to you, Senator.
2 SENATOR RIVERA: All righty.
3 Now recognize Senator Tom O'Mara for
4 5 minutes.
5 SENATOR O'MARA: As I'm talking
6 [inaudible] --
7 SENATOR RIVERA: Unmute yourself, sir.
8 You muted yourself.
9 Now you're good.
10 SENATOR O'MARA: I did it twice.
11 Thank you.
12 Thank you both for testifying here today, and
13 I as well want to commend the hospitals across
14 New York State, in their phenomenal response to the
15 needs from this pandemic, and the increase in
16 hospital beds across the state.
17 So thank you for all of that.
18 And with the volunteering of ventilators and
19 other PPEs and other equipment to those hospitals
20 that were stressed, to what extent have ventilators
21 and other equipment that was loaned out, so to
22 speak, been replaced to your hospitals, or have you
23 been reimbursed for those supplies and ventilators
24 that were provided?
25 BEA GRAUSE: They're all back --
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1 SENATOR O'MARA: They're all back?
2 BEA GRAUSE: -- all hospitals.
3 Yep, they're all back.
4 SENATOR O'MARA: You as well, Ken?
5 KENNETH RASKE: Yes, absolutely.
6 SENATOR O'MARA: So they're back.
7 KENNETH RASKE: As far as I can determine.
8 We've done an inventory of serial numbers,
9 and all the rest of that, supplied it back to the
10 State.
11 And, you know, there -- on the ventilator
12 issue, I have to tell you, there's two things I have
13 a quick comment on.
14 Number one is, the coordination between the
15 City, State, and us was phenomenal on the
16 ventilators.
17 You know, the -- Larry Schwartz, former
18 secretary to the governor, a volunteer, did a
19 magnificent job in helping us access ventilators on
20 that basis.
21 But, you know, there are problems.
22 A lot of ventilators came to us without
23 tubing.
24 You'll see in one of the books that
25 Mike Doweling wrote at Northwell, and I'm holding it
187
1 up here, which is probably good reading about
2 handling the pandemic, Mike said, you know, that
3 they had to go out to, basically, hardware stores to
4 get tubes.
5 Well, you know, we did that, and we did
6 makeshift things in order to make things work.
7 So my feeling is, is that this is a story
8 that needs to be told.
9 And recognition for innovation and heroism
10 has gone unrecognized among our colleagues and all
11 of the workers within the hospital community.
12 SENATOR O'MARA: But I certainly recognize
13 the efforts that went into the great work that was
14 done.
15 So I appreciate the work of all the hospitals
16 across the state in what was done.
17 KENNETH RASKE: Thank you, sir.
18 SENATOR O'MARA: Do the hospitals in your
19 associations, are they aware of how many patients
20 that came from nursing homes ultimately died within
21 hospitals?
22 KENNETH RASKE: Bea, do you know if they --
23 I'm not -- I'm sure that we have source of origin,
24 obviously, for the patients that came in.
25 But a statistic that I'm available to, right
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1 now I have no idea.
2 SENATOR O'MARA: Okay.
3 So the state department of health has been
4 not forthcoming with this type of information that
5 has been a critical issue in our review of this.
6 What information do hospitals keep on hand,
7 and what is provided to the department of health, as
8 far as statistics on where a patient comes from?
9 Is it noted that they come from a nursing
10 home?
11 And what records can we request to get that
12 information?
13 KENNETH RASKE: Bea, do you want to try that?
14 BEA GRAUSE: Sure.
15 Well, certainly, hospitals do collect quite a
16 bit of data.
17 I would have to go back and look at the
18 details to understand -- really understand the depth
19 of your question, which I'm happy to do.
20 KENNETH RASKE: Yeah, I don't have -- you
21 know, the problem is, I don't have -- I don't know,
22 either.
23 But the amount of information we have on
24 patients is astronomical.
25 So I would probably guess we would know where
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1 the patients came from, how they came into the ER,
2 point of pickup, and all of that, is somewhere in
3 the level of documentation, sir.
4 So -- but is it readily available to either
5 Bea or me? I don't -- we both say no.
6 BEA GRAUSE: Yeah.
7 SENATOR O'MARA: Okay.
8 But your hospitals report that to the
9 department of health?
10 KENNETH RASKE: I don't know.
11 SENATOR O'MARA: You do not know?
12 KENNETH RASKE: I don't know.
13 SENATOR O'MARA: Okay.
14 Did you -- what have you seen now with your
15 hospitals since the elective surgeries and other
16 procedures have been opened up in the hospitals
17 after they were closed down?
18 They were kind of slow to resume.
19 At what capacity do you think you're seeing
20 now in hospitals, with patients returning for these
21 elective procedures, and whether there's still a
22 general reluctance to go to the hospital for fear of
23 contracting COVID in the facility for those
24 procedures?
25 KENNETH RASKE: You know, that's a great
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1 question. And we just finished a poll, sir, on
2 that.
3 And --
4 SENATOR RIVERA: Quickly, quickly, Ken, since
5 his time has expired. But I'll let you answer. Go
6 ahead.
7 KENNETH RASKE: Okay, well, I'm just trying
8 to answer the question.
9 In our display we have a poll of attitudes of
10 New Yorkers.
11 This is a -- 1200 people were polled across
12 New York State. 800 in the downstate area, so
13 oversampled there.
14 And we asked the question about your attitude
15 towards being hospitalized, or going to a hospital,
16 going to a doctor.
17 If you take a look at Panel 19, you will see
18 that the remarkable results, and this has changed
19 over a period of time, on the --
20 SENATOR RIVERA: We will do, we will do that,
21 on page 19 in the document that we have all
22 received.
23 We just have to make sure we move on, Ken.
24 Sorry about that.
25 Assembly.
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1 ASSEMBLYMEMBER MCDONALD: We will move on to
2 Ranker Kevin Byrne for 5 minutes.
3 ASSEMBLYMEMBER BYRNE: Thank you.
4 And thank you for being here to provide your
5 testimony this afternoon.
6 A couple questions, just to follow up on
7 Senator O'Mara a little bit.
8 Did you find that the nursing home admissions
9 to any of your hospitals, or your members, was a
10 significant challenge, factor, in staffing capacity,
11 or severity in the response to the pandemic?
12 BEA GRAUSE: No.
13 It would be no.
14 I mean, I think our hospitals were equipped
15 24/7 under any circumstances to care for any
16 patients.
17 So, admitting patients from nursing homes was
18 just part of what they do.
19 KENNETH RASKE: Yeah, I would only say that,
20 you know, the staffing issue, it warrants a
21 considerable amount of attention.
22 Again, I have a whole paper, which is
23 attached to our testimony, on staffing issues.
24 But we -- we -- during the height of the
25 epidemic, and the pandemic, we were stretched very
192
1 thin.
2 Ladies and gentlemen, I want you to note,
3 everything has a breaking point.
4 And if you take a look at the uptake of the
5 pandemic in New York State, and match that against
6 Florida and California and all those other places,
7 we were probably within 5 to 7 percent of the
8 breaking point.
9 So, sir, to the question: What does the
10 "breaking point" mean?
11 "Breaking point" means, literally, you put
12 people in the hallways.
13 That's what it could mean.
14 Does it is mean you triage people going out
15 to vents? In other words, you're making
16 life-and-death decision about who is going to go on
17 a ventilator?
18 That's how close it came in relationship to
19 this, and the key here was the staff.
20 Did we have enough staff at the height?
21 Yes, but, if we pushed it, we could have hit
22 a breaking point.
23 And that is the hard, cold reality of what
24 went on here.
25 And that's including the 12,000 or
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1 13,000 people that came in through the State's great
2 efforts. People came in from all over the
3 United States to help us out.
4 And you know what?
5 It wasn't enough even as we approached the
6 worst point.
7 ASSEMBLYMEMBER BYRNE: Thank you for those
8 comments, and I can definitely relate.
9 I represent Westchester County as part of my
10 district.
11 And Westchester, and specifically
12 New York City, those hospitals, I could tell, just
13 anecdotally, speaking to staff and folks that
14 I know, they were very, very stressed.
15 And I commend you and your members for all
16 the work, and your staff, for what they've done
17 throughout this pandemic.
18 Senator O'Mara asked about numbers and data.
19 So I'm not sure exactly, and I understand you
20 may not know exactly what was reported to the
21 department of health.
22 But if you were asked by the department of
23 health, or perhaps the legislature, do you believe
24 you could provide numbers as to the fatalities that
25 occurred in hospitals, and where they came from,
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1 including if they had occurred -- they came in from
2 nursing homes?
3 Is that something you could provide if asked?
4 BEA GRAUSE: Didn't Commissioner Zucker say
5 that, I think, at the end of the pandemic, that he
6 would provide more data?
7 We certainly are willing to take a look at
8 what data we can compile, and provide that.
9 But I think the commissioner said that he
10 would be doing it.
11 KENNETH RASKE: You know, my staff -- my
12 staff gave me a note here, sir, to that question.
13 They said, I'll read it to you, but I have no
14 idea if this is true or not.
15 But, ultimately, reported by hospitals in
16 SPARCS claims data, but there is a time delay.
17 BEA GRAUSE: Yeah.
18 KENNETH RASKE: I don't know what that time
19 delay is.
20 That's what our staff says here in New York.
21 ASSEMBLYMEMBER BYRNE: Certainly not real
22 time.
23 KENNETH RASKE: Not real time.
24 ASSEMBLYMEMBER BYRNE: And I agree with the
25 comments you referenced from the commissioner.
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1 I'm just -- I want to make sure this is
2 something that we can ultimately access. And if
3 it's -- if we're going through all these hoops and
4 hurdles with the department, if this is something
5 that maybe -- you know, we want to make sure it
6 exists, and that we can obtain this information, to
7 get a complete picture, so we can craft better
8 policies and just do the best job that we can.
9 A question about, just regulations in
10 general.
11 A lot of things may have been suspended
12 through executive orders, directives, as a way to
13 increase hospital capacity.
14 It was a question I asked the commissioner
15 earlier, and this is kind of an open-ended question
16 for any of you.
17 If there are things -- I know, obviously,
18 funding is a big piece that we've heard about,
19 federal and state support.
20 But is there any other regulations or
21 restrictions from the State that could be revisited,
22 to increase hospital capacity and allow to you care
23 for more patients?
24 BEA GRAUSE: Yeah, I think, generally,
25 flexibility, as a principle, is really, really
196
1 important. And I think we learned that during the
2 pandemic.
3 I think, in particular, any permits for, you
4 know, certificate of need.
5 All of the changes that happened with
6 telemedicine, which our members were amazing in how
7 quickly they stood up telemedicine centers, and
8 really started transitioning over to telehealth
9 appointments, everything, from pediatrics to
10 psychiatry.
11 So I think that kind of flexibility, and
12 being innovative, regulations that allow innovation,
13 is something that we'd like to see more of --
14 SENATOR RIVERA: Thank you so much.
15 BEA GRAUSE: -- and have more of a
16 [indiscernible] conversation about that.
17 SENATOR RIVERA: Thank you, Ms. Grause.
18 Thank you, Assemblymember.
19 Currently, there are no senators on deck.
20 ASSEMBLYMEMBER MCDONALD: And we have two
21 assemblymembers.
22 And we will to go Ranker Brian Manktelow.
23 ASSEMBLYMEMBER MANKTELOW: Thank you.
24 Ken, just a quick couple questions for you.
25 I was looking at your teetering point there,
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1 financially, for the hospitals.
2 KENNETH RASKE: Uh-huh?
3 ASSEMBLYMEMBER MANKTELOW: And being a
4 business -- former business owner, and farmer, and
5 understanding money and budgets, you know, we know
6 that cost [indiscernible] are going to go up.
7 We know that; we know it's going to happen.
8 We know that the revenues are going to be,
9 you know, down; the volume, the payer mix, the
10 Medicaid.
11 What are some things we can do here in
12 New York State -- let's leave the federal government
13 out of it, let's just talk about New York State --
14 what are some of the things that we can do to help
15 our local hospitals, especially in our rural areas
16 where the numbers are going to go down.
17 You know, we have people leaving this state
18 in droves, and those are part of that payer mix.
19 They pay a lot of the bills, these people that are
20 leaving.
21 And what can we do legislatively, or, just in
22 general, in New York State to help us get over this
23 hurdle?
24 It's coming, it's going to be a big hurdle.
25 KENNETH RASKE: Yeah, you know, thank you,
198
1 sir, for the question.
2 That really requires a very studious answer
3 on my part, and I would be more than happy to make a
4 listing of suggestions, which we can get to the
5 respective chairs and co-chairs, as well as the
6 things that can be done.
7 Right now, we're only beginning to see the
8 breadth and depth of the potential problem, and our
9 hospitals have to cope with it immediately, sir, as
10 a business -- as a business.
11 And this doesn't make any difference, whether
12 it's public or private hospitals, we're going to
13 have to cut costs. We're going to have to get costs
14 out of the cost structure of our institutions.
15 And I'm desperately worried about how best to
16 do that at this particular time.
17 And -- and -- and -- and if I could find a
18 way to make recommendations to the New York State
19 Legislature and Executive Branch of how best to do
20 that, and help us, I will do that.
21 And I promise to you, I will get that to you
22 at this point.
23 But, right now, I know that some of our
24 hospitals are contemplating layoffs.
25 Now, can you think of the conundrum that
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1 we're in?
2 We just asked our staff to do heroic things,
3 and now we're going to turn around -- because our
4 revenues have collapsed, and we're going to turn
5 around and send out a layoff notice?
6 How terrible is that?
7 How terrible is that?
8 And -- and -- but, the balance, the revenue,
9 and you all have to understand this, the revenue is
10 collapsing.
11 And will that mean -- and I'm going to go
12 right to the point: What does that drive to?
13 And, Chairman Rivera, you asked the point
14 about safety-net institutions.
15 They're on the bubble.
16 David Pearlstein is going to follow us.
17 Right? David runs St. Barnabas Hospital.
18 He does a super job under a tremendously
19 difficult situation.
20 And we are facing a growing crisis, and that
21 is unfolding at this point.
22 How fast we get the patient base back, how
23 fast we get the payer mix back, what relief we get
24 from Washington -- question mark, question mark,
25 question mark.
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1 I don't have any great answers, sir, to the
2 question.
3 You asked.
4 I will try to help -- I'll try to figure out
5 ways that we can send you some meaningful
6 suggestions on how best to get costs out of the
7 health-care system without damaging our health-care
8 services.
9 I will do that.
10 ASSEMBLYMEMBER MANKTELOW: And I think that's
11 why, through this pandemic, we, as legislators,
12 especially in the rural upstate areas and up north,
13 you know, we should have took a different approach
14 with the hospitals, because some of our rural, rural
15 counties, we just didn't have the volume of COVID
16 patients.
17 We should have allowed some of those
18 hospitals to possibly operate, very carefully, with
19 other -- you know, with other areas of the state to
20 make sure that happens.
21 And sometimes, again, New York State, one
22 size fits all, doesn't work.
23 I feel so sorry for the hospitals, the staff,
24 and the patients in the New York City area. They
25 were just deluged with what was going on.
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1 But that's where we need to work together
2 with the other parts of the state, and making sure
3 that we, as legislators, Senate and Assembly, are
4 engaged with our governor, to let him know that we
5 are -- we can be open because we don't have the pure
6 volumes.
7 And this is going to affect all of New York
8 State.
9 And I don't want to see one hospital close,
10 I don't want to see one -- one person get laid off,
11 because they were the front-line units that were
12 taking care of all of our people during the
13 pandemic.
14 KENNETH RASKE: Absolutely, I'm with you,
15 I don't want to see one person laid off, too.
16 ASSEMBLYMEMBER MANKTELOW: So, get me that
17 information, and I would love to take a look at it.
18 And I would love to get back to you, and talk about
19 that in the near future.
20 Thank you.
21 KENNETH RASKE: Yes, sir.
22 BEA GRAUSE: And I'd like to add, that our
23 hospitals are our economic engines in many of these
24 rural communities.
25 And I think providing them with regulatory
202
1 relief, but, also, looking for ways to help ingrain
2 the hospital, really, more as part of the community
3 in terms of goods and services that can be provided
4 to the hospital, and then back again into the
5 community, I think is one way to promote economic
6 development upstate.
7 SENATOR RIVERA: Thank you, Ms. Grause.
8 BEA GRAUSE: I think it's something we should
9 double-down on.
10 SENATOR RIVERA: Thank you, Ms. Grause.
11 Thank you, Assemblymember.
12 Next I'll recognize Senator Skoufis for
13 5 minutes.
14 SENATOR SKOUFIS: Thank you very much.
15 And thanks to you both.
16 As some of my colleagues have noted, I want
17 to really applaud and acknowledge your members.
18 In my area, St. Luke's Cornwall,
19 Orange Regional, did phenomenal work over the past
20 five months, among others, and really nimble work.
21 Right?
22 I mean, it seemed like, every day, hospitals
23 needed to respond to a new directive, new guidance,
24 new circumstances, and in previously unthinkable
25 situations.
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1 So thanks to you and your members.
2 To that point, as we try and assess the past
3 five months, and look at, you know, perhaps some
4 things that are now in place that weren't in place
5 before, that may be worth keeping in place, can you
6 speak to, maybe, some lessons learned, some --
7 either through directives or through guidance or
8 through just voluntarily doing things differently
9 yourselves?
10 What are some things that have been changed
11 internally with your members these past five months
12 that are worth keeping around permanently?
13 Similarly, is there a directive or two, is
14 there some sort of State action, that you think --
15 and hindsight is 20/20 -- but that you think, you
16 know, should have been reconsider -- or, should be
17 reconsidered if there is a next wave or a next
18 pandemic?
19 So if you can maybe pick one or two items
20 from each of those lists, and briefly share, so that
21 we, as a legislature, can sort of get that guidance
22 from you as we move forward.
23 BEA GRAUSE: Sure.
24 I'll kick this one off, and then kick it over
25 to Ken.
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1 I think as Ken and I have both said, I think
2 our very talented teams have done a lot of work,
3 talking to our members, where we have identified
4 lists of lessons learned, and things that we want to
5 continue to make the system better.
6 And a lot of those revolve around clarifying
7 roles, improving communication.
8 Obviously, you know, focusing on a potential
9 surge, and figuring out how to, you know, stockpile
10 PPE.
11 A lot of workforce issues, in, you know,
12 sharing staff, and a whole host of patient-care
13 issues, I think that we can address to make sure
14 that we are even more flexible, more nimble, and
15 more collaborative when and if the next pandemic
16 comes to New York State.
17 So we have -- we have done that work.
18 We're happy to share that with you.
19 And so --
20 SENATOR SKOUFIS: Please do.
21 I would love to see that list that you're
22 referencing of lessons learned.
23 And is there one or two -- are there one or
24 two State actions that you wish were handed down a
25 little bit differently?
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1 BEA GRAUSE: I can't think of anything off
2 the top of my head.
3 Maybe if Ken comes up with one, I'll chime
4 in. But, I'll turn it over to Ken.
5 KENNETH RASKE: Well, thank you, Bea.
6 I can't think of any, either.
7 Attached to my testimony is patient-load
8 reduction.
9 It was an earlier question that was asked,
10 I think of a number of panelists as well.
11 And if you go into that document, it deals
12 with, how do you best take care of the situations
13 that we were confronting within a hospital system,
14 and then from one hospital system to another?
15 We have a data mechanism in New York that we
16 put together called "SitStat," which has a way of
17 working with the EMS people, who are terrific to
18 work with, and how to balance these EMS ambulances
19 going to institutions that are overloaded with -- in
20 their ED, and how to redirect them to other
21 institutions.
22 And that's some of the suggestions that we
23 have.
24 But as it relates, sir, to the question,
25 State action? I can't think of any at this
206
1 particular point.
2 So I would join with my colleague Bea and say
3 that, we'll ask our staffs, and I'm sure they
4 probably are smarter than we are, to come up with
5 suggestions, and we'll get them to you, sir.
6 SENATOR SKOUFIS: Very good.
7 Hey, thank you; thank you both.
8 SENATOR RIVERA: All right.
9 Thank you.
10 Assembly.
11 ASSEMBLYMEMBER MCDONALD: Ron Kim, 3 minutes.
12 ASSEMBLYMEMBER KIM: Thank you.
13 So I understand that, during this pandemic,
14 especially in March and April when everyone was
15 scrambling, many health-care facilities called on
16 groups like yours to help with PPE supply.
17 Did your organizations allocate funds to
18 purchase and distribute PPE to your members?
19 KENNETH RASKE: Well, that's an
20 interesting -- you know, there's --
21 BEA GRAUSE: I'm sorry. I didn't hear the
22 question.
23 ASSEMBLYMEMBER KIM: Did you purchase and
24 distribute PPE to your members, you know, when
25 things were rough back in March and April?
207
1 BEA GRAUSE: We did receive federal funds
2 that we used, that our members -- that we passed
3 through to our members, that our members used to
4 purchase PPE.
5 ASSEMBLYMEMBER KIM: But not directly from
6 your association funds?
7 BEA GRAUSE: No.
8 ASSEMBLYMEMBER KIM: No.
9 BEA GRAUSE: We did not.
10 KENNETH RASKE: You know, that's a very
11 interesting question.
12 We just sold -- Greater New York has a number
13 of for-profit businesses, and one of the businesses
14 we sold was a consulting firm to a national group
15 called Premier, Inc. And they have -- they do
16 purchasing, sir, for 2500 hospitals across the
17 United States.
18 So we maintained a significant informal
19 relationship with that group, to assist our
20 hospitals. And they ended up -- for all practical
21 purposes, they ended up providing services to about
22 70 percent of the hospitals in New York State.
23 ASSEMBLYMEMBER KIM: Thank you, Ken.
24 Well, the public records do show that your
25 associations did allocate nearly $500,000 during
208
1 this pandemic toward political contributions in
2 Albany, which is nearly double the amount from 2018
3 around the same cycle.
4 No one in this hearing or the people
5 listening in is naive about how political
6 contributions provide access, you know, to co-create
7 policies and regulations.
8 You know, for example, on April 2nd, the
9 Greater New York Hospital sent out a press release
10 about how you successfully drafted and passed a
11 broader legal immunity law that retroactively covers
12 non-COVID cases, and also protects hospital CEOs,
13 board members, et cetera.
14 Besides the legal immunity law, did your
15 associations draft or lobby any other policies,
16 regulations, or even executive orders, during the
17 peak of this crisis?
18 KENNETH RASKE: Sir --
19 BEA GRAUSE: [Indiscernible cross-talking] --
20 KENNETH RASKE: Bea, let me answer that
21 question because this is more directed at me than at
22 you.
23 The -- the -- first, let me clarify one
24 thing.
25 We spent $8 1/2 million, sir, on an ad
209
1 campaign to allay the fears of New York public to go
2 back to the hospital.
3 So, that number, and that is attached in our
4 testimony today, so you can see that.
5 So political contributions are small in
6 comparison to the public-service messages we put
7 forward.
8 That's one.
9 Number two, I want to be perfectly clear to
10 you, the following: That we lobbied extensively for
11 the immunity law, and I'm proud to have done it, and
12 continue to do it right now in Washington as it
13 relates to the federal level.
14 But, when you say that we wrote the law,
15 that's not true.
16 And let me do this clarification --
17 SENATOR RIVERA: Very quickly, sir.
18 KENNETH RASKE: -- on the record, under oath.
19 I want to do this, because I have to.
20 SENATOR RIVERA: Go ahead.
21 KENNETH RASKE: And -- and -- and what we
22 have done was the following:
23 We gave a draft to the executive branch of
24 some ideas to be included.
25 We share drafts of legislation with many of
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1 you on a routine basis in the Assembly and the
2 Senate, and in Congress, and in the executive.
3 That's nothing new.
4 So we did that.
5 Was that draft ultimately different than the
6 law?
7 Yes, and materially different.
8 So we did not draft the law.
9 So as a result -- but we had a memo, and this
10 is what you're referencing, sir, and I appreciate
11 for you bringing it to the public's attention, we
12 had a memo which we [indiscernible cross-talking]
13 that issue.
14 And I went on the record with my board last
15 week and made that clarification.
16 And now that [indiscernible cross-talking] --
17 SENATOR RIVERA: Thank you, Mr. Raske.
18 Thank you, Assemblymember.
19 I want to make sure we -- we have a
20 senator on deck.
21 I recognize Senator Biaggi for 3 minutes.
22 SENATOR BIAGGI: Thank you very much,
23 Mr. Chair.
24 Thank you both for being here to testify with
25 us today.
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1 My question actually piggybacked off of
2 Assemblymember Kim's.
3 So now that we're all in the realm of
4 immunity, and to your point, Mr. Raske, that you
5 have -- you provide, historically, drafts of
6 legislation to legislators, as well as others, is it
7 fair to say that you provided a draft of the
8 immunity provision to the executive branch?
9 KENNETH RASKE: I just said that.
10 Yes.
11 BEA GRAUSE: And we did, too.
12 SENATOR BIAGGI: I'm making it clear: Did you
13 also provide the draft to the department of health
14 commissioner?
15 KENNETH RASKE: Oh, I don't know about that.
16 We gave it to the executive branch.
17 I don't remember ever giving it to the DOH.
18 SENATOR BIAGGI: Have you had any
19 communications, prior to the passage of the budget,
20 with regard to the immunity provision with the
21 department of health commissioner?
22 KENNETH RASKE: Could you repeat the
23 question?
24 SENATOR BIAGGI: Did you have any
25 conversations with regard to the immunity provision,
212
1 prior to the passage of the budget, with the
2 department of health commissioner?
3 KENNETH RASKE: Well, you know, our legal
4 counsel was in contact with legal counsel of the
5 executive branch.
6 I don't know what that all transpired in
7 terms of discussions.
8 So she was the one that would have had any
9 discussions at all.
10 As it relates to me, I don't have discussions
11 about that, that level detail.
12 SENATOR BIAGGI: So then we will follow up on
13 that, to determine whether communications were
14 actually made, and that will be part of the 21-day
15 follow-up questioning that will come from me.
16 KENNETH RASKE: Yeah, I can -- well, she's
17 actually in the room. I mean, you know, I'll ask
18 her.
19 I don't know.
20 SENATOR BIAGGI: Okay, very good.
21 Thank you.
22 And just to be super-clear, the press release
23 that Assemblymember Kim is referring to, that was
24 later deleted by Greater New York Health, actually
25 stated, quote, That Greater New York Health drafted,
213
1 and aggressively advocated, for the legislation.
2 But you have just stated that
3 Greater New York Health did not actually draft the
4 legislation.
5 So, which one of these statements is true?
6 KENNETH RASKE: No, I -- I'm going to be very
7 clear:
8 We gave the executive branch a draft of
9 legislation -- okay? -- a provision.
10 That draft is not what was the final law.
11 It was extensively changed and increased in
12 terms of breadth.
13 So to say that we drafted it would be wrong.
14 However --
15 SENATOR BIAGGI: Okay. So the [indiscernible
16 cross-talking] --
17 KENNETH RASKE: However, what you're
18 referencing was a member's letter that was sent out,
19 which reflected a misstatement on our part, of that.
20 We should have just simply said --
21 SENATOR BIAGGI: Okay. Thank you for
22 clarifying that.
23 KENNETH RASKE: -- we gave them a draft --
24 SENATOR BIAGGI: I just have 30 seconds left,
25 I just want to ask this final question because it's
214
1 very important.
2 I appreciate you answering that question.
3 So, just throughout the conversation here
4 with all of the other members, there's a real
5 emphasis on a budget deficit.
6 And so, you know, the state is obviously
7 deeply dependent on revenue.
8 And without a clear indication of whether
9 Washington is going to provide aid to localities and
10 municipalities, what exactly do you believe the best
11 plan is?
12 And, do you believe we should be raising
13 revenue in the state of New York to make sure that
14 we deal with this budget shortfall?
15 KENNETH RASKE: Bea, do you want to try that
16 first?
17 BEA GRAUSE: No, I -- I think that we don't
18 have the ability to close a deficit without federal
19 revenue.
20 So I think we have to wait for that first,
21 and really work together to see if we can get
22 Congress to act.
23 SENATOR RIVERA: Thank you, Senator.
24 SENATOR BIAGGI: That doesn't answer the
25 question --
215
1 Thank you very much.
2 SENATOR RIVERA: Thank you, Senator.
3 Assembly.
4 ASSEMBLYMEMBER MCDONALD: We have
5 Assemblymember Andrew Garbarino.
6 ASSEMBLYMEMBER GARBARINO: Thank you.
7 Thank you, Chairman.
8 Thank you both for testifying today.
9 I just had two questions.
10 You both briefly spoke about fiscal stress
11 from COVID in your testimony, due to, I think, the
12 cost of PPE and loss of elective surgeries.
13 Is there anything currently now that your
14 members aren't allowed to do, due to government
15 intervention, that you think you guys can do safely?
16 You know, like, I know you can do elective
17 surgeries again.
18 Is there anything else that the State is
19 stopping you from being able to do to help -- to
20 help you guys get funding in?
21 BEA GRAUSE: This is Bea.
22 I don't think the State is preventing, you
23 know, services, or anything from -- that are -- that
24 is preventing hospitals from generating revenue.
25 I think we are just hoping to get relief
216
1 funding from the federal government.
2 But the State is not standing in the way, as
3 far as I'm aware of.
4 You know, we're certainly working with the
5 State to comply with regulations around planning for
6 a fall surge. And that is taking up some bandwidth
7 in hospitals, but it's not -- but it's not
8 preventing them from operations.
9 KENNETH RASKE: Well, I would say, Bea, on
10 that score, what we do with the State is partner.
11 BEA GRAUSE: Yeah.
12 KENNETH RASKE: We are preparing for a second
13 wave, make no mistake.
14 We're making sure that we have enough PPE, we
15 have enough drugs, we have enough equipment, and so
16 forth and so on.
17 And I'm worried about the mental-health
18 status of our employees on top of it. They have
19 been under great stress.
20 And, you know, we're working with a number of
21 organizations, DoD, the AMA, to try to figure out
22 ways to help relieve their stress levels.
23 But at this particular time, I don't see that
24 the State of New York is an impediment to anything.
25 I treat them as a partner, a full-fledged partner,
217
1 all the way.
2 ASSEMBLYMEMBER GARBARINO: Great.
3 And just another one.
4 During the crisis high point, we changed --
5 the Javits Center was changed to COVID-only.
6 Do your members believe that they -- if there
7 is a second phase and an uptick, do your members
8 believe that they should be the first stop for COVID
9 patients, or should we directly go to a COVID-only
10 field hospital?
11 Do your members believe they're preparing
12 enough and they'll be able to handle the uptick --
13 KENNETH RASKE: Remember, the Javits and the
14 "Comfort," both, were, basically, nothing more than
15 safety belts.
16 And I think the commissioner remarked, you
17 know, they also had prepared, but we didn't use,
18 Westchester, and there was a number of places out on
19 the island as well.
20 These were all to be safety belts in case we
21 got to the breaking point that we were -- that
22 I referenced earlier.
23 But, also, the "Comfort" was not going to
24 take COVID patients initially.
25 ASSEMBLYMEMBER GARBARINO: No, yeah, I know,
218
1 but --
2 KENNETH RASKE: And that was a Department of
3 Defense decision.
4 And my guess is, you know why? They didn't
5 want to have the sailors get infected, and,
6 therefore, reinfect others across in the U.S. Navy.
7 So, I mean -- but --
8 ASSEMBLYMEMBER GARBARINO: You guys should be
9 the first stop, though, is what I'm saying?
10 KENNETH RASKE: The hospitals, clearly.
11 [Indiscernible cross-talking.]
12 KENNETH RASKE: Even on the "Comfort," they
13 were not equipped to do isolation.
14 ASSEMBLYMEMBER GARBARINO: That's
15 [indiscernible cross-talking] --
16 SENATOR RIVERA: Thank you, Mr. Raske.
17 Thank you, Assemblymember.
18 ASSEMBLYMEMBER GARBARINO: Thank you very
19 much.
20 SENATOR RIVERA: Thank you, Assemblymember.
21 Currently, no members of the Senate to ask
22 questions.
23 ASSEMBLYMEMBER MCDONALD: And we're clear on
24 the Assembly.
25 SENATOR RIVERA: I believe -- actually,
219
1 I believe that Assemblymember Quart might have
2 raised his hand at some point?
3 ASSEMBLYMEMBER MCDONALD: And he lowered it.
4 SENATOR RIVERA: Did he?
5 ASSEMBLYMEMBER MCDONALD: He lowered it.
6 SENATOR RIVERA: Oh, he lowered it?
7 ASSEMBLYMEMBER MCDONALD: We verified that,
8 yep, we verified that.
9 SENATOR RIVERA: Very well.
10 All right.
11 So with that, I will thank both of you for
12 being part of these hearings. And we might have
13 some follow-up questions for you, that we
14 [indiscernible cross-talking] --
15 KENNETH RASKE: Yes, [indiscernible
16 cross-talking] --
17 BEA GRAUSE: Absolutely.
18 SENATOR RIVERA: Thank you both.
19 Thank you, Senator, and thanks to the
20 legislature.
21 KENNETH RASKE: Thanks very much.
22 SENATOR RIVERA: Thank you, both.
23 Moving on to Panel Number-- oh, actually, I'm
24 sorry.
25 We had talked about this before.
220
1 We will take our first 10-minute break for
2 the sandwiching and the toileting, not at the same
3 time.
4 10 minutes, ladies and gentlemen.
5 Thank you.
6 (A recess commences.)
7 (The hearing resumes.)
8 SENATOR RIVERA: Welcome back, everyone.
9 We will now be moving on to Panel Number 4.
10 We are joined by Veronica Turner-Biggs,
11 executive vice president of SEIU 1199, who will
12 split her time with Arelda [ph.] Arleda [ph.] Moore,
13 who's an environmental service worker, from the
14 Garnet Health Medical Center.
15 We are also joined by David Van de Carr,
16 1199 member, and a respiratory therapist at
17 Mount Sinai Morningside.
18 And, last, but not least,
19 Judy Sheridan-Gonzalez, a registered nurse, and the
20 president of the New York State Nurses Association.
21 ASSEMBLYMEMBER GOTTFRIED: Okay.
22 And do each of you swear or affirm that the
23 testimony you are about to give is true?
24 VERONICA TURNER-BIGGS: I do.
25 DAVID VAN de CARR: Yes, I do.
221
1 JUDY SHERIDAN-GONZALEZ: I do.
2 ASSEMBLYMEMBER GOTTFRIED: Okay. Fire away.
3 SENATOR RIVERA: Thank you, sir.
4 Veronica Turner-Biggs.
5 Ms. Turner-Biggs, go ahead.
6 VERONICA TURNER-BIGGS: Thank you.
7 Good afternoon.
8 I am the downstate health systems senior
9 executive vice president for 1199, United Healthcare
10 Workers East, leading our work with over
11 100,000 health-care workers in hospitals in New York
12 and Long Island.
13 I appreciate the opportunity to speak to you
14 all today, and appreciate the opportunities that you
15 are granting to allow our members to speak directly
16 to you.
17 1199 hospital members do everything, from
18 advanced critical care, to keeping facilities clean.
19 They include nurses, dietary aides, environmental
20 service workers, medical assistants, and laboratory
21 technicians, as well as a whole host of other roles
22 that provide compassionate care, and keep patients
23 safe, and they were on the front line of this
24 pandemic.
25 Our members were sick, and some still are.
222
1 They face tremendous fear and anxiety, and
2 had experiences that left lasting trauma.
3 Many suffered financial hardship, as they
4 spent their own money to stay in hotels and take
5 cabs to work to keep their families safe.
6 Some members and members of their families
7 passed away, including a number of our union
8 delegate leaders.
9 As you probably know, just as in the general
10 population, workers of color were disproportionately
11 affected by the pandemic.
12 These essential workers are heroes, and the
13 routine nature of their work exposes them to illness
14 and disease.
15 But we should never again -- we should never
16 again -- tolerate workers entering a hospital
17 without the tools to keep patients and themselves
18 safe.
19 We've heard the stories about PPE shortages
20 and shifting guidance, which undermined worker
21 safety, but there are other parts to this story.
22 Within hospitals there were often a hierarchy
23 of access to PPE, particularly with N95 masks.
24 Bedside clinicians were the priority, while
25 ancillary staff, who also had patient contact, often
223
1 did not receive N95.
2 And among hospitals, there was also a
3 hierarchy of access, with Manhattan hospitals having
4 better access to PPE compared to the outer boroughs.
5 These are just some of the challenges members
6 faced during the pandemic, but we must also
7 recognize how hospitals and hospital systems
8 collaborated with and supported their workforce
9 during such a challenging crisis.
10 Our union is reflecting on what happened.
11 And as we've begun to capture the COVID-19
12 best practices, fortunately, it is a long list, and
13 they fall into a couple of broad categories that
14 include:
15 Early identification and communication about
16 patients and staff who may be exposed;
17 Accessing stockpiling, and training all staff
18 with PPE;
19 Collaboration and communication with labor
20 partners at all levels, and focus on
21 problem-solving, including daily reporting;
22 Attention to the full range of support that
23 workers need to do their jobs in an unprecedented
24 environment of school closures, questions about the
25 safety of mass transit, and the real potential of
224
1 bringing a deadly infection home from work.
2 This pandemic has really tested our hospitals
3 and state's ability to respond to an emergency of
4 this breadth and scale.
5 Rank-and-file hospital workers, among others,
6 responded to the challenge heroically, and at great
7 personal sacrifice.
8 We must honor their dedication by learning
9 the hard lessons from their experience and
10 dedicating the resources needed to enact change.
11 You are now going to hear from two of our
12 member leaders, and you have my full testimony.
13 Thank you.
14 SENATOR RIVERA: Thank you, ma'am.
15 And we are now going to be joined by
16 Arelda Moore -- Arleda [ph.] -- Arleda Moore.
17 Apologies.
18 It's Arleda, or Arelda?
19 ARDELA MOORE: Ardela.
20 SENATOR RIVERA: Arleda [sic] Moore.
21 ARDELA MOORE: I'm Ardela Moore. I work at
22 Garnet Hospital in Middletown, New York. I'm an EVS
23 worker. Essentially, my job is to clean up behind
24 everything.
25 The discharging of the patients, the
225
1 COVID-19, it really impacted us.
2 We were the ones that suffered the most as
3 far as the PPE, where we were the last ones on the
4 totem pole. They didn't stock any of the PPE that
5 we needed to take care of the cleaning and the daily
6 needs of the nurses.
7 Any part of the hospital that needed to be
8 cleaned, that was considered COVID. We needed
9 everything, and it was a fight to get what we
10 needed.
11 The hospital overlooked everything that we
12 wanted to keep ourselves safe. They were worried
13 about the nurses, the doctors, respiratory, you
14 know, the higher-ups in our hospitals [inaudible].
15 It hurt a lot of us.
16 We questioned coming to work anymore, but
17 then we remembered the patients need us. The
18 hospital wouldn't function without EVS.
19 And it's just that we shouldn't have to fight
20 for something that we know we need, and they know we
21 need as well.
22 A lot of the members of my team have been out
23 sick due to the COVID, contracted through work.
24 We all have families.
25 I'm scared to bring it home to my children.
226
1 Scared to give it to my mother, who is very sick,
2 always in the hospital.
3 SENATOR RIVERA: If could you finish --
4 finish your thought, please, since your time has
5 expired.
6 If you could finish your thought, ma'am, as
7 you were saying.
8 ARDELA MOORE: Say that again?
9 SENATOR RIVERA: If you could finish --
10 finish your thought, as your time has expired.
11 Go ahead.
12 ARDELA MOORE: Yes.
13 But we just want them to know that EVS is a
14 major part of the hospital, and hope they can get us
15 the PPE we need for the next wave if it comes.
16 Thank you.
17 SENATOR RIVERA: Thank you so much,
18 Ms. Moore.
19 Next, we will hear from David Vander de Carr,
20 1199 member, a respiratory therapist at Mount Sinai
21 Morningside.
22 DAVID VAN de CARR: Good afternoon.
23 My name is David Van de Carr, and I'm a
24 respiratory therapist at Morningside -- Mount Sinai
25 Morningside Hospital in Manhattan.
227
1 I'm also the 1199 union delegate for my
2 department.
3 I appreciate the opportunity to speak with
4 you today and share my experiences during the
5 pandemic.
6 COVID-19 presents most often as a respiratory
7 illness, with shortness of breath and low oxygen
8 levels in the blood, treated first with non-invasive
9 ventilation; i.e., a BiPAP or a high-flow nasal
10 cannula. Then sometimes a breathing tube and a
11 ventilator. Often the disease manifests as a deadly
12 pneumonia.
13 As a respiratory therapist, I have been at
14 the front of the front lines at work, or, as I put
15 it, I've been neck deep in COVID-19 for five months.
16 I have been with these patients from their
17 arrival in the ER, through their complete course of
18 treatment and recovery, and/or death.
19 Simply put, respiratory therapists help
20 people breathe.
21 On a normal day at the hospital we might have
22 15 to 25 ventilated patients, with an equal or
23 lesser number on non-invasive ventilation.
24 At the height of the pandemic we had 75 to
25 80 vents running every day, with an equal or
228
1 slightly lesser number of non-invasive.
2 At the same time, about 10 to 15 percent of
3 my department was out sick with COVID.
4 So it was intense, it was relentless,
5 overwhelming, and terrifying.
6 I also live in Jackson Heights, Queens, near
7 Elmhurst Hospital, which is one of the hardest-hit
8 areas of the city.
9 I'm happy to say that my family and I are so
10 far healthy, at least physically, because myself and
11 my team are still traumatized.
12 None of us will ever be the same, and we
13 don't know if we can go through this again.
14 For months now, every little ache and pain
15 makes me wonder if this is the day of the encounter
16 with a patient that, you know, I bring it home, and
17 I get sick, and I make my wife sick or my family
18 sick.
19 I'm proud of the work my team did.
20 I'm proud of the nurses, doctors, and other
21 specialists who joined me on the front lines every
22 day.
23 I love my Morningside family.
24 I'm very proud of my union sisters and
25 brothers who also joined me on the front lines every
229
1 day, who walked through the doors of that hospital
2 and were right with us, neck deep, feeding,
3 cleaning, transporting, supplying, and caring for
4 all these people, and supporting the staff and
5 patients in a hundred different ways.
6 I feel very good about the hospital's overall
7 response.
8 Mount Sinai had to scramble for PPE, but they
9 got it.
10 They got us help in the form of more
11 ventilators and other equipment and additional
12 staff.
13 Everybody had to think on their feet, and
14 Sinai did a good job of that.
15 Where I'm disappointed in the hospital's
16 response was with our "ancillary" staff and crisis
17 pay.
18 The hospital did not do a good enough job
19 supporting the ancillary staff with PPE, like
20 Miss Arleda. Some of them got sick.
21 They are absolutely part of the overall care
22 team and deserve to be treated as such. They have
23 intimate patient contact.
24 I'm also disappointed in how the hospital
25 handled crisis pay.
230
1 There are lots of ways to recognize the value
2 of your people, and pay is one of the clearest.
3 Other first-class hospital systems in
4 New York City stepped up voluntarily, establishing
5 an industry standard.
6 The fact that we had to fight so hard with --
7 over this, the failure to meet the industry
8 standard, and the mishandling of the payout, left a
9 bad taste in our mouths about the hospital.
10 Again, I appreciate the opportunity to share
11 my experiences during the pandemic.
12 I hope that we can use this time to be even
13 better prepared for another possible surge.
14 Right now, my co-workers and I dread another
15 surge; everybody that I work with.
16 We don't know if we can do it again, but it
17 will make us feel better if we feel like we're
18 better prepared.
19 Thank you.
20 SENATOR RIVERA: Thank you for that,
21 Mr. Van de Carr.
22 And, next, we will hear from
23 Judy Sheridan-Gonzales, president of the
24 New York State Nurses Association.
25 JUDY SHERIDAN-GONZALEZ: Hello, and thank
231
1 you.
2 My name's Judy Sheridan-Gonzalez. I'm the
3 president of NYSNA, where we represent over
4 40,000 nurses across the state. And, of course, our
5 members were in the front lines in the fight against
6 the pandemic.
7 I also live and work in The Bronx, and I have
8 been an ER nurse in this unfortunate county for
9 almost 40 years, right at the apex of the epicenter
10 of this virus.
11 So our experience as front-line health
12 workers, as caregivers, and patients, as rescuers
13 and victims, offer a unique look at the serious
14 weaknesses of our health-care infrastructure, its
15 capabilities to manage disasters, and the systemic
16 inadequacies that existed prior to the invasion of
17 the COVID-19 virus.
18 These are the factors that exacerbated the
19 deficiency of our response, and they have not been
20 corrected.
21 I wanted to repeat that: They have not been
22 corrected.
23 Should a surge occur, we won't be able to
24 withstand it unless we fundamentally change the
25 financing, administration, structure, and
232
1 functioning of our health-care delivery system, and
2 the issues that drive the social determinants of
3 health, as well, as an understanding that those of
4 us who care for patients, who save their lives,
5 cannot be left out of planning. That, was a fatal
6 flaw; a fatal flaw that we saw time after time, and
7 it continues.
8 The economic inequities that exist, and the
9 profit-driven nature of our health care, has starved
10 the system of resources essential to provide care
11 for our patients.
12 This mantra of austerity versus fair taxation
13 has resulted in underfunding public hospitals and
14 safety-net facilities. These facilities were in the
15 epicenter of the virus, with patients, mostly people
16 of color, suffering and succumbing at a 2- or even
17 3-to-1 margin over other populations, including
18 immigrants and the institutionalized.
19 Health-care cuts rendered all of our
20 hospitals helpless to undertake the critical
21 preparation essential to manage a pandemic,
22 resulting in otherwise preventible deaths and severe
23 complications.
24 I emphasize the word "preventible."
25 So these factors included:
233
1 Chronic understaffing and the absence of
2 mandated ratios created such severe shortages that
3 even a massive influx of volunteer and temporary
4 staff could not meet our needs.
5 The absence of a standby critical care
6 workforce resulted in ICU nurses forced to care for
7 two and three times what is marginally acceptable,
8 and a shifting of untrained staff to ICUs and
9 medical units where ratios were also double and
10 triple what was needed.
11 This resulted in deaths, complications,
12 employee exhaustion, illness, serious illness,
13 burnout, premature resignations, premature
14 retirements, and ongoing PTSD among our staff.
15 We have not even been able to process that
16 yet.
17 The lack of stored PPE, and the denial that
18 this is, indeed, an airborne virus, and the absence
19 of ventilation devices and medical equipment, and
20 that's kind of like having no sandbags when you're
21 waiting for a flood.
22 That was the situation we were in.
23 This led to illicit and ineffective use of
24 protective equipment due to what is called
25 "scarcity."
234
1 What was the result?
2 Worker deaths and illness at unprecedented
3 proportions, and poor patient outcomes.
4 Hospital administrations' unwillingness to
5 partner with direct caregivers to coordinate care,
6 deployment, training, and logistics resulted in
7 inefficient and dangerous operational errors,
8 negative outcomes, worker infection, and unnecessary
9 restructuring of operations.
10 Overcrowding, resulting from the closure of
11 units, beds, and entire hospitals -- and I would
12 point to Mount Vernon Hospital's pending destruction
13 as a stark example -- made social distancing
14 impossible, and they turned our ERs and other
15 units into COVID petri dishes.
16 The loss of funds to hospitals due to
17 cancellation of lucrative elective procedures
18 exacerbated pre- and peri-COVID financial stresses,
19 especially in safety-net facilities.
20 This created what we call a "COVID
21 smokescreen" to justify dire cuts in ancillary staff
22 and essential services, fulfilling a prior goal to
23 save money, and dramatically increase efforts to
24 shutter inpatient mental-health services with
25 deleterious effects on those with mental illness,
235
1 their families, and communities.
2 And this is going on across the state.
3 So what will save our hospitals, health
4 workers, and our patients, especially should a surge
5 of COVID recur?
6 Involvement of front-line workers in all
7 plans;
8 Implementation of minimum staffing ratios;
9 Reusable PPE procurement, such as
10 elastomerics and PAPRS, reusable gowns, so we never
11 again will even care about a shortage because we'll
12 have everything ready to go;
13 A moratorium on closures, a reduction in
14 services;
15 Immediate implementation of a program to
16 guarantee equal access to quality care for all;
17 Fair distribution of hospital funding based
18 on community needs and safety-net support;
19 Begin the transformation of health care into
20 a system that removes profit as a driver, that is
21 our dream, and our goal.
22 SENATOR RIVERA: Ms. Sheridan-Gonzalez, if
23 you could finish your --
24 JUDY SHERIDAN-GONZALEZ: And that's last --
25 my last sentence.
236
1 SENATOR RIVERA: Okay.
2 JUDY SHERIDAN-GONZALEZ: And to generate the
3 needed revenue -- this is probably the most
4 important one -- to generated the needed revenue to
5 rebuild the system with a fair taxation policy that
6 will help everybody.
7 Thank you.
8 SENATOR RIVERA: Thank you, ma'am.
9 And we will have the Assembly leading us off.
10 ASSEMBLYMEMBER MCDONALD: Okay. Looks like
11 we will start off with our health chair,
12 Mr. Richard Gottfried.
13 ASSEMBLYMEMBER GOTTFRIED: [Inaudible.]
14 ASSEMBLYMEMBER MCDONALD: Who will unmute
15 himself.
16 And while he's doing that, I'll recognize my
17 colleague, Mr. Steve Otis, who also joined us.
18 Go ahead, Richard.
19 ASSEMBLYMEMBER GOTTFRIED: So, any of you can
20 comment on this.
21 Our hospital trade associations, and, in our
22 last hearings, the nursing home trade associations,
23 have all been very enthusiastic in commending the
24 administration/the executive branch for meeting with
25 them frequently, and, in some cases, we heard daily,
237
1 to consult with what the needs of their institutions
2 were, and about policies, and what should be
3 changed, et cetera, et cetera, which was terrific.
4 What I've kept wondering is, are you aware of
5 any kind of meeting schedules like that, for regular
6 consultation with organizations representing
7 workers, like your organizations, or with patients
8 or their families?
9 JUDY SHERIDAN-GONZALEZ: Well, I can say that
10 most of our units had to demand those meetings.
11 They were not offered immediately.
12 Once the meetings took place, they were not
13 meetings of collaboration. They weren't proactive.
14 Basically, we were told, this is what's
15 happening.
16 We weren't given the data that we requested
17 very often.
18 We still don't have the data of the number of
19 deaths and illnesses of our own members and of
20 patients.
21 And, the way in which it was managed was
22 confrontational instead of collaborative, which is
23 very unfortunate.
24 ASSEMBLYMEMBER GOTTFRIED: Interrupt for a
25 second.
238
1 Are you talking about meetings with
2 management of your facilities, or meetings with the
3 health department or the Cuomo administration?
4 JUDY SHERIDAN-GONZALEZ: There were meetings
5 with some of our leaders with the Cuomo
6 administration.
7 But I -- again, the issue of listening to us,
8 and, of course, and believing what we said, a
9 significant issue is the absence of PPE and the
10 issue of airborne respiration -- respirators --
11 airborne transmission of the virus.
12 Initially, hospitals had assured the governor
13 that we had the equipment that we need.
14 The governor said we had the equipment that
15 we need.
16 But we did not have the equipment we needed,
17 and that was kind of a big battle to have to get
18 into that.
19 We were having people reusing PPE, and using
20 materials that were totally not scientifically
21 sound, and, therefore, getting quite ill.
22 And the emergency room in which I work,
23 I think, practically, 80 percent of our staff got
24 sick.
25 ASSEMBLYMEMBER GOTTFRIED: So the sense of
239
1 close cooperation and consultation that the trade
2 associations have discussed with us at these
3 hearings, you never felt anything like that.
4 I wonder if 1199 wants to comment on that?
5 VERONICA TURNER-BIGGS: Absolutely,
6 absolutely.
7 So while we had access to the administration,
8 it certainly wasn't daily conversations.
9 And as Judy said, we -- in meeting with
10 hospital administration, it was usually very
11 confrontational.
12 It was [indiscernible] a confrontation about
13 trying to ensure collaboration, and an understanding
14 of the guidance and protocols.
15 So, yes, we had access to the administration,
16 but not, I assure you, not at the same level as the
17 trade associations.
18 ASSEMBLYMEMBER GOTTFRIED: Thank you.
19 Those are my questions.
20 SENATOR RIVERA: Thank you, Assemblymember.
21 Recognize Senator Tom O'Mara for 5 minutes.
22 SENATOR O'MARA: Thank you, Chairman.
23 Thank you all for participating in our
24 hearing today, and your testimony, very important
25 testimony, from the front lines.
240
1 And I want to thank each and every one of
2 you, and the members of all your organizations, for
3 the phenomenal work that has been done over the many
4 months now that we've been dealing with this
5 pandemic.
6 And, certainly, could not have handled it
7 anywhere as close to as well as we have handled it
8 without the dedicated workforce that we have there.
9 I have been, you know, asking questions
10 throughout these hearings with regards to nursing
11 homes, and particularly, patients being transferred
12 to hospitals, and ultimately dying there.
13 I was wondering if, I guess, David, you're
14 hands-on as a respiratory therapist there, if what
15 anecdotal information you can provide about what
16 you've seen as far as nursing home patients coming
17 in, and ultimately not returning to the nursing
18 home?
19 DAVID VAN de CARR: I mean, previous to the
20 pandemic, there were a number of nursing homes in
21 the area that we received patients from.
22 Our patient population is, mainly -- it's in
23 Morningside Heights in Manhattan. It's mainly
24 people of color.
25 So we would regularly receive patients from
241
1 nursing homes.
2 Especially if it's not a skilled nursing
3 home, if there's not, you know, adequate medical
4 care available to that patient, then -- and they
5 certainly would send a COVID patient to the
6 emergency room.
7 So we see that on a daily basis.
8 And that increased during the pandemic, there
9 were more patients coming from nursing homes.
10 And, you know, when I moved to New York, one
11 of my first jobs was in a nursing home, a skilled
12 nursing facility, in Brooklyn, with a vent unit.
13 And my father-in-law got sick in Texas with
14 COVID in a nursing home.
15 So we've seen an increase of patients, and,
16 yes, some of them died. These are very ill people.
17 And the main health resource for the
18 community that I serve is really the emergency room.
19 And -- so they end up, and a lot of them
20 perished. You know, they have a lot of
21 comorbidities. You know, kidney disease, there's
22 heart disease, dementia, that make them more
23 susceptible, as the nursing home population, and it
24 is the population that we serve.
25 SENATOR O'MARA: How about the others on the
242
1 panel, any anecdotal information on that topic?
2 JUDY SHERIDAN-GONZALEZ: Yeah, I think the
3 transport of very sick patients was a big problem,
4 which is why we really need a cushion, in every
5 hospital, of capable ICU staff, capable med-surg
6 staff, and space and rooms for patients, because we
7 received in the emergency room quite a few patients
8 who were already dead, through the transport
9 process, I don't know if, when they left? as soon as
10 they arrived?
11 And these were infected patients that
12 unnecessarily spread the infection, because,
13 obviously, it's not a safe situation when you have
14 somebody who is loaded with virus in an area.
15 But the transport was really serious.
16 We were kind of the nursing home central of
17 The Bronx, Montefiore Medical Center. And so many
18 of our patients did come from nursing homes.
19 Some returned, but they were very, very ill.
20 And, again, as I said, this transport issue
21 became a nightmare for many of us because people
22 really weren't safely transported.
23 And this is, again, it's so important for
24 every single health-care facility to have enough
25 space and enough staff to take care of people who
243
1 walk into our doors.
2 Our emergency rooms were already where people
3 were packed like sardines, just -- where just people
4 were on top of each other.
5 How do you avoid getting sick if you aren't
6 sick?
7 So in the beginning it was horrific, it was a
8 nightmare.
9 Eventually, we started to get control of the
10 situation a bit, but it never should have happened
11 that way. And we never want to see that again.
12 SENATOR O'MARA: Do you have any sense of
13 what percentage of those patients coming from
14 nursing homes did not survive?
15 JUDY SHERIDAN-GONZALEZ: I don't have access
16 to that data, but I'm sure that we can get ahold of
17 it.
18 OFF-CAMERA SPEAKER: Yeah, I don't have
19 access to that data, either.
20 SENATOR O'MARA: Any other panel members wish
21 to comment on that topic?
22 OFF-CAMERA SPEAKER: I don't have access to
23 that data.
24 SENATOR O'MARA: No, the question before, the
25 question before, just on the general influx of
244
1 nursing home patients to your hospitals?
2 VERONICA TURNER-BIGGS: So, yes, same as both
3 David and Judy said, a number of patients.
4 [Indiscernible.] But, my peers who lead the
5 nursing home long-term-care work consistently talked
6 about the number of COVID-positive patients in
7 nursing homes, and residents that didn't make it.
8 SENATOR RIVERA: Thank you, Senator.
9 SENATOR O'MARA: Time's up?
10 SENATOR RIVERA: Yeah, your time has expired.
11 SENATOR O'MARA: Thank you, Senator.
12 SENATOR RIVERA: Have a good one, man.
13 ASSEMBLYMEMBER MCDONALD: On the Assembly?
14 SENATOR RIVERA: Assembly, yes.
15 ASSEMBLYMEMBER MCDONALD: Yes, we have
16 Assemblymember Dan Quart/Chair Quart.
17 ASSEMBLYMEMBER QUART: Thank you.
18 ASSEMBLYMEMBER MCDONALD: 5 minutes.
19 ASSEMBLYMEMBER QUART: Thank you.
20 And thank you to the panel for your very
21 critically important and moving testimony.
22 I'm not sure -- to all the panel members who
23 gave testimony, I'm not sure if you have weren't
24 this morning.
25 I wanted to focus some of my questions in
245
1 relation to Dr. Zucker's testimony this morning,
2 and, really, two specific parts: one about PPE, and
3 another change in Chapter 117 of the reporting laws.
4 We'll start with Dr. Zucker's comments
5 about PPE.
6 The nurses association filed lawsuit in
7 April, setting forth in pretty detailed fashion,
8 from firsthand testimony, and other sources, a lack
9 of PPE equipment, specifically within hospitals,
10 which runs contrary to Dr. Zucker's representation
11 this morning that there was sufficient PPE within
12 the hospitals.
13 And Dr. Zucker specifically said that not
14 everything reported is accurate, I guess challenging
15 the voracity of the information provided in that
16 lawsuit and the front-line nurses and hospital
17 personnel.
18 So, to all the panel members, if would you
19 like to be able to respond to Dr. Zucker's
20 representation, this is your opportunity to do so
21 now.
22 JUDY SHERIDAN-GONZALEZ: So I can speak from
23 personal experience.
24 When, initially, even prior to the terrible
25 invasion of COVID that occurred after the first week
246
1 of March, and that escalated just exponentially, we
2 tried to meet, to discuss the airborne nature of the
3 disease, which the science really did provide.
4 And I have to blame the CDC for allowing the
5 "scarcity" guidelines to give cart blanche to
6 hospitals to say, well, we're following the CDC
7 guidelines.
8 That was inexcusable, because we had enough
9 opportunity to be able procure a proper PPE in
10 advance.
11 Initially, we were even told in many of the
12 hospitals: Don't wear masks. It makes the patients
13 uncomfortable.
14 Then that got changed, we were allowed to
15 wear masks.
16 Then they said: Don't wear N95s. You don't
17 need them. It's not airborne.
18 In fact, in some of our facilities, nurses
19 were disciplined for procuring their own N95s to
20 protect themselves, when the hospital said that they
21 didn't need them.
22 Then when it was obvious that people were
23 dying, they allowed people to wear N95s, but then
24 they were told: Wear them for a week. Put it in a
25 plastic bag, put it in a paper bag, maybe it will be
247
1 re-sterilized.
2 That obviously did not work.
3 We had to fight, we had to even have social
4 distance rallies, petitions, press coverage, to get
5 the appropriate use of PPE, because there is
6 something called "crisis contingency and standard
7 use."
8 We should always be using standard use.
9 We're not in a country that has no resources.
10 So that is not true.
11 Getting scrubs, getting gowns, getting
12 appropriate gowns, getting non-permeable gowns, and,
13 shields, getting shields that didn't fall apart.
14 We didn't have the appropriate PPE.
15 That's why we came to the conclusion that we
16 needed reusable PPE.
17 Number one: It doesn't contaminate the
18 environment with all the waste of disposables;
19 And, number two: It's something that allows
20 you to not have a shortage.
21 If you have the elastomeric or PAPR, which
22 you can again, it's a personal device, it's not even
23 that expensive. The elastomeric is about the price
24 of what it costs to wear N95s for two months. It
25 doesn't scar your face permanently.
248
1 I don't know if any of you have seen what's
2 happened to some of our staff, with the permanent
3 scars and abrasions all over their faces, and
4 breathing in their own carbon dioxide, passing out,
5 fainting. And, also, the removal and putting back
6 on allows more contamination.
7 So our big struggle now is to procure these
8 reusable devices.
9 Several hospitals in Brooklyn have taken that
10 step. We are so proud of Brooklyn Hospital and
11 One Brooklyn Health for doing so.
12 But, initially, it was a nightmare.
13 Eventually, after having to be out in the
14 streets, and engage in all kinds of confrontational
15 activities, we did get PPE. But, we don't feel
16 confident that there's enough for us.
17 And we think that now is the time to start
18 procuring the disposable items that will save our
19 patients and save our staff.
20 Nobody should have died taking care of these
21 patients, and many did.
22 ASSEMBLYMEMBER QUART: Thank you.
23 I have about -- thank you for your comments.
24 Just one last question, since I have about
25 45 seconds left.
249
1 We talked about, this legislature, and signed
2 by the governor, amended Chapter 117 of the laws of
3 2020. But, actually, the original law goes back to
4 2002, and it's all about reporting; about avenues
5 open to hospital front-line workers to make
6 complaints about situations that are deficient
7 within hospitals.
8 We changed the law to add another way in
9 which to complain about, quote/quote, improper
10 quality of workplace safety.
11 But the form in which to make those
12 complaints existed as of March of this year. We
13 just added on to that.
14 My question is, to all those on the panel:
15 Whether you feel comfortable about any sort of
16 communication avenue between yourselves, your
17 hospitals, and DOH, to levy complaints about
18 improper quality of care within the hospital.
19 SENATOR RIVERA: If anybody has a quick
20 answer to that, since his time has expired.
21 VERONICA TURNER-BIGGS: David? Ardela?
22 DAVID VAN de CARR: Yeah, I mean, I didn't --
23 I've frankly been so busy during the whole thing,
24 I didn't -- I mean, I didn't see anything glaring in
25 my experience, you know.
250
1 SENATOR RIVERA: Got you.
2 All right, thank you, sir.
3 Thank you, Assemblymember.
4 Move on to the Senate, recognizing
5 Senator Skoufis for 5 minutes.
6 SENATOR SKOUFIS: Thanks very much.
7 And as many of my colleagues have already
8 said, I want to thank all of you on the panel for
9 testifying, and, more importantly, for everything
10 that you've done these past many months during
11 COVID.
12 My question, I want to ask all of you:
13 I can't even begin to imagine the emotional,
14 psychological, toll that these past five months have
15 been to all of you; your members, your colleagues,
16 in hospitals.
17 And I'd like you to speak to, if you can,
18 what, if any, services were made available by your
19 employers, the hospitals, to try and take care of
20 these needs that, you know, I think, quite frankly,
21 weren't front and center for folks in government,
22 for folks in the industry, but are incredibly
23 important?
24 Were any programs set up, or any
25 psychologists hired, mental-health professionals,
251
1 made available to all of you?
2 I imagine it's similar to PTSD during war
3 time when people are serving overseas. Right?
4 Can you speak to some of that?
5 DAVID VAN de CARR: We had -- my department
6 had several meetings with a sort of grief counselor.
7 And a kind of therapist who was made
8 available to myself and some nurses for like a Zoom
9 call that happened.
10 I know I was on it once.
11 And I think they -- you know, I think Sinai
12 did provide some of that help.
13 SENATOR SKOUFIS: Do you think it was
14 adequate, what they did?
15 DAVID VAN de CARR: I've been through therapy
16 before.
17 I mean -- I mean, we all need a ton of help
18 with this.
19 And, you know, it's kind of -- I get a lot of
20 my therapy from the people I work with, you know,
21 talking about it, because they're the ones that
22 understand what happened.
23 So --
24 VERONICA TURNER-BIGGS: I would add --
25 DAVID VAN de CARR: [Indiscernible
252
1 cross-talking] --
2 VERONICA TURNER-BIGGS: I'm sorry. I'm
3 sorry, David.
4 I would add that a number of the health
5 systems and institutions provided some minimal level
6 of programs.
7 The issue is, that this -- it's very
8 traumatic, and there will be lasting trauma, and so
9 it has to be ongoing work that is done.
10 At 1199, through our benefit fund, we have
11 ongoing therapy, or programs, for folks -- for our
12 members.
13 And so, yeah, I think we just have to be very
14 thoughtful, that this is -- you know, this is -- the
15 trauma is real, and a few sessions are not going to
16 get people through what they experienced.
17 JUDY SHERIDAN-GONZALEZ: Yeah, I totally
18 agree with what was said previously.
19 Our union also developed an assistance
20 program. And several social workers in the
21 community offered their services for free.
22 I think we got most of our support from each
23 other, as David said, and from our community.
24 The people who brought us food, and who
25 clapped, and just created an environment of love and
253
1 support, was really helpful during the time.
2 As I said, we haven't really processed, we're
3 still kind of in it.
4 So I think the ongoing effects are definitely
5 going to be very dramatic.
6 Some people were traumatized just because of
7 the virus itself, and the outcome, and the
8 problems.
9 But I think prevention is -- I mean, you can
10 provide therapy. But when you can also provide
11 staff that you need, and you're not doing it; when
12 you can provide the equipment that you need; the
13 space that you need; the training that you need; all
14 the things that would have eased some of that pain
15 of trauma, of having people die because they say:
16 Well, don't go in the room, you're not really
17 protected. Don't spend time with the patient.
18 Don't stay in the room.
19 If you don't stay in the room, the patient
20 doesn't survive.
21 So we had that, as professionals, not being
22 able to give what we could give.
23 Being with a patient is what nurses do to
24 save lives.
25 Being told, don't go in the room, don't stay
254
1 in the room, of course we're not protected.
2 Protect us so we can do that.
3 The prevention would have alleviated some of
4 the trauma.
5 But certainly, without, this disease has
6 created trauma for everybody.
7 And nobody is going to survive as a caregiver
8 if we have to go through it again.
9 That's why prevention and preparation and
10 planning and participation are all critical.
11 VERONICA TURNER-BIGGS: I agree, I agree.
12 And I would just add that, for ancillary
13 staff, who, every single day, had to fight to ensure
14 that they had the adequate PPE, the relationship and
15 the trauma that they are experiencing because they
16 lost co-workers is very, very real.
17 SENATOR SKOUFIS: Thanks for your answers.
18 SENATOR RIVERA: Thank you, Ms. Turner-Biggs.
19 Thank you, Senator.
20 Assembly.
21 ASSEMBLYMEMBER MCDONALD: In the Assembly we
22 will recognize myself for 5 minutes.
23 I want to thank all of you, not only -- and
24 all of your members, for not only on the front
25 lines, but your testimony today. It's very
255
1 meaningful, and it's sincerely appreciated.
2 Veronica, in your beginning, it really caught
3 my attention, and, of course, I'm an upstate guy who
4 hasn't really -- doesn't know the ins and outs of
5 the downstate hospital system.
6 So I'm going to put that out front. All
7 right?
8 But what concerned me about this hierarchy of
9 distribution of masks -- and we probably don't have
10 enough time to get into this today -- I'm very
11 interested, though, in some supporting information,
12 because I think that -- that's bothersome to me.
13 I know -- I'm a practicing pharmacist.
14 I know when hydroxychloroquine was the new
15 thing, all of a sudden, doctors I've never seen
16 before were looking for hydroxychloroquine. And
17 they were using their privileges to do so, and
18 that's not fair at the end of the day.
19 All people on the front line need to be
20 treated fairly and equitably.
21 So this was really happening in your
22 operation?
23 VERONICA TURNER-BIGGS: Absolutely,
24 absolutely.
25 As you heard Ardela's testimony, like,
256
1 initially, EVS workers, who had to go in and clean
2 the rooms, were told that they were okay to wear
3 surgical masks.
4 Unit clerks who were on COVID-positive units
5 were told that it was okay to wear a surgical mask.
6 The folks that register you when you come in
7 through the ER were told that it was okay to wear
8 surgical masks.
9 It was very real.
10 Transporters, transporting COVID patients,
11 were told it was okay to wear surgical masks.
12 ASSEMBLYMEMBER MCDONALD: Okay, but,
13 individuals that were caring for patients were told
14 they couldn't? Is that what you're telling me?
15 VERONICA TURNER-BIGGS: Yes.
16 Bedside clinicians were given, for the most
17 part, adequate PPE.
18 Although, as Judy said, initially, they were
19 told that they could wear the PPE if it wasn't
20 soiled, for seven days, the masks, the N95.
21 ASSEMBLYMEMBER MCDONALD: I remember Judy's
22 testimony well.
23 Well, that seems to me a little bit
24 backwards, if you ask me.
25 No disrespect to -- I mean, everybody should
257
1 be treated fairly at the end of the day.
2 I would appreciate, after, if we could have
3 some more follow-up about this, because that just
4 strikes me as unfair.
5 VERONICA TURNER-BIGGS: Absolutely.
6 ASSEMBLYMEMBER MCDONALD: The other thing,
7 the whole Manhattan Hospital versus the other --
8 I don't want to get into a borough warfare down
9 there -- but, is that a function of -- you know --
10 I mean, I'll be honest with you, I'm a health-care
11 provider too, it was a hustle to try to get
12 supplies.
13 Do you think that was more, that they had the
14 resources, or they had the right people doing
15 procurement, or it was just a matter of luck?
16 Or -- because you probably have members in --
17 I imagine, all your organizations have members in
18 all the different boroughs.
19 Where -- what is the underlying issue there?
20 VERONICA TURNER-BIGGS: So, in my opinion,
21 I think it was absolutely related to the resources;
22 having the resources to compete in the private
23 market.
24 ASSEMBLYMEMBER MCDONALD: Uh-huh.
25 Thank you.
258
1 And, David, your testimony about crisis pay,
2 and you mentioned that other systems seemed not to
3 have a problem doing this.
4 And I wasn't clear if somebody -- if there
5 was eventually some crisis pay paid. Or --
6 DAVID VAN de CARR: There was.
7 ASSEMBLYMEMBER MCDONALD: -- oh, there was
8 some.
9 Okay, but it was more --
10 DAVID VAN de CARR: It was --
11 VERONICA TURNER-BIGGS: After a fight.
12 DAVID VAN de CARR: -- NYU, Montefiore,
13 Columbia, all gave their 1199 members.
14 It was voluntary, completely voluntary, by
15 Sinai and all the other hospital systems.
16 We were -- we're under a contract that goes
17 till 2021.
18 So they all -- all these hospital systems,
19 you know, came to our members and said, and the
20 industry standard was, NYU is a little higher, about
21 $2500.
22 Sinai did a -- sort of a complex weekly
23 bonus, which then tied into overtime, which was
24 advantageous to the hospital because, for most
25 five-day-a-week workers, when they work their sixth
259
1 day, that $100 a week that they got for a day shift
2 was -- their overtime was calculated upon.
3 It was a very complex thing.
4 And what ended up happening was, we got
5 this -- I mean, straight up, maybe 1500;
6 $1,000 thousand cash, which was -- we were given an
7 ultimatum [indiscernible].
8 ASSEMBLYMEMBER MCDONALD: I don't want to cut
9 you short, because I do want to follow up with this,
10 so we can follow up after this.
11 But I guess the question that needs to be
12 asked, which maybe you don't have the answer,
13 because we talked to the hospital associations
14 earlier:
15 I wonder, I'm just wondering out loud, if
16 there was a correlation between the amount of money
17 they were getting from the feds, that could be
18 actually transported.
19 You know, obviously, the money was provided
20 to providers, to share with their staff.
21 Now, if it was shared unfairly, we need to
22 investigate that further.
23 VERONICA TURNER-BIGGS: We certainly --
24 ASSEMBLYMEMBER MCDONALD: Thank you.
25 VERONICA TURNER-BIGGS: I'm sorry.
260
1 We certainly made the argument, when we
2 demanded to have discussions with some of our
3 institutions around hazard pay for health-care
4 workers.
5 We absolutely referred to the money that they
6 received from the feds, in a way -- a potential way
7 for them to apply hazard pay for folks.
8 SENATOR RIVERA: Thank you.
9 ASSEMBLYMEMBER MCDONALD: Thank you very
10 much.
11 SENATOR RIVERA: I'll recognize myself for
12 5 minutes.
13 Judy, I want to follow up with, when you were
14 talking about nurses being disciplined for wearing
15 N95 masks.
16 If I understand correctly, what you said was,
17 that there were situations in which some of the
18 nurses that you folks represent brought their own
19 equipment, and they were penalized for doing so?
20 JUDY SHERIDAN-GONZALEZ: In some facilities
21 they were told they couldn't do it. And some
22 facilities there were memos that sent out, that had
23 a vague reference, that was very clear, that what
24 they said, "inappropriate use of N95s could lead to
25 termination."
261
1 Meaning, they were still locked into that,
2 it's not an airborne virus.
3 And if you're not involved in aerosolized
4 procedures --
5 Which, you know, we can talk about later what
6 those are. You know, to me a sneeze is an
7 aerosolized procedure.
8 -- you know, people would be disciplined.
9 We had to go to the press.
10 Every time, to defend people, we had to go to
11 the press, go to you, go to others, to put pressure
12 on the facilities to deal with that.
13 So when we found out about stuff in advance,
14 we were able to stop it. But in some facilities
15 people were told, if they didn't take off their own
16 equipment, they would have to go home, and things
17 like that.
18 SENATOR RIVERA: So in your experience, did
19 you find that there -- before --
20 Because, obviously, what led you to go public
21 is that you wanted to make sure that those things
22 didn't happen.
23 -- were there members of your union that
24 were -- that for -- that -- where disciplinary
25 actions were taken against them?
262
1 JUDY SHERIDAN-GONZALEZ: I think that those
2 were initiated, but we were able to deal with every
3 issue that I know about.
4 But there, sometimes, members don't come to
5 us and we don't know even what happens to them.
6 In every instance in which we were aware, we
7 intervened to defend the member.
8 And I think, as the science became much
9 clearer, the hospitals were sort of like had their
10 tails between their legs.
11 SENATOR RIVERA: But in your experience,
12 whenever -- whenever it was brought to their
13 attention, it was rescinded --
14 JUDY SHERIDAN-GONZALEZ: Yeah --
15 SENATOR RIVERA: -- the disciplinary action?
16 JUDY SHERIDAN-GONZALEZ: -- and -- insofar as
17 I know.
18 I don't know about every situation throughout
19 the state, but the area -- that what I'm aware of,
20 we were able to stop it.
21 But people were wearing -- many people
22 brought their own stuff from home because they were
23 just very -- I know a nurse -- I know several nurses
24 that paid almost $1,000 for their own PPE because
25 they were so unsafe.
263
1 SENATOR RIVERA: Miss Turner-Biggs, do you --
2 did any of your members have experiences similar to
3 this, as far as disciplinary action for bringing on
4 their own equipment?
5 VERONICA TURNER-BIGGS: Absolutely.
6 Absolutely, we had members who had to don
7 trash bags because they did not have the gowns,
8 working in nursing homes attached to hospitals.
9 We had members who were told that they did
10 not need to wear N95s, and who insisted on wearing
11 N95s, because they had direct patient-care
12 responsibilities as well, and who were threatened
13 with discipline.
14 SENATOR RIVERA: Now, there were instances
15 where -- that we have heard -- there were -- there
16 were instances that we know of, where some workers
17 said, we were not getting the equipment that we
18 needed. But the hospital was not telling the State
19 that they needed -- you know, that they needed
20 equipment.
21 I'm sure that you're aware of that going
22 back-and-forth.
23 We asked the department of health, as well as
24 the hospitals, and they said, no, if they needed
25 something, they should have asked us. And when we
264
1 asked them whether they needed it, they said they
2 didn't.
3 So there was obviously a disconnect somewhere
4 there.
5 And although some of it, I'll -- you know,
6 again, we give everyone the benefit of the doubt in
7 this type of very serious crisis, that in a time of
8 triage there might have been a lack of
9 communication.
10 My question to you is: Do you believe that
11 there might be a way -- is there a way that you
12 believe that, maybe legislatively, we could address
13 this type of -- this type of situation as it relates
14 to disciplining members?
15 Because, for example, I remember that there
16 was a situation where it was a personal friend.
17 I managed to get my hand on a -- on a -- like
18 five N95 masks. And he's an ICU nurse.
19 And I said I was going to give them to him,
20 because I could use other ones.
21 And he was, like, I can't -- I can't take
22 them because I can't use them.
23 And I was, like, I don't -- that makes no
24 sense to me if you're, like -- he's an ICU nurse.
25 So -- but my question is: Do you believe
265
1 that there's something that, legislatively, we
2 could, potentially, to be able to deal with this?
3 VERONICA TURNER-BIGGS: So I would say, yeah,
4 folks ought to be protected for advocating on their
5 own behalf.
6 There was so much, early on, that folks
7 didn't know, and there was high anxiety, and folks
8 wanting to ensure that they had the adequate PPE.
9 And remember, the guidance was changing every
10 single day. And hospital protocols were changing
11 every single day.
12 So just as soon as our members understood the
13 day-before guidance and protocol, the very next day,
14 or the very next week, the guidance and protocols
15 would change.
16 And so I do believe that there is something
17 that should be done.
18 I am not sure on what it is, but I don't
19 believe that people should be disciplined for
20 advocating that they keep themselves safe, their
21 co-workers safe, and their families safe --
22 SENATOR RIVERA: Thank you.
23 VERONICA TURNER-BIGGS: -- while caring for
24 patients.
25 Thank you.
266
1 SENATOR RIVERA: Thank you, ma'am.
2 Assembly.
3 ASSEMBLYMEMBER MCDONALD: [Inaudible.]
4 SENATOR RIVERA: Chair McDonald, we can't
5 hear you.
6 ASSEMBLYMEMBER MCDONALD: I know. I hear
7 you.
8 We will now hear from our ranker,
9 Kevin Byrne.
10 ASSEMBLYMEMBER BYRNE: Thank you.
11 And allow me to echo what my colleagues have
12 already said, to thank each and every one of you and
13 the members that you represent.
14 We need more of you, a lot more of you, and a
15 lot more of your members, in this state.
16 I wanted to follow up on the some of the
17 comments and questions that were asked by my
18 colleagues earlier.
19 Certainly, I know this was -- this pandemic
20 has stressed our health-care system tremendously,
21 especially during the peaks.
22 And, Judy, you mentioned Montefiore.
23 And I know there was a -- even a -- I believe
24 it was a CBS Special, that highlighted the high
25 pressures at the hospital in The Bronx.
267
1 And, David, I believe you talked about some
2 of the challenges as well, and Veronica.
3 One thing that I think maybe David may have
4 even said it, or Judy, people putting in retirement
5 early.
6 And that struck a little bit of a nerve with
7 me, just because two women that I care about most in
8 this world, obviously, my mother and my wife, and
9 both of them work in health care.
10 My mom's a respiratory therapist, but she
11 just retired. And she ended up retiring in the
12 middle of this, two weeks before my child's due
13 date. That way, she could actually hold my newborn
14 son when there was time.
15 And I don't feel like that's something most
16 people have to, you know, think about when they're
17 retiring. It's a frightening situation.
18 But I wanted to ask about the mental health
19 and stressors that are on your members.
20 Senator Skoufis/Chairman Skoufis talked about
21 what programming is available, and I think he made a
22 comparison about our military. And I think that
23 was -- that made sense.
24 We do have peer-to-peer programming for
25 veterans, peer-to-peer supported by the State.
268
1 I believe the New York Shields has something
2 similar, or did at least, called "Cops to Cops." So
3 there are similar programs for first responders.
4 Is that something you think would be helpful
5 or beneficial as well for health-care workers, and
6 would it require more State support?
7 DAVID VAN de CARR: I do believe -- yeah,
8 I do believe that. And any State support for that
9 would be welcome.
10 And I did one Zoom call with a nurse that
11 I know from the ICU, and this therapist from Sinai.
12 And, I mean, after the call, it was, like, you know,
13 I can just talk to Beth at work in the ICU.
14 And I appreciate the woman's efforts, but
15 she's been at home on Zoom for that whole time.
16 And, you know, I commend your wife, sir, for
17 being a respiratory therapist.
18 ASSEMBLYMEMBER BYRNE: That's my mom.
19 My wife's a PA.
20 DAVID VAN de CARR: Oh.
21 ASSEMBLYMEMBER BYRNE: But my mother was a
22 respiratory therapist.
23 DAVID VAN de CARR: Oh.
24 ASSEMBLYMEMBER BYRNE: And, David, I want to
25 follow up, just because I don't have so much time:
269
1 Just, anecdotally, from people I know that
2 work in the field, you know, the -- obviously, very
3 stressful time for respiratory therapists.
4 I believe you're one of the most, if not top three,
5 top two, most exposed profession with this virus.
6 I think it's dentists and respiratory
7 therapists are at the top.
8 With the use of ventilators, and we heard the
9 commissioner talk about that, in New York, every
10 patient that needed a ventilator got one.
11 Was that something that you -- in your
12 experience, that you could confirm as well? Or was
13 it, at times, really cleaning a ventilator and
14 putting it onto the other patient?
15 Because I've heard different stories
16 anecdotally.
17 DAVID VAN de CARR: We -- at Morningside
18 every patient that needed a ventilator got a
19 ventilator. Maybe not the type of ventilator that
20 the doctors wanted.
21 We had a lot of what are called
22 "LTV ventilators," which are used for transport,
23 really, from the, I think, Homeland Security, or
24 something. A disaster prepare -- FEMA, maybe, that
25 we got for a while.
270
1 And I got to say, Sinai really stepped up and
2 really got us the equipment.
3 But there was still, you know, a shortage
4 of the preferred-up name ventilator, the
5 Maquet Servo I, and the circuits for those
6 ventilators; circuits for the high-flow nasal
7 cannulas; different therapies, nitric oxide,
8 VELETRI -- inhaled VELETRI.
9 Yeah, we were struggling.
10 You know, I mean, I'd have a patient, a
11 doctor come to me in the ICU with a used high-flow
12 nasal cannula which has just been on a patient,
13 aerosolizing, you know, COVID all over the room.
14 He brings me, "I want this on this patient.
15 Here it is."
16 And I can't just put it on that next patient,
17 you know.
18 But, yeah, overall, they really -- at my
19 hospital they really came through.
20 They shuffled ventilators between, you know,
21 Mount Sinai Main and West. And -- and, you know,
22 they didn't always get the ventilator they wanted,
23 but -- and they purchased a lot of equipment as
24 well.
25 ASSEMBLYMEMBER BYRNE: That's encouraging.
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1 Thank you, sir.
2 I know I'm out of time.
3 Thank you, Senator.
4 SENATOR RIVERA: Thank you, Assemblymember.
5 Currently, no member of the Senate to ask
6 questions.
7 Back to the Assembly.
8 ASSEMBLYMEMBER MCDONALD: Back to the
9 Assembly, we will have Member Tom Abinanti.
10 ASSEMBLYMEMBER ABINATI: There we go.
11 Thank you all for joining us today.
12 And I want to join my colleagues in
13 expressing a real gratitude for the work that you
14 and all of your fellow front-liners have done.
15 You really were very important.
16 I want to go to a different topic that I've
17 been asking everyone about.
18 I have a lot of concerns about the policy
19 that the State imposed, restricting visitors, what
20 we call "visitors," to patients.
21 In many cases, the, quote, visitors were
22 parents of children with disabilities who could not
23 speak for themselves, or they were staff from a --
24 let's say a group home with those children.
25 Then you had some senior citizens who came in
272
1 who really needed additional care.
2 Do any of you have any comments on what the
3 policy was in the beginning, what it became, and
4 what it is today?
5 Are the parents, are the visitors, in the
6 way? Are they helpful?
7 And what is the policy today?
8 What do -- how do you guys react to it?
9 What do you think the policy should be?
10 I just want your thoughts on that.
11 Maybe we start with Judy?
12 JUDY SHERIDAN-GONZALEZ: Yeah, I mean, I can
13 say there's -- pre-COVID, there was a variety of
14 visitor policies that existed in all the facilities,
15 because there were always problems with visitors
16 that could have been mitigated by, I think,
17 ombudsmen -- ombudspersons, in general, that would
18 have really been helpful.
19 The hospitals used to have translators,
20 ombudspersons, other people, to support visitors and
21 family members and caregivers of patients when
22 things became difficult.
23 With the crowding that exists, particularly
24 in our underserved communities, the visitor issue
25 becomes unfortunate and unnecessary trauma for
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1 everybody, because people have the right to be with
2 family members. And I'm talking about pre-COVID.
3 But when it's so crowded and so dangerous,
4 even without COVID, then you have to figure out,
5 what are you going to do?
6 Again, prevention is -- what, an ounce of
7 prevention is worth a pound of cure.
8 I think creating facilities that are safe
9 enhances visitor participation.
10 During COVID, I think in the beginning it was
11 just very scary.
12 The testing wasn't there.
13 If testing had been there, I think the
14 visitor policy could have been adjusted.
15 But there wasn't testing, there wasn't
16 tracing.
17 So much was unclear. The restriction of
18 visitors probably was necessary at that point.
19 But once there was a handle on it, and I know
20 with pediatrics, there was one caregiver was
21 permitted, as far as I know, in most of the
22 facilities.
23 But it was a touch-and-go situation.
24 I think that if we had additional staff to
25 work with family members and visitors, that would
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1 have alleviated a lot of the trauma that families
2 went through. And I think that it probably could
3 have been addressed a lot better.
4 But it was a very touchy situation in the
5 beginning because the transmission of infection just
6 couldn't be -- it had to be addressed; we couldn't
7 allow it to happen.
8 SENATOR RIVERA: Thank you, Judy.
9 Thank you, Assemblymember.
10 Still nobody in the Senate.
11 Back to the Assembly.
12 ASSEMBLYMEMBER MCDONALD: Back to the
13 Assembly.
14 And with that, we will go to Ranker
15 Brian Manktelow.
16 ASSEMBLYMEMBER MANKTELOW: Yes, thank you,
17 Chairman.
18 Judy, just a couple of questions for you.
19 First of all, and for all of you, thank you
20 so much for your commitment to the people you deal
21 with every day, and for being on that front line.
22 Much appreciated.
23 Judy, is there a lack of nurses right now
24 that you see?
25 JUDY SHERIDAN-GONZALEZ: Working in the
275
1 facilities, absolutely.
2 I think there are nurses that aren't working
3 in facilities that exist, but they're not hired.
4 ASSEMBLYMEMBER MANKTELOW: What can we do to
5 make that happen?
6 JUDY SHERIDAN-GONZALEZ: Well, I think if we
7 had minimum staffing ratios, they would be forced to
8 hire.
9 We now have a situation, although census is
10 low, in our emergency department, the census is
11 rising.
12 In my own hospital, they're not allowing
13 people to work overtime or bring in per diem nurses
14 to cover.
15 So we're back to the situation of nurses
16 taking care of 10 and 12 patients at a time, or 6 or
17 7 critical-care patients.
18 So I think that we need to have standards.
19 Ratios are the best standards because they
20 ebb and flow with ebb and flow of patients.
21 It's not like you have to have 1,000 nurses.
22 You have to have one nurse for every four patients,
23 or one nurse for every five patients.
24 So there gives the hospitals the flexibility
25 that they say that they require, but it ensures that
276
1 every patient gets the care that they need, and
2 every nurse is used to the best of his or her
3 ability.
4 But, definitely, there are nurses that are
5 looking for jobs, that want to have jobs. There
6 have been nurses laid off.
7 And I would also include, there's an
8 incredible amount of ancillary staff.
9 We work in a health-care team, not just about
10 registered nurses.
11 It's about LPNs, it's about respiratory
12 therapists, it's about nurses aides; we all work as
13 a team. And cutting one piece of that team, there's
14 harm done to the other piece of that team.
15 So all of the staff that is needed should be
16 there, and those cuts have been deadly, which is why
17 cuts -- cuts kill.
18 VERONICA TURNER-BIGGS: I appreciate you
19 adding that, Judy.
20 ASSEMBLYMEMBER MANKTELOW: So -- anybody:
21 So the cuts, that's really what is hurting
22 you.
23 Is it totally financial, or is it -- why are
24 there the cuts?
25 VERONICA TURNER-BIGGS: I'm very concerned
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1 that there's going to be additional cuts.
2 I believe in the earlier panel --
3 Oh, gee -- oh, sorry.
4 ASSEMBLYMEMBER MANKTELOW: You're good.
5 ASSEMBLYMEMBER BYRNE: -- in the earlier
6 panel, Ken Raske talked about there needing to be
7 additional cuts.
8 I'm concerned that those cuts will be on the
9 backs of workers; it will be workers that are the
10 cost that get cut after they just were on the front
11 line in this pandemic.
12 And I know that many of our institutions are
13 talking about either the voluntary severance
14 packages, early-retirement incentives, or, layoffs,
15 they're going to be faced with layoffs.
16 So I am very concerned about being prepared
17 for a second wave.
18 ASSEMBLYMEMBER MANKTELOW: Is everyone on the
19 panel hearing layoffs? Is that what we're hearing?
20 JUDY SHERIDAN-GONZALEZ: Yeah, it's out
21 there.
22 I just want to add one other thing, this
23 question of trauma.
24 You know, many of us still haven't processed
25 the trauma. You know, we're not ourselves, we're
278
1 not normal.
2 And we're -- and, in addition to the staff
3 cuts and the other pressures on us, hospitals now
4 are kind of now laying the blame on us.
5 If we can't get certain things done, even
6 though we don't have enough staff, even though we're
7 not ourselves, even though we're traumatized, we're
8 seeing a huge rise in employee discipline, based on
9 simple things. Documentation omissions, things like
10 this.
11 The hospitals are being very punitive right
12 now.
13 And I think more people are going to leave
14 the profession after they process what they've been
15 through and the way they're being treated.
16 And we're seeing this as a trend that is
17 very, very dangerous and very damaging, and
18 incredibly disrespectful to people who have given
19 their health and their lives to their communities.
20 This -- I don't -- I believe it's happening
21 across the board.
22 ASSEMBLYMEMBER MANKTELOW: Yeah, I -- just
23 like in life, you know, money seems to be an issue
24 all the time. When the money's short, things
25 happen, unfortunately.
279
1 But, Judy, earlier on you had said something
2 about a fair taxation policy.
3 Could you share a little bit of that with me?
4 JUDY SHERIDAN-GONZALEZ: Yeah, there's
5 several taxes that have been put forward: the
6 pied-á-terre tax, the billionaire tax, the
7 stock-transfer tax.
8 And like I say, some of these bil -- there's
9 118 billionaires. They won't even lose a swimming
10 pool when -- if they pay their fair share of taxes.
11 And some of them, there's a group called
12 "Patriotic Millionaires." They're saying, Tax us
13 more.
14 The money is out there.
15 These are taxes that existed years ago, that
16 we had no deficit when we had those taxes.
17 Many of us in the community, in the
18 workforce, feel that we have paid our fair share of
19 taxes. But, meanwhile, Jeff Bezos and all these
20 multi-millionaires and -billionaires have made money
21 out of the pandemic.
22 It's just an outrage.
23 We shouldn't have people starving. We
24 shouldn't have people being evicted. We shouldn't
25 have people denied health care. We shouldn't have
280
1 people have to go into debt.
2 These are things that are wrong.
3 We should have enough staff to take care our
4 community.
5 What good is government if it can't protect
6 and care for its people?
7 And that's what taxation is supposed to do.
8 So, absolutely, we're talking about taxes
9 that do not affect the middle class, do not affect
10 even the upper-middle class.
11 We're talking about the very richest of
12 people.
13 ASSEMBLYMEMBER MANKTELOW: All right.
14 Thank you so much.
15 And thank you everyone for being on the panel
16 today.
17 SENATOR RIVERA: Thank you, Assemblymember.
18 Still back to you folks. Nobody on our side.
19 ASSEMBLYMEMBER MCDONALD: Thank you very
20 much.
21 We will now go to Missy Miller for 3 minutes.
22 ASSEMBLYMEMBER MILLER: [Inaudible.]
23 Sorry.
24 Thank you so much for being here, and for
25 everything that you have gone through, and have done
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1 for everybody. We sincerely thank you.
2 I hear all of these problems, and I'm just
3 curious, from a legislative perspective, how can we
4 help, moving forward?
5 And what can we help to do if there is a
6 second wave?
7 What -- what, you know, honestly,
8 realistically, can be done?
9 JUDY SHERIDAN-GONZALEZ: I mean, I think
10 passing legislation to get more revenue is critical,
11 even without a surge, but absolutely will be
12 essential if there's a surge.
13 I think passing legislation that really
14 examines the different way of financing health care,
15 because the issue of profit driving health care is a
16 problem.
17 It is not profitable to have storages of
18 masks and equipment.
19 It is not profitable to have people,
20 especially trained, where you don't need them for
21 the moment.
22 It's not profitable to have a hospital open
23 when it's costing you money, quote/unquote.
24 Health care should be a public good --
25 treated like a public good, and everybody should be
282
1 able to have it.
2 We need the revenue there to be able to make
3 that happen, and we need the health-care system to
4 be structured in such a way that profit is not an
5 issue.
6 It's health care; it's about the people, it's
7 about everyone. Every single human being having the
8 right to quality health care, not just people who
9 can afford it or who happen to have the right
10 insurance.
11 So I think that those are definitely some
12 things.
13 And also having ratios or staffing numbers
14 put into place that ensure that every hospital and
15 every facility has enough staff to take care of the
16 patients to give them what they need.
17 ASSEMBLYMEMBER MILLER: Do you [indiscernible
18 cross-talking] --
19 JUDY SHERIDAN-GONZALEZ: Those are
20 [indiscernible cross-talking] --
21 VERONICA TURNER-BIGGS: I'm sorry. I was
22 just [indiscernible cross-talking] --
23 ASSEMBLYMEMBER MILLER: Do you think this --
24 this catastrophe that unfolded was the result of not
25 enough funding?
283
1 VERONICA TURNER-BIGGS: I think --
2 JUDY SHERIDAN-GONZALEZ: [Indiscernible
3 cross-talking] -- I don't know if Veronica wants to
4 answer.
5 I mean, I think it's not enough funding in
6 the way hospitals -- the health care is structured.
7 As I said, being driven by profit does not
8 give you a good public health-care infrastructure,
9 when you look at other countries who at least had
10 some stuff in place to be able to take care of
11 people, even though we all suffered from the virus.
12 But the structure of health care driven by
13 profits is not conducive to dealing with a disaster
14 where you need preparation, you need materials, you
15 need planning; you need things in place that don't
16 generate money. And you need to take care of people
17 that don't have money.
18 VERONICA TURNER-BIGGS: That part.
19 ASSEMBLYMEMBER MILLER: Is that what you were
20 going to say, Veronica?
21 VERONICA TURNER-BIGGS: Very similar.
22 Very similar.
23 We have to take advantage of this time now to
24 prepare for the second wave, and that means learning
25 from the best practices, and ensuring that we're
284
1 coordinating the purchases -- the purchasing of
2 adequate PPE.
3 I don't think ever again that we should
4 tolerate an institution not having what they need,
5 and health-care workers not having what they need.
6 ASSEMBLYMEMBER MILLER: Thank you.
7 SENATOR RIVERA: Thank you, Assemblymember.
8 Back to you folks.
9 ASSEMBLYMEMBER MCDONALD: And last, but not
10 least, for 3 minutes, Ron Kim.
11 ASSEMBLYMEMBER KIM: Thank you,
12 Chair McDonald.
13 So, earlier today Senator Skoufis talked
14 about the need for mental health in dealing with
15 some of the trauma among our workers.
16 I had a -- I just -- I had a very small
17 glimpse of what the workers were going through in
18 April when I was visiting these facilities.
19 I mean, I had workers crying because of the
20 stress.
21 And, you know, I just -- just seeing even a
22 small glimpse, I can't imagine what you're
23 processing now.
24 So I just want to lend my support for
25 Senator Skoufis and others that want to make sure
285
1 that we have enough resources to take care of our
2 mental health of our workers, moving forward.
3 You know, we have these associations, the
4 management, and everyone else, you know, putting up
5 thank-you signs, and the governor wants to do a
6 parade for you all, and celebrate all the heroic
7 work.
8 Do you want a parade or you want to get paid?
9 VERONICA TURNER-BIGGS: Our members want to
10 be paid.
11 ASSEMBLYMEMBER KIM: Okay. That's what
12 I thought.
13 VERONICA TURNER-BIGGS: We absolutely
14 appreciate the Friday evenings, gatherings and
15 hand-clappings. But our members want to be paid.
16 Again, our members used their own money,
17 staying in hotels, catching cabs to and from work,
18 so that they can ensure that their families were
19 safe.
20 Yeah, our members want to be paid.
21 ASSEMBLYMEMBER KIM: Okay.
22 And, Judy, you know, you mentioned about, and
23 I think this is very important, that a lot of
24 workers were infected doing transporting and
25 arranging for care of COVID patients.
286
1 And I asked the commissioner earlier, whether
2 we should be investigating this, some of the bad
3 practices, the last few months, because workers and
4 the patients deserve justice.
5 His response was that, we're still in the
6 middle of the pandemic, and we can't -- we don't
7 have time to go back and investigate those cases.
8 Do you think we need to get this right,
9 moving forward, and try to figure out, for the
10 workers who did get infected, who were impacted, and
11 the families were impacted, to go back and try to
12 seek retroactive justice for all those impacted
13 workers?
14 JUDY SHERIDAN-GONZALEZ: I mean, we still
15 have health workers that have to fight to get
16 workers' compensation.
17 You know, we were told initially that, well,
18 if you -- you know, my hospital CEO went on record
19 as saying, Well, we know, it's clear, that
20 82 percent of our workers got COVID in the
21 community.
22 Like, that's outrageous.
23 You know, we got it because we were exposed
24 to people and we weren't protected.
25 We got it because some of us did have
287
1 comorbidities and weren't given an alternative and a
2 place to work.
3 I don't just mean in my hospital. I mean
4 across the state.
5 People were afraid they would lose their jobs
6 if they wouldn't, you know, care for COVID patients,
7 even though they were immunosuppressed, or pregnant.
8 We had a lot of issues surrounding that.
9 Or lactating.
10 All the kinds of issues that occurred.
11 So I think that, you know, people --
12 investigation should be always happening, research
13 should always be going on.
14 Ask people what they think, ask people what
15 they need.
16 But this question of being denied
17 workers' compensation, because you have to prove,
18 I caught COVID on Tuesday from this patient at that
19 moment.
20 Really?
21 That's an outrage.
22 People should be able to be cared for.
23 We don't know the long-terms effects of this
24 illness. And people could have said, I'm not
25 working anymore. I'm not coming to work.
288
1 And they had the right to do that.
2 I absolutely support that right.
3 But there were people that went to work
4 anyway, and were in danger.
5 They need to be supported.
6 SENATOR RIVERA: Thank you, ma'am.
7 Thank you, Assemblymember.
8 I believe that we're done on that side?
9 All right.
10 Thank you everyone who was part of this
11 panel.
12 Have a great rest of your afternoon.
13 Moving on to Panel Number 5, we're joined by:
14 Elisabeth Benjamin, vice president of
15 Health Initiatives of the Community Service Society
16 of New York;
17 Anthony Feliciano, director of the Commission
18 of the Public's Health System;
19 Judy Wessler, a resident of New York, and a
20 legendary health-care expert;
21 And, Lois Uttley, women's health program
22 director for Community Catalyst, and coordinator for
23 Community Voices for Health System Accountability.
24 ASSEMBLYMEMBER GOTTFRIED: [Inaudible.]
25 SENATOR RIVERA: We can't hear you,
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1 Gottfried.
2 Let's see if they're going to be coming in in
3 a second.
4 ASSEMBLYMEMBER GOTTFRIED: Okay. Sorry.
5 Do each of you swear or affirm that the
6 testimony you're about to give is true?
7 ELISABETH BENJAMIN: Yes.
8 LOIS UTTLEY: Yes.
9 SENATOR RIVERA: Okay.
10 ASSEMBLYMEMBER GOTTFRIED: Okay.
11 SENATOR RIVERA: Are the rest of the folks --
12 okay.
13 Are the rest of the folks coming on?
14 While that happens, go ahead, Ms. Benjamin.
15 You may begin.
16 ELISABETH BENJAMIN: Go ahead, who? Me?
17 SENATOR RIVERA: Yes.
18 ELISABETH BENJAMIN: Okay. Sorry.
19 It's a little hard to hear, so, I'll do my
20 best.
21 Thank you all very much for having this
22 really important hearing today on COVID and
23 New York State's hospitals.
24 I work at the Community Services Society.
25 We're a 175-year-old non-profit. We serve --
290
1 I mean, we try to bring the voices of low-income and
2 vulnerable New Yorkers to the policy conversation.
3 In addition, I run the health department that
4 serves around 130,000 New Yorkers, finding
5 insurance, addressing medical debt, and dealing with
6 insurance problems.
7 I want to start out my comments today by
8 thanking and commending the workers at hospitals who
9 have, you know, so tirelessly, as we just heard, you
10 know, sacrificed on behalf of us all.
11 And it is extremely moving to be able to
12 speak after them and be able to applaud them.
13 I wish they were still on to hear my
14 applause.
15 And I do think they should get more pay,
16 also, because I think we also heard they don't want
17 just applause.
18 My testimony today will address the
19 structural policies that have led to these disparate
20 impacts on the COVID virus we've seen on communities
21 of color.
22 I think everyone here probably knows that,
23 outside of New York City, in the rest of the state,
24 people of color suffer from COVID, and died of
25 COVID, at a rate of four times that of White people.
291
1 In New York City those rates are twice that of White
2 people.
3 This is unacceptable.
4 There is no biologic or genetic reasons for
5 these disparities. It is socially constructed.
6 And I want to talk about, now, two reasons,
7 besides, you know, all the social determinant health
8 and essential workers.
9 I think there are real health-policy issues
10 that this body, the New York State Legislature, can
11 address, that have led to these disparities and
12 helped reinforce these disparities.
13 First of all, medical care is unaffordable
14 and there are disparities in health-insurance
15 coverage.
16 Obviously, enacting the New York Health Act
17 would resolve that.
18 But, I think it's really important to really
19 think about what medical debt looks like in
20 New York.
21 We helped a woman, Janet Mendez, who was
22 profiled in "The New York Times," with a $400,000
23 bill for her COVID treatment.
24 These kinds of bills, and what is happening
25 out there, are traumatizing patients. They are
292
1 fearful for seeking care.
2 In "The Albany Times Union," you know, we are
3 seeing the testing sites, even though there are
4 federal funds for them, are billing extraordinary
5 prices to uninsured New Yorkers. And that can't
6 happen.
7 Of course, hospitals, we did a study that was
8 released in March. It showed New York State's
9 so-called "non-profit" hospitals have sued
10 40,000 patients, residents of New York, in the last
11 five years.
12 These lawsuits disparately impact people of
13 color.
14 For example, in Syracuse, 41 percent of the
15 community of color have medical debt.
16 On the other hand, White, that number is just
17 14 percent.
18 So that's over three times the rate.
19 And those kinds of disparities are seen
20 around medical debt throughout the state.
21 In addition, I want to briefly mention that
22 the hospital capacity is unfairly allocated and
23 unfairly resourced in New York State.
24 We're missing 24,000 beds over the last
25 20 years; they've been closed. And those closures
293
1 have happened in rural areas and communities of
2 color and urban areas.
3 So, for example, Queens has 1.5 beds per
4 1,000 people, while Manhattan has 6.4.
5 In other words, Manhattan has almost
6 six times, five times, the number of beds that
7 Queens does.
8 And similar experiences are happening all
9 over this state.
10 Our pool that is designed to support
11 safety-net institutions, called the "indigent-care
12 pool," is woefully misallocated. We spread it
13 around like peanut butter.
14 No other state provides indigent-care
15 funding, disproportionate-share hospital funding, to
16 every single hospital in the state.
17 We do.
18 It's not fair.
19 That means the safety-net hospitals have,
20 basically, been shorted $13 billion over the last
21 20 years.
22 That's not okay.
23 And, that, there's no -- that's why we're
24 seeing closures of hospitals. We're missing
25 four hospitals, for example, in Queens, near
294
1 Elmhurst Hospital. They could not survive without
2 this safety-net support.
3 It was brought through rate regulation,
4 hospital rate review -- we all remember
5 [indiscernible] -- and with this indigent-care pool
6 being properly allocated.
7 Now, let's talk about the federal CARES Act
8 money.
9 I think Assemblymember Kim was asking about
10 this, and so was Councilwoman Rivera.
11 The CSS has just finished a new analysis of
12 the CARES Act money.
13 All in all, Health and Hospitals, for
14 example, received $68 million per hospital.
15 New York Presbyterian alone, just got
16 $570 million over these past six months.
17 That's not fair.
18 We can't -- so it's -- it's -- it's -- it's
19 just not a correct allocation.
20 It's also misallocated around the state.
21 Franklin County received 297,000 per COVID
22 case, while Putnam received $2,000 per COVID case.
23 SENATOR RIVERA: If you could finish
24 [indiscernible cross-talking] --
25 ELISABETH BENJAMIN: And Manhattan
295
1 [indiscernible cross-talking] --
2 SENATOR RIVERA: -- finish your thought,
3 Ms. Benjamin.
4 ELISABETH BENJAMIN: I know my time is up,
5 and I look forward to your questions, because I have
6 so much to say.
7 Thank you.
8 SENATOR RIVERA: Thank you, Ms. Benjamin.
9 Followed up by Anthony Feliciano, director of
10 Commission of Public -- of the Public -- on the
11 Public's Health System.
12 ANTHONY FELICIANO: Thank you.
13 Again, my name is Anthony Feliciano. I'm the
14 director of the Commission on the Public's Health
15 System.
16 [Indiscernible] a Latino, and not only just
17 as the director of our organization that cares about
18 access to health care.
19 It pains me that we have to even talk about
20 how many Black and Brown people died more than
21 Whites, and also older adults.
22 It could have been prevented.
23 And all I can come up with is that, we have
24 an indiscriminate virus that was unleashed in
25 racially unjust systems, and our health-care system
296
1 is included in that.
2 And -- and all I can -- but I can be angry --
3 I can't be angry at the virus.
4 I have to be angry at the state department of
5 health, and federal, city, and state executive
6 branches, because they're accessories to this issue.
7 This is -- they compounded this tragedy
8 because of years of decisions around state budgets,
9 allocation to the safety-net hospitals, and, also,
10 being influenced by political associations in terms
11 of what's going on.
12 And so if we really want to honor, or think
13 about how we prevent this and take care that we
14 don't go back to this, we need to have a better and
15 more fairly funded health-care safety net. But,
16 also, we have to have a more prepared -- overall
17 prepared health-care system.
18 And one of the ways that we need to think
19 about it is, we can't go back to cutting more
20 Medicaid.
21 It is -- we compounded the tragedy again by
22 having custom Medicaid.
23 You know, we should be revisiting that.
24 And if we can't, and we need to find aid, and
25 we can't get it from the federal government, then we
297
1 need to look at alternate revenue sources.
2 Judy Gonzalez talked about, we have to tax
3 the ultra-rich.
4 We need to find other sources to help.
5 The other thing is that, all of us, even the
6 hospitals agree, that we have to increase Medicaid
7 reimbursement, but it really should be targeted to
8 support the safety-net hospitals.
9 There shouldn't be, again, a play of where it
10 gets distributed and where it goes.
11 It is -- I feel that we spend a lot of time,
12 knowing that our health-care system, [indiscernible]
13 Health and Hospitals, essentially, were there.
14 And if they weren't around, I can imagine how
15 many more deaths, in particularly, Black and Brown
16 communities, would have occurred.
17 And the other thing is the indigent-care
18 pool. It's been mentioned before.
19 The ICP funds need to be better targeted to
20 the essential safety net.
21 Many of us fought for changes there. And
22 while we got some incremental, we're at the time
23 where we can't wait for the epidemic to end.
24 We need to have our safety net strengthened
25 and supported, financially, through the ICP.
298
1 Then there's this issue about some shared
2 sacrifice.
3 We need our wasteful executive pay and
4 non-patient care spending addressed.
5 These exorbitant salaries from CEOs, they
6 need to be addressed.
7 We can spend our money better, in better
8 ways.
9 And then I want to go into, really, what --
10 while this is focused on hospitals, hospitals are
11 made up of a community of workers, and they're
12 anchored in communities.
13 And so we need to address this not just as a
14 focus on hospitals, but a focus on where they're
15 serving, and who -- and what they're doing. And
16 then front-line communities and workers need their
17 support.
18 So we have to address rachial disparities.
19 We have to expand more funding for systemic
20 responses to the [indiscernible] of health.
21 We keep failing in that in every so-called
22 "health-care reform," or body that's being created,
23 and disguised as a way to cut more Medicaid, or to
24 make reforms that benefit the hospital, but not
25 benefit the communities.
299
1 And we need an accord decision-making of
2 workforce and communities, particularly
3 organizations that are run by people of color, in
4 terms of what we're addressing around racial
5 disparities, and what are we doing around the
6 funding streams, and the inequities that are there,
7 just along with the funding streams.
8 I also want to just urge, you know, while we
9 have to increase surge capacity, we've got to think
10 about a moratorium on hospital closures. We have to
11 revisit how decisions are being made on the long
12 run.
13 We need to have more community involvement,
14 and the community is, it is not decisive in terms of
15 what's convenient in terms of what community.
16 I'm talking about really diverse set of
17 folks, real stakeholder, who are not just brung at
18 the table when it's convenient, but are part of the
19 entire planning, part of the actual designing.
20 And many of us will mention it many times
21 over. Many of us have been at the table, and it
22 hasn't been real engagement.
23 And so I have to fault all those things of
24 why we have so many Black and Brown people that
25 died, because we have years and decades of
300
1 decisions.
2 It's not alone this governor. There's been
3 plenty of governors that have done this.
4 But this governor is now in power, and he has
5 the regulatory, with the state department, to make
6 change; and, instead, they're not doing what they
7 need to do.
8 And we're going to continue, when a spike
9 comes, to have the same problems all over again, and
10 the same traumas, and the same pain, going forward.
11 So we have to also -- part of my -- also my
12 demands is also around data disaggregation and
13 health-care readiness.
14 Like, let's go back and think about:
15 What it means to do community health
16 planning.
17 What it means to really disaggregate data so
18 it really shows a real picture, so we can target the
19 funds to the real needs and community health needs.
20 And then, let me just say, that we need
21 to pass --
22 SENATOR RIVERA: Can you wrap up?
23 ANTHONY FELICIANO: -- the New York Health
24 Care Act.
25 But we need to understand that insurance is
301
1 not just access -- it's not about all access.
2 We need to address these inequities, and as
3 part of this funding, and part of the
4 decision-making.
5 Thank you.
6 SENATOR RIVERA: Thank you, Mr. Feliciano.
7 Next we will hear from Judy Wessler.
8 JUDY WESSLER: Thank you.
9 I submitted written testimony, so I'm going
10 to read little parts of it.
11 But the major, first I want to say, thank you
12 for allowing me to testify, and, also, just
13 associate myself with remarks by both Chair Riveras,
14 the council and Senate chairs, and
15 Assemblyman Gottfried, about racial inequities and
16 the safety net, and how that needs to be the focus.
17 And [indiscernible] what we have learned --
18 what have we learned from this pandemic?
19 I didn't learn, but, certainly, have had
20 reinforced, the fact that not only do we live in a
21 racist society, city and state, we are also trying
22 to survive in what amounts to an
23 institutionally-racist health system.
24 And it's systemic, and institutional, and
25 that's part of the problem, and then we have to work
302
1 on that.
2 Not the folks that we had representing
3 workers earlier or their workers, but the
4 institutions and their policies.
5 And, certainly, the State plays a very, very
6 important role in that.
7 I've said that the legislature was wonderful
8 in responding. And we actually have a definition of
9 "safety net" in state legislation, only because you
10 all did it for two or three years, until the
11 governor decided not to -- not to veto it again.
12 But we don't use that, or it's used very
13 indiscriminately.
14 And I have several examples of the things
15 that I've been seeing over the years, which I will
16 not trouble you with, but just go on to say, that,
17 you know, there are things that I know some of you
18 have asked, what the state legislature can do?
19 And a couple of things are:
20 You've got to open up the process.
21 Right now, there's at least one academic
22 medical center leader who is being the,
23 quote/unquote, voice for the system to the governor,
24 and does not represent our interests, certainly, and
25 I'm not sure whose he does.
303
1 And they've been asked to do a look at the
2 racial inequities, and they're really using
3 inappropriate people to do that.
4 So one thing you can do is, to ask for a
5 broadening of that request, and what the outcome of
6 that request will be.
7 And so my fourth question was: What did we
8 learn from this?
9 And -- sorry.
10 Hopefully, we now recognize the depth of the
11 impact of systemic racism.
12 And with this recognition, we now need to
13 work together to change what we see.
14 One of the things, and Anthony started to
15 address this, is we do need some community-based
16 health planning that brings in people in those
17 communities, so that there's an understanding of
18 what the needs are and how they should be addressed.
19 But more than that, we need to look at how
20 resources and dollars go out, and where they go, and
21 how they're concentrated.
22 When, you know, the pandemic first broke out,
23 what did the governor do?
24 He put resources into Midtown Manhattan,
25 where people were getting sick in Queens and
304
1 Brooklyn and The Bronx. And, you know, after a
2 time, he finally did something about that.
3 So we've got to have a different kind of
4 thinking.
5 And in terms of funding and resources, if
6 there's going to be Medicaid cuts, and we hope there
7 won't, but, looks like there might be, that they'll
8 be -- that there not be Medicaid cuts for the
9 essential safety-net hospitals that have been
10 already defined in legislation. That they be
11 protected from those kinds of cuts.
12 And then, also, we need focus on resources
13 going back into, or initially into, community-based
14 health-care providers in communities that have been
15 identified as needing those services, and making
16 sure that we don't have to rely as heavily on our
17 hospitals.
18 We should have had some intermediary so that
19 the hospitals didn't get overwhelmed. And we need
20 to start thinking in those terms.
21 And we would love to work with you on, you
22 know, some of those solutions, and how to -- how to
23 make it work.
24 Thank you.
25 SENATOR RIVERA: Thank you, Ms. Wessler.
305
1 Next we will hear from Luis Ut --
2 Lois Uttley, women's health program director for
3 Community Catalyst, and coordinator for Community
4 Voices for Health System Accountability.
5 That must be one heck of a card, ma'am.
6 LOIS UTTLEY: CVHSA, is what we shortened it
7 to.
8 And HSA is referring, of course, to health
9 systems agencies, which used to do health planning
10 in this state, and we could use it again.
11 I'm very grateful for the opportunity to
12 present some comments on behalf of CVHSA.
13 It's a growing statewide alliance of
14 community and health advocacy organizations.
15 We're trying to give consumers a greater
16 voice in determining the future of their local
17 hospitals.
18 And I'm going to focus specifically on state
19 health policies, such as certificate of need, in my
20 recommendations.
21 You've heard much about the disparate impact
22 of COVID on Black and Latinx communities.
23 And you've also heard that many of the
24 neighborhoods where Black and Latinx workers live,
25 New Yorkers live, and seek medical care, are the
306
1 very places where hospitals have been closed down or
2 downsized in recent years, and where even more
3 closures are proposed.
4 More than 40 hospitals have closed across the
5 state over the last two decades, and other community
6 hospitals have been taken over by some of the large
7 health systems, which then proceed to downsize or
8 merge them, and force local patients to travel
9 outside their communities to system hub hospitals,
10 often academic medical centers, for inpatient care.
11 Pending health-system proposals will only
12 worsen these inequities.
13 And I have two examples for you, and it's a
14 sharp contrast.
15 One is, the proposed closure of Mount Vernon
16 Hospital that you have heard referred to here.
17 This is a city that is 64 percent Black, and
18 has suffered one of the worst COVID-19 rates in
19 Westchester County.
20 The residents will be left with only a
21 freestanding ER and ambulatory care, and would have
22 to be sent out of the city for COVID-19 treatment
23 and other inpatient care.
24 And you heard about the dangers of
25 transferring patients like that.
307
1 Meanwhile, the Northwell Health System wants
2 to spend $2 billion on upgrading and doubling the
3 size of Lenox Hill Hospital in the Upper East Side,
4 a largely White, affluent community with low
5 COVID-19 case rates.
6 The complex would boast a huge tower,
7 single-occupancy patient rooms, and luxury amenities
8 designed to make it a destination hospital.
9 This is not right. This is inequity
10 [indiscernible].
11 So, we want to urge several things.
12 First, I want to echo the call for a
13 moratorium on State consideration of more proposed
14 hospital downsizings and closings, or, major
15 construction projects that have no obvious
16 health-equity benefit.
17 These transactions should be put on hold
18 until the department of health has conducted a
19 thorough evaluation of the true need for hospital
20 inpatient capacity across the boroughs in New York,
21 and in many of those rural areas we have heard and
22 talked about in New York State.
23 Second, we urge the introduction of a
24 health-equity impact assessment into the
25 certificate-of-need process.
308
1 This would require health facilities to
2 explain, specifically, in their CN applications how
3 their proposed projects would improve health equity,
4 such as by filling geographic gaps in access to
5 care, and, make sure that they are going to actually
6 improve outcomes for Black and Latinx New Yorkers,
7 low-income communities, women, LGBTQ people, people
8 with disabilities, and also rural residents.
9 Finally, we must have more consumers on the
10 New York State Public Health and Health Planning
11 Council.
12 Governor Cuomo ordered the commissioner of
13 health to appoint two consumers to this council
14 called the "PHHPC" last December.
15 To our knowledge, these appointments have not
16 been made.
17 We urge speedy appointment of them,
18 especially of representatives from groups that can
19 really speak to the specific needs of low-income
20 consumers and communities of color.
21 We know, and commend, both houses of the
22 legislature have passed a bill to add two consumer
23 states to the PHHPC.
24 We urge the governor to hurry up and sign
25 this bill, and get those consumers appointed, so
309
1 that we can have real consumer voices on this
2 important council, who can raise the kind of
3 questions that need to be asked about these
4 health-industry transactions.
5 Thank you so much for the opportunity to
6 present testimony.
7 SENATOR RIVERA: Perfect timing, Ms. Uttley.
8 You've practiced that.
9 I will recognize myself for 5 minutes.
10 I'm sure that most of you folks probably have
11 tuned in for most of the day, so you probably have
12 heard most of the testimony that we've heard so far.
13 I'm going to go back to a question that
14 I asked of the commissioner in the morning, because
15 I think that, probably, certainly everybody who is
16 on this panel, and I'm sure that many of my
17 colleagues --
18 By the way, my time is not moving, which
19 I certainly don't mind, but it's not fair to my
20 colleagues. So I will wait to make sure that my
21 5 minutes are up.
22 Thank you.
23 -- so, anyway, when we -- there's many of us,
24 certainly on this panel, and many of my colleagues,
25 and myself as well, were not surprised when it
310
1 became clear, the numbers started to come out as far
2 as the deaths, as far as where the hospitalizations
3 were, et cetera.
4 We were not surprised of where they were
5 happening, who were the folks that were being struck
6 the hardest, because we have been fighting for
7 health equity, period, for a very long time, most --
8 all of us in different -- you know, different
9 capacities.
10 So the question that I have for you is the
11 one I posed to the commissioner this morning.
12 From your perspective, particularly on those
13 first three weeks of April, when, again, this was
14 not a surprise to many of us, but the data started
15 making clear that the places where people were dying
16 and where most resources were necessary were
17 hospitals that are safety net, that are serving
18 people of color and poor communities across the
19 state.
20 So the question is: What is your perspective
21 on whether there was a calibration from the State,
22 in as far as the resources and the guidance, to make
23 sure that the resources went to where the -- the
24 places where it was actually necessary?
25 Anybody can take it.
311
1 JUDY WESSLER: I can't tell you definitively,
2 but from what I saw, the answer is absolutely not.
3 You know, that tent that was set up in
4 Central Park as part of Mount Sinai, again, in
5 Manhattan, rather than in the boroughs where there
6 were the most people sick, and not -- I hate when
7 people use the word "cases" instead of "people"
8 because it really dehumanizes it.
9 But, no, the resources didn't go, at least
10 initially.
11 Finally, I think after some of the data
12 really became public and the media paid some
13 attention to it, that there was some reallocation.
14 But initially, no.
15 SENATOR RIVERA: Got you.
16 Anthony or Elisabeth?
17 ANTHONY FELICIANO: If I can add:
18 I agree with Judy, but, this goes back to
19 what I think the thread of all of our testimonies
20 have been.
21 Who you put into decision-making and into
22 power to do that, there's a problem.
23 If you want [indiscernible] as if people of
24 color were not going to get hurt, and then you want
25 to pay an association to do a study on us, you know,
312
1 to figure out why, that's a problem.
2 It should be, what is happening, and what can
3 we do? should be more of the research, than saying
4 "why?" because we know the "why."
5 The other part is, when you keep hiding the
6 data, and you don't disaggregate it in ways that can
7 actually show you a proper picture, you can continue
8 creating those delays in terms of where the
9 resources should go and the funding.
10 SENATOR RIVERA: And you believe that the
11 data has not been segregated in the way that it
12 needs to be?
13 ANTHONY FELICIANO: Yeah.
14 We're still fighting right now, even at the
15 city level, for data that could be better
16 disaggregated, even by certain -- by race,
17 ethnicity, and so on.
18 Yes, they done better, but it doesn't yet --
19 it's not yet there in terms of addressing -- giving
20 a picture of the inequity.
21 SENATOR RIVERA: Got you.
22 Ms. Benjamin.
23 ELISABETH BENJAMIN: And then data that has
24 been released, for example, the CARES funding data,
25 the idea that, you know, I mean, Franklin County has
313
1 52 COVID-positive people, about $297,000 per
2 COVID-positive person, whereas Putnam County
3 got 2,000 for its 1400 COVID-positive people,
4 and Queens, you know, got $7,000 for
5 68,000 COVID-positive people.
6 So there's a crisis in how the structure of
7 how we allocate our resources amongst hospitals.
8 And I think that's what all of us are talking
9 about: that we have to rethink -- we just have to
10 start over on how we're reimbursing hospitals and
11 getting so-called "non-profit" hospitals to behave
12 like the charitable entities that they're supposed
13 to be, and really serve all people --
14 SENATOR RIVERA: Got you.
15 ELISABETH BENJAMIN: -- not just
16 [indiscernible cross-talking].
17 SENATOR RIVERA: Got you.
18 Ms. Uttley, do you want to add anything?
19 LOIS UTTLEY: Well, I would just add that, as
20 I understand it, Mount Vernon Hospital, which is
21 threatened with closure, had two floors that were
22 closed, mothballed, by Montefiore, but had capacity
23 for 80 beds.
24 Did they reopen those to serve the people in
25 Mount Vernon? No.
314
1 Instead, all the attention was on the
2 Javits Center and a ship that would come to
3 Manhattan.
4 And, meanwhile, the patients from
5 Mount Vernon --
6 SENATOR RIVERA: Since I only have
7 25 seconds, I think I know the answer to this
8 question, but, do you believe that having the
9 New York Health Act, that would guarantee health
10 care for every single New Yorker, regardless of who
11 they are; regardless of their wealth, their status,
12 their immigration status, et cetera, do you believe
13 that that would be helpful in putting it into place?
14 ELISABETH BENJAMIN: Yes.
15 LOIS UTTLEY: Yes.
16 JUDY WESSLER: No, because it doesn't change
17 the question of access.
18 SENATOR RIVERA: Ah.
19 JUDY WESSLER: It does reimburse, but it
20 doesn't change, you know, what happens to Black and
21 Brown people, what happens to people who don't speak
22 English, what happens to people who live in
23 communities where there aren't the resources that
24 are needed.
25 Yes, it's a very important step, but it does
315
1 not change access.
2 SENATOR RIVERA: Thank you, Ms. Wessler.
3 My time is expired.
4 Assembly.
5 ASSEMBLYMEMBER MCDONALD: We will now go to
6 Mr. Gottfried, for 5 minutes.
7 ASSEMBLYMEMBER GOTTFRIED: Thank you.
8 So this has been a terrific panel.
9 Almost every question I would ask, if I had a
10 whole hour, has been talked about, and my question
11 answered.
12 Bud I'd like to ask any of you who would like
13 to comment on this a little more:
14 On the question of hospital capacity, and
15 control of hospitals, have we -- a lot of people
16 have said we overcut capacity.
17 Is it a question of overcutting capacity, or,
18 is it a question of which hospitals got closed, and
19 which communities were being served by the hospitals
20 that got closed?
21 And, in terms of control of the remaining
22 hospitals, what are the consequences of the
23 consolidation of power in our hospital system in the
24 hands of the big and predominantly rich academic
25 medical centers, all of which, in any other part of
316
1 our economy, we would be chalking up to White power
2 and corporate power?
3 How does that play out in the hospital world?
4 LOIS UTTLEY: The hospital beds,
5 Chairman Gottfried, are mal-distributed.
6 There are too many in some places, like the
7 Upper East Side, where, you know, Northwell now
8 wants to put more beds up there, fancy beds; and not
9 enough in other places.
10 So there has to be some system by which the
11 department of health would do a good analysis of,
12 what is the need for bed capacity in each of these
13 places, and then evaluate these certificate-of-need
14 proposals against that analysis.
15 So, such an analysis would say, no, we don't
16 need any more beds on the Upper East Side.
17 We need them in Queens.
18 We need them in The Bronx.
19 We need them in Mount Vernon.
20 That's what we need.
21 ANTHONY FELICIANO: Don't trust the state
22 department of health to do any proper assessment,
23 unless it has community and health-care workers on
24 the front line of -- actually, of how that's going
25 to look like.
317
1 Why?
2 Because, when we have one of the first wave
3 [indiscernible] we had -- there was the MRT, (the
4 Medicaid redesign team), the first one.
5 It went through discussing, even Queens was
6 [indiscernible] was considered underbedded, and they
7 still allowed for a shutdown of hospitals there,
8 even when the assessment showed that there was less
9 beds.
10 The problem is, is the formula is so archaic,
11 that it doesn't look in terms of also the staffing
12 of those beds.
13 And so it needs to be a much broader
14 criteria, how you're formulating what is considered
15 "overbedding," or not.
16 And so that's an issue in itself.
17 JUDY WESSLER: Many years ago, we sued the
18 state health department and the then-Health Systems
19 Agency because they were basing decisions and
20 approvals on just flaky -- what I call "flaky data."
21 And we negotiated a form that an institution
22 had to fill out, that let you know who they served,
23 where they came from, and, also, who the staff were,
24 who the physicians and others were, that were
25 providing this care.
318
1 Unfortunately -- and some people in the
2 advocacy community don't support this, but,
3 unfortunately, that form and that requirement
4 disappeared.
5 Until we have the data that we need, we know
6 what community needs are, but we don't know what the
7 institutions are doing. And that's a missing piece.
8 ASSEMBLYMEMBER GOTTFRIED: Judy, can you send
9 us some information about that litigation?
10 JUDY WESSLER: Oh, I'd be so happy to,
11 Assemblyman.
12 Yes.
13 ASSEMBLYMEMBER GOTTFRIED: I thought so.
14 JUDY WESSLER: Yeah.
15 ASSEMBLYMEMBER GOTTFRIED: And we want to
16 make you happy.
17 Thank you, I'd appreciate that.
18 JUDY WESSLER: I would be very -- I tried to
19 get into some studies, but people were ignoring it.
20 So, again, until we recognize that there is
21 racism, and, you know, resistance to changing the
22 way that institutions and the State does business,
23 and until we show what those issues are, it's just
24 going to continue.
25 And it would be, pardon by language, a damn
319
1 shame if what we didn't learn coming out of this
2 horror was to change the way we do business.
3 OFF-CAMERA SPEAKER: Judy, I gasped at that
4 language.
5 JUDY WESSLER: I am so sorry.
6 I could have used another word, but I didn't.
7 ASSEMBLYMEMBER MCDONALD: We've heard worse,
8 that's for sure.
9 SENATOR RIVERA: Thank you, Assemblymember.
10 Your time has expired.
11 Currently, no members of the Senate.
12 Are there members of the Assembly?
13 ASSEMBLYMEMBER MCDONALD: The Assembly seems
14 to be satisfied with the panel's comments.
15 Thank you.
16 SENATOR RIVERA: You people were amazing.
17 Thank you so much for being here with us
18 today.
19 Enjoy the rest of your day.
20 JUDY WESSLER: Thank you for allowing us.
21 SENATOR RIVERA: Of course.
22 All right.
23 We now move on to the next panel,
24 Panel Number 6.
25 Leading off there will be
320
1 Dr. David Pearlstein, president and CEO of
2 St. Barnabas Hospital;
3 Dr. Bonnie Litvack, Medical Society of the
4 State of New York;
5 Carole Ann Moleti, who has a lot of letters
6 after her name, and is a certified nurse-midwife,
7 along with MPH, DNP, CNM -- I don't know what any
8 of -- many of those are -- New York Association of
9 Licensed Midwives;
10 And, Patricia Burkhardt, also with a lot of
11 letters after her name -- so a lot of very great
12 folks here -- treasurer for the New York State
13 Association of Licensed Midwives.
14 ASSEMBLYMEMBER GOTTFRIED: And do each and
15 every one of you swear or affirm that the testimony
16 you're about to give is true?
17 DR. BONNIE LITVACK: Yes.
18 ASSEMBLYMEMBER GOTTFRIED: A few more voices?
19 DR. DAVID PEARLSTEIN: Yes.
20 SENATOR RIVERA: Everybody's good?
21 ASSEMBLYMEMBER GOTTFRIED: Fire away.
22 SENATOR RIVERA: All right.
23 Dr. Pearlstein, lead us off, please.
24 DR. DAVID PEARLSTEIN: Thank you, Senator.
25 First of all, I want to thank everybody for
321
1 having me here.
2 And I need to state very clearly how proud
3 I am, as the president and CEO at SBH, to have led,
4 really, what was an incredible effort by my
5 employees, by the health-care workers, and
6 I couldn't be prouder.
7 I do have a submission that I will send to
8 you.
9 I have pared it down quite a bit, but I hope
10 you let me continue to actually talk for longer than
11 5 minutes here, but we'll see.
12 So COVID-19 has impacted all New Yorkers, but
13 some are being impacted more than others.
14 Communities of color, the impact of these
15 inequalities, is causing an already unlevel playing
16 field to tip over.
17 Poverty rates and unemployment rates in
18 communities of color, such as ours at SBH, were too
19 high before COVID.
20 This is more worrisome now with the loss of
21 jobs, school closings, and decreasing community
22 support services which are impacting our community
23 at a much higher rate than others.
24 The virus is also killing more people of
25 color throughout the country.
322
1 Many say that COVID-19 doesn't discriminate
2 and we're all equally vulnerable, but it doesn't
3 mean that it isn't biased.
4 If you're a person of means with resources,
5 income, and savings, you can still get infected by
6 COVID-19, however, you can also weather it for a
7 long period of quarantine, protecting your family
8 and friends.
9 In much of New York City, and especially in
10 poor neighborhoods of color, such as in The Bronx,
11 social distancing and quarantining is a luxury that
12 many cannot afford.
13 More starkly, according to the CDC and the
14 New York City Department of Health's COVID-19
15 database, almost 90 percent of Bronx residents who
16 died from COVID-19 had underlying health conditions,
17 such as diabetes and hypertension. Compare that to
18 an average rate for the other boroughs of
19 73 percent.
20 This is a direct -- directly a result of
21 poverty. In a large part, this poverty is a direct
22 result of decades of structural racism that has led
23 to health-care disparities in our community.
24 In other words, the social determinants of
25 health are real and the impact has been devastating.
323
1 The human, economic, and social cost of COVID
2 are immense because, our service area, the pervasive
3 poverty.
4 Most of our patients who are lucky to be
5 insured are covered by government-sponsored
6 health-insurance programs, mostly by the Medicaid
7 program.
8 Even most of our elderly patients who may be
9 covered by Medicare are also Medicaid-eligible due
10 to that poverty.
11 And this doesn't even account for those
12 undocumented members of our community who, despite
13 working and paying taxes, receive few, if any,
14 benefits.
15 An unfortunate truth is that, in the current
16 health-care delivery system, St. Barnabas Hospital
17 is not financially viable.
18 That fact's not new, and we've experienced
19 growing negative margins over the past several years
20 as our revenue has not kept up with expenses.
21 That is a direct result of rising labor and
22 supply costs, and a period of flattened decreasing
23 government-based revenue. But, just because we're
24 not financially viable, it doesn't mean that we're
25 not essential.
324
1 As an anchor institution, we employ over
2 3,000 people, half of whom currently living in
3 The Bronx.
4 We serve as a trauma center, heart attack
5 center, spokes center, behavioral-health hub. We
6 have large women's and children's programs, as well
7 as very busy substance-abuse programs.
8 Before COVID, our intensive-care units were
9 full. It was hard to find an available bed on the
10 inpatient units.
11 Our emergency department cares for
12 90,000 people per year, and our total ambulatory
13 business number, over 650,000.
14 We train hundreds of residents and students
15 per year.
16 And we delivered high-quality care. We have
17 eliminated most hospital-acquired conditions right
18 the top -- amongst the top hospitals for health
19 first in quality.
20 We became a fiduciary for Bronx Partners for
21 Health and Communities, which is part of the DSRIP
22 program.
23 We're efficient, effective, we're
24 outcomes-driven, and patient-centered.
25 After COVID, we're going to face an even
325
1 worse financial situation.
2 During the height of the pandemic, we
3 expanded our inpatient capacity, including
4 quadrupling the number of ICU beds.
5 We delivered the majority of our primary and
6 specialty care via telephonic visits.
7 We closed our inpatient, pediatric, and detox
8 floors to accommodate acute medical capacity.
9 We eliminated all elective cases.
10 We stopped receiving interventional cardiac
11 patients.
12 We paid for all of our heroic staffs' --
13 members' meals. We covered the cost of their
14 parking and their transportation.
15 We spent millions of dollars on supplies and
16 capital and overtime. These were millions that were
17 not budgeted.
18 Though our COVID volume has fortunately
19 dropped, we have not completely recovered our
20 budgeted pre-COVID volumes, and our outpatient
21 services remain committed to delivering telemedicine
22 in our community despite the technological and
23 financial challenges and disparities.
24 The outlook is not rosy.
25 We're facing another $9 million in cuts from
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1 the MRT II cut.
2 And although, thankfully, New York State has
3 reassured us that they will continue to support us,
4 we have no guarantee.
5 In addition, CMS, as you know, has continued
6 to cut funding to hospitals that care for Medicaid
7 patients.
8 At present, unless there is a change in this
9 system, we are facing probably an over 10 percent
10 operating loss which is not survivable.
11 We may not be alone, but as you heard today,
12 that will not reassure our staff or our patients or
13 our community if we have to close.
14 I'm going to state that very clearly:
15 A hospital and community that's been in the
16 middle of one of the worst pandemics on record will
17 not have a health provider in their community
18 anymore.
19 I do not believe the current health-care
20 system can survive the pandemic without changes.
21 Poor community hospitals and public hospitals
22 which depend primarily on government payers,
23 especially Medicaid, will not be able to make up the
24 losses.
25 SENATOR RIVERA: If you could finish your
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1 thought, Doctor?
2 DR. DAVID PEARLSTEIN: Yep.
3 Without a change we won't survive.
4 I just have two more comments, if you don't
5 mind.
6 SENATOR RIVERA: At this time [indiscernible
7 cross-talking] --
8 DR. DAVID PEARLSTEIN: The first comment is:
9 We need to make investments in -- we need to make
10 significant investments in technology because our
11 patients don't have access to high -- to Wi-Fi.
12 And we need to --
13 SENATOR RIVERA: Second?
14 DR. DAVID PEARLSTEIN: Yes, sir.
15 SENATOR RIVERA: And second?
16 DR. DAVID PEARLSTEIN: I'm just telling you,
17 the changes that need to be made are not pipe
18 dreams.
19 SENATOR RIVERA: Thank you.
20 DR. DAVID PEARLSTEIN: We are the wealthiest
21 nation on earth, and you know that.
22 We need to do this or we will not be able to
23 live with ourselves.
24 SENATOR RIVERA: Thank you, Dr. Pearlstein.
25 Followed up by Dr. Bonnie Litvack from the
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1 Medical Society of the State of New York.
2 DR. BONNIE LITVACK: Hi. I'm Bonnie Litvack,
3 president of the Medical Society of the State of
4 New York.
5 And I'd like to thank you on behalf of our
6 more than 20,000 physician, resident, and medical
7 student members for allowing me to testify today.
8 The COVID crisis has impacted the medical
9 profession, and been like nothing that we've ever
10 seen before.
11 The images of mass death and suffering are
12 going to stay with our physicians forever.
13 We -- through the efforts of all New Yorkers,
14 we were able to go from being a -- the center of the
15 pandemic to being a national model for containing
16 the virus.
17 And we would like to thank the governor and
18 the department of health for their strong
19 leadership.
20 I'd like to highlight a couple of things from
21 my written testimony.
22 One has to do with physician burnout, which
23 was a problem before the pandemic, but it's been
24 exacerbated with the pandemic.
25 We're seeing more stress, and we are
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1 concerned about more depression, suicides, and
2 posttraumatic stress disorder.
3 The physician community, Medical Society of
4 the State of New York is working with the hospitals
5 on physician wellness programs. And we've invited
6 them to join us and the AMA.
7 The Medical Society of the State of New York
8 has also started a peer-to-peer program, which is a
9 confidential program.
10 It allows physicians to speak to a peer and
11 have a non-judgmental discussion, and gain some
12 perspective. And, if needed, they can be directed
13 to treatment. And that program is up and running.
14 It's outside of the employer environment, and so
15 it's a safe space for physicians.
16 Next, I'd like to highlight the PPE issues,
17 which have already been talked about.
18 PPE was an issue early on in the pandemic,
19 but it is still an issue currently for physicians.
20 Our physicians, we did a survey recently that
21 showed that 72 percent of physicians said that they
22 were still having difficulty with PPE, and that they
23 had seen significant jumps, with nearly 40 percent
24 saying that the cost had to go up more than
25 50 percent to pre-pandemic levels.
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1 The ask here, is that you look at what other
2 states are doing, like California, which has worked
3 with their physician community to make sure that
4 their physicians have PPE and it's not impacting
5 patient care.
6 It is impacting patient care in New York.
7 Our survey showed that our physicians needed
8 to cut down on their patient-treatment capacity by
9 25 percent.
10 Next, I'd like to talk about restrictions on
11 delivering patient care, which has also been talked
12 about before here and mentioned.
13 The bans on elective surgery meant that
14 cancer patients often couldn't get surgery, and that
15 people couldn't get cancer screening. And some
16 portions of the state really had surges and were not
17 able to take care of them, while others didn't.
18 The ask here, is that if there is a second
19 surge, that the bans on elective surgery and
20 procedures, if needed, be region by region, and that
21 they not be just across the board.
22 The other issue with this, is that some of
23 our physicians wanted to volunteer, but because of
24 contract provisions, they were not able to volunteer
25 at other institutions when they were furloughed.
331
1 And, again, it would be in the best interests
2 of the public if those can be waived if there is
3 another surge.
4 The last issue I really want to talk about is
5 a scope of practice.
6 Many of our physicians and other health-care
7 providers during the surge were working outside of
8 their area of expertise and training. And this was
9 necessary because it was an all-hands-on-deck
10 approach.
11 That is why the liability protections were
12 initially put in place, and why, if we have another
13 surge, that these need to continue.
14 But we are not currently in a surge
15 environment right now, and we're concerned about
16 Executive Order 20255, which continues the waiver
17 for the statutory requirements for physician
18 supervision.
19 We are concerned about this because it's a
20 de facto scope of practice change that sort of
21 bypasses our state legislature.
22 And so, since we're not in a surge capacity
23 right now, we feel that that should be overturned at
24 the moment, and that the statutory requirements
25 should be restored as soon as possible.
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1 Just a couple of other little things that
2 were mentioned earlier were:
3 That we do feel that the -- we do need to see
4 increased federal funding.
5 And we also need to make sure that the
6 health-care provider pool is increased, and
7 telehealth is made permanent.
8 And, I thank you for your attention, and I'm
9 happy to answer any questions.
10 SENATOR RIVERA: Perfect timing, Doctor.
11 Thank you so much.
12 Next we will hear from Carole Ann Moleti.
13 And, Ms. Moleti, you have so many letters
14 after your name, so I salute you.
15 CAROLE ANN MOLETI: Thank you for the
16 invitation to provide testimony today.
17 I'm a certified nurse-midwife in
18 New York City, and I specialize in the care of women
19 at high psychosocial risk, who are at high risk of
20 pregnancy complications and poor outcomes.
21 They include a disproportionate number of
22 women of color and recent immigrants, and are
23 residents of all five boroughs, over 35 years of
24 practice.
25 The COVID-19 pandemic shredded the safety net
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1 we have cobbled together over all that time.
2 On or about March 13th of 2020, most
3 in-person visits were canceled and rescheduled as
4 telephone visits, which eventually became video
5 visits, with the exception of patients who had
6 abnormal results.
7 Pregnant women were seen for initial visits,
8 then again at 28 weeks, and then again between
9 36 and 40 weeks.
10 But in between that, many could not be
11 reached by telephone. And those without Internet
12 access could not avail themselves of video visits
13 which allowed the provider to do visual assessment
14 of general appearance, mood, and affect.
15 Patients were prescribed blood pressure
16 monitors and scales so they could provide reading on
17 subsequent telehealth visits. But with the
18 shortages, few were able to obtain them.
19 Many pregnant women went three or months --
20 three or more months without a visit, or registered
21 late in the second or third trimester of pregnancy.
22 This delay (video freezes) --
23 SENATOR RIVERA: Ms. Moleti --
24 CAROLE ANN MOLETI: -- the first time
25 (video freezes) --
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1 SENATOR RIVERA: -- you froze for about
2 five seconds there, and you are still -- you're now
3 refrozen.
4 CAROLE ANN MOLETI: -- patient --
5 Okay, I'm moving a little bit.
6 Is that better?
7 SENATOR RIVERA: Okay, now you're back on.
8 You were frozen for about 10 seconds.
9 CAROLE ANN MOLETI: Okay. Yeah, we have a
10 thunderstorm here, so I may have to move around the
11 room.
12 So testing was delayed, early recognition of
13 problems as well.
14 And for the first time in as long as I can
15 remember, patients were declined outpatient services
16 until they applied for Medicaid, but the offices had
17 been closed.
18 When patients did get into clinic, they
19 waited for hours.
20 We found many with undiagnosed or untreated
21 infections, fetal growth concerns, untreated anemia,
22 uncontrolled gestational diabetes.
23 Many were anxious or depressed, facing
24 social, financial, housing, or food insecurity.
25 Some were at risk of domestic violence and
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1 becoming homeless.
2 And some needed direct admission to the
3 hospital for moderate to severe preeclampsia.
4 We did perform some testing, and even minor
5 surgical procedures, in clinic, so as not to send
6 patients to the overburdened inpatient services or
7 emergency room.
8 On the labor-and-delivery unit, patients were
9 isolated from their support person until they were
10 in a private room, which sometimes took hours.
11 All of them labored wearing masks
12 (video freezes) --
13 SENATOR RIVERA: And we might have some
14 more --
15 CAROLE ANN MOLETI: -- and results were often
16 delayed.
17 Mothers who had any sign or symptom --
18 mothers who had any signs or symptoms or developed
19 fevers from obstetrical complications were separated
20 from their babies until COVID results, which
21 returned many hours later, disrupting initiation of
22 bonding and breastfeeding, and causing much
23 emotional distress.
24 Most patients were discharged early. And
25 though they were anxious to go home, often did not
336
1 keep follow-up appointments for incision care or
2 monitoring of blood pressure, bleeding, or
3 infection, which are the three main causes of
4 maternal morbidity and mortality, which is very much
5 in the news right now.
6 Many women were discharged on heparin to
7 prevent blood clots, which must be injected twice
8 daily.
9 Home-care visits for supervision of the
10 injections and evaluation of maternal and newborn
11 [indiscernible] or suspended due to the pandemic.
12 Social services were remote and not readily
13 available.
14 Few women wanted to return for postpartum
15 exams and family planning, and many were lost to
16 follow-up.
17 I did have some remarks prepared about the
18 lack of PPE, but I think that's been well covered,
19 so I think I'll stop there and let Dr. Pat Burkhardt
20 take over.
21 SENATOR RIVERA: Thank you, Ms. Moleti.
22 And, yes, next we will hear from
23 Dr. Pat Burkhardt, treasurer of the New York State
24 Association of Licensed Midwives.
25 DR. PATRICIA BURKHARDT: Good afternoon, all.
337
1 Glad to be here.
2 Somebody made a statement earlier on in these
3 testimonies that talked about a different kind of
4 thinking.
5 So I think I'm going to present to you all a
6 different kind of thinking, because, right now, it
7 has become very clear through this whole pandemic
8 operation that we have inherent contradictions in
9 our health-care system and structure, and we need to
10 rethink and reformulate, so that should we have a
11 future epidemic of some sort.
12 And we will. It's the one piece that
13 everybody seems to agree on when it comes to the
14 current pandemic.
15 So, basically, in a time of
16 infectious-disease epidemics, hospital resources
17 need to be used for those who are sick.
18 Now, despite what Carole said about some of
19 her clients and patients that she was seeing,
20 pregnancy and birthing are not sickness for the vast
21 majority of women.
22 That is a healthy process, normal physiologic
23 process, certainly that can go wrong at some point
24 for some women; thus, the need for the clinicians to
25 follow those women and be able to spot those
338
1 deviations from the norm.
2 But in the main, women, 85 percent, go
3 through pregnancy and childbirth as healthy, well
4 women.
5 In order to do that, we need to have a change
6 in the structure of health-care delivery.
7 And I know this is about hospitals, so let's
8 start with them, and this has already been said:
9 Hospitals are businesses, and I understand
10 that.
11 At the same time, patients are -- through the
12 hospital criteria, if you will, or model, patients
13 are a means to generate revenues.
14 And so we have to somehow get some balance
15 within the health-care structure and system, that,
16 in fact, there is some equity, not just on a racial
17 situation, but in a resource and a value-structure
18 system for health-care delivery to pregnant and
19 birthing women and families.
20 One of the ways to consider this is through
21 community-based -- or, community-based care
22 resources as part of an integrated health-care
23 system that need to be envisioned and created.
24 So I'm talking about the future.
25 I'm not talking about this current pandemic,
339
1 except for the lessons we have learned and the
2 realities we have encountered.
3 But the bottom line is, we need to have a
4 solidly constructed and process-based,
5 community-based, health-care system.
6 This critically includes midwives who lead
7 birth centers, a concept that passed into law
8 three years ago, but floundered in the DOH
9 regulation writing and implementation process, as
10 both Assemblyman Gottfried and Senator Rivera know.
11 Regulations were done, and finally, in
12 December 2019, but continued to be a barrier rather
13 than a pathway to opening birth centers.
14 And so, again, my ask, if that's the proper
15 phraseology, is that hospitals within this system
16 help foster.
17 And there were some efforts early on in the
18 pandemic because of the terrible burdens that were
19 put on families who couldn't have their support
20 person, who couldn't have anybody with them, during
21 their laboring process in the early days.
22 And so that, you know, Northwell was talking
23 about trying to set up, you know, an
24 out-of-hospital.
25 The bottom line is, if you're healthy and
340
1 only having a baby, and that's a big "only," but
2 it's still just having a baby, you don't want to go
3 into a den of germ-ridden reality that is a hospital
4 filled with COVID virus.
5 Just don't want to do that.
6 And as Carole mentioned, a lot of their
7 patients did not come follow-up -- back for
8 follow-up. They just didn't want to stay involved
9 at all.
10 Bottom line is, available clinicians at any
11 time in our health-care system have to work to their
12 strengths and the well-being of people seeking care,
13 be they sick or well.
14 So physicians do real well with sick because
15 their education, their skill set, is diagnosis and
16 treatment of disease. That's what they do, they do
17 it well.
18 Midwives, their knowledge and skill set is
19 the support, the encouragement, the education, the
20 counseling, of well women going through life's
21 processes that women go through, be it pregnancy, be
22 it delivery, having a baby; all of that.
23 One of the things that stymied me as I was
24 trying to -- wanted to talk more about this, is the
25 lack of data, that I could not access, could not
341
1 find, relevant to maternity-care services.
2 And I know many hospital services in
3 Upstate New York have closed; they have closed their
4 maternity units because of whatever reason.
5 And yet you can't find that data anywhere.
6 And when I was -- we were talking to DOH a
7 while ago, trying to get these regs written for the
8 birth centers, people at DOH were surprised that
9 there were hospitals that had closed their maternity
10 centers -- I mean, maternity units. Sorry.
11 And I have to stop because my time's up.
12 SENATOR RIVERA: Thank you very much,
13 Dr. Burkhardt.
14 And now for questions, leading off, the
15 Assembly.
16 ASSEMBLYMEMBER MCDONALD: I do not see any
17 questions as of yet, although the testimony was very
18 good.
19 SENATOR RIVERA: I will lead off, then, if
20 there are no assemblymembers.
21 So I wanted to, first of all, just for the
22 record, Dr. David Pearlstein, I appreciate you being
23 here, sir.
24 You lead an institution that's in the middle
25 of my district. We talked plenty in the height of
342
1 the crisis.
2 And as a representative of all the
3 health-care warriors that you lead in that amazing
4 institution, thank you for all that you did during
5 that time.
6 But to -- but -- but I -- but I definitely
7 want to linger on your testimony because, connected
8 with the prior panel, we're talking about the thing
9 that I just keep insisting, and that I wanted to
10 make sure that Dr. Zucker acknowledged this morning,
11 there are institutions that were in crisis before
12 there was a crisis.
13 And so you have institutions, like
14 St. Barnabas, which is a safety-net institution.
15 What is the percentage of people that you
16 serve who are Medicaid patients on a regular year?
17 DR. DAVID PEARLSTEIN: It's approximately
18 88 percent right now.
19 SENATOR RIVERA: 88 percent of your patient
20 base is Medicaid.
21 And so that -- and this is some of the
22 neediest ZIP Codes in The Bronx, some of the most --
23 so you have people who have all of the, you know,
24 high dia -- you know, high rates of diabetes, heart
25 disease, et cetera, et cetera, et cetera.
343
1 And so the question I'll ask you is like the
2 question that I asked of the commissioner as well,
3 as well as the last panel: Did you feel that, at
4 the height of the crisis, at the late March, early
5 April, the first three weeks of April, when things
6 were really, really, really, really bad, do you feel
7 that there was a calibration from the health
8 department and from the State to provide the
9 resources, the type of that your institution needed
10 and, hopefully, others like yours across the state?
11 DR. DAVID PEARLSTEIN: So, it's actually a
12 challenging question because, I'll tell, we -- we
13 all hands were on deck, and all of our staff and our
14 management were involved in this.
15 But the fact is, is that there was a lot of
16 communication. And we did get a lot of support from
17 Greater New York and from HANYS and from the State,
18 and from the City, for that matter.
19 And we did hit a critical moment, and I think
20 you and I spoke at that time as well, where we
21 were -- we were down to four ventilators, we were
22 running out of gowns.
23 And through my conversations with you, with
24 the City, and with the governor's office, we were
25 able to get the supplies that we needed.
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1 I think this hit us so hard and so fast that
2 nobody really was prepared.
3 And I wish that weren't true.
4 And, hopefully, when this comes back one day,
5 or another one comes, we will have learned from
6 this.
7 But even my own organization, who had a CMO
8 (a chief medical officer) who, back in January, was
9 telling us to lock down all of our N95s, because
10 he was watching the pandemic very carefully, he was
11 prescient. We made changes pretty early to protect
12 our inventory.
13 But I don't think any of us would have
14 thought we would have quadrupled our ICU beds.
15 I mean, we had a hundred and, I think,
16 nineteen intubated patients at some point. And,
17 generally, we just have about, you know, 28 to 30.
18 So it was tough; it was very tough.
19 SENATOR RIVERA: So, again, thank you for you
20 and everybody else that you lead in that amazing
21 institution.
22 Kind of biased in that regard.
23 I want to make sure that the -- that both,
24 Ms. Moleti and Dr. Burkhardt, I am glad that you're
25 part of this conversation, particularly because
345
1 there have been -- we have -- and the reason we
2 invited you, because we wanted to make sure that
3 we -- the plight of women dying in childbirth is --
4 as you said, Dr. Burkhardt, childbirth is not a
5 disease, so it should not lead, but, unfortunately,
6 sometimes it does, and very much, unfortunately, the
7 numbers talk about the maternal mortality amongst
8 women of color, particularly Black women, is
9 incredible concerning.
10 So your testimony today about the impact of
11 COVID-19 on what was already a challenging situation
12 is important.
13 If you had a couple of things, and I just
14 have a minute --
15 I'm sure that maybe some of my colleagues,
16 hopefully, will ask you as well so that you can
17 expand.
18 -- but just for the last minute, what are
19 some of the policies you think, top of the line,
20 that we need to focus on as it relates to averting
21 this type of situation amongst mothers in the years
22 to come?
23 DR. PATRICIA BURKHARDT: Are you asking about
24 how -- I mean, basically, decreasing the mortality,
25 for sure.
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1 The morbidity in the communities of color?
2 SENATOR RIVERA: Yes, ma'am.
3 DR. PATRICIA BURKHARDT: I think that -- you
4 know, my experience, and I worked at Presbyterian
5 for years, I taught at NYU for years, bottom line
6 is, I think part of it is just inherent racism, as
7 we all are becoming aware.
8 And a lot of people do not believe that
9 exists. And those who don't believe it exists have
10 not looked into their own souls well enough yet, in
11 my view.
12 But the bottom line is, women of color, in my
13 experience, are not treated well in institutions.
14 And they're cared for not necessarily by the best
15 providers.
16 Any woman who goes to Lenox Hill or
17 Mount Sinai gets an attending physician. Any
18 Medicaid patient gets a resident. Residents are
19 first-year, second-year, third.
20 There's a whole inherent, in my view,
21 mismatch of what the client's/the woman's needs are
22 and what the institution provides her in terms of
23 care that she gets.
24 Midwives do a better job because they are
25 licensed providers. They're not learning to be
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1 midwives.
2 SENATOR RIVERA: Thank you, ma'am.
3 Thank you for your testimony today. And,
4 hopefully, some of my colleagues follow up. But I'm
5 glad that we have your written testimony to include
6 into the record.
7 That is my time.
8 Assembly?
9 ASSEMBLYMEMBER MCDONALD: We'd like to
10 recognize Chairman Gottfried for 5 minutes.
11 ASSEMBLYMEMBER GOTTFRIED: Yeah, I have one,
12 maybe two, questions for Dr. Litvack.
13 You talked about making, quote/unquote,
14 telehealth permanent.
15 I mean, we enacted an extraordinarily broad
16 telehealth statute quite a number of years ago.
17 We passed something a couple of months ago
18 that seemed aimed at making -- making it more
19 eligible for Medicaid coverage.
20 And I never had it quite clear, but there
21 was, apparently, a question of whether federal
22 Medicaid covers all telehealth services or not.
23 Can you maybe explain what it is that you
24 think we need to make permanent that isn't already
25 permanent?
348
1 DR. BONNIE LITVACK: So I think that the
2 State has done a fairly good job on that. And we
3 appreciate the legislation that was just passed in
4 the month of May or June on the State side.
5 But there's still more work to be done
6 because a lot of our patients in New York are
7 covered by ERISA plans, and so those are under
8 federal. And many of those larger companies are
9 ending their telehealth coverage as of the --
10 September, October.
11 And also, on a national level, it's not clear
12 that those are going to be made by the federal
13 government permanent.
14 The other thing that's, you know, very
15 important here is that we need to make sure that,
16 when we have this within the state and outside of
17 the state, that there's payment parity.
18 And so by that I mean that, you know, the
19 physicians and other providers are paid the same
20 whether a patient is in the office or whether
21 they're on telehealth.
22 ASSEMBLYMEMBER GOTTFRIED: Okay. If you --
23 DR. BONNIE LITVACK: And the last thing was,
24 what we enacted in New York I believe was for
25 Medicaid patients only.
349
1 ASSEMBLYMEMBER GOTTFRIED: Yeah.
2 If MSSNY has or could put together a memo on
3 that whole topic of what it is you think New York
4 needs to do differently to give better coverage for
5 telehealth, that would be very helpful.
6 And if you can just email that to me.
7 And just, can't resist, on the question of
8 the restrictiveness of ERISA plans, when the
9 New York Health Act becomes law, we won't have to
10 worry about ERISA plans.
11 So you can just make that as a note to self.
12 DR. BONNIE LITVACK: Right.
13 Yes, we're happy to send along a memo to you
14 on all the information on telehealth.
15 Thank you.
16 ASSEMBLYMEMBER GOTTFRIED: And if I've got
17 maybe a minute more, you talked about
18 scope-of-practice issues in -- I guess, in some of
19 governor's executive orders.
20 DR. BONNIE LITVACK: Uh-huh.
21 ASSEMBLYMEMBER GOTTFRIED: Can you just say a
22 little more about what those were?
23 DR. BONNIE LITVACK: So in the governor's
24 executive order, he had suspended the statutory
25 requirements for physician supervision for nurse
350
1 practitioners, nurse anesthetists, and physician
2 assistants.
3 And those -- he just recently re-upped on
4 those, and so that is continuing.
5 And so we're concerned about that, as I said,
6 because it's becoming that it is a de facto
7 scope-of-practice change on a broad level, and we're
8 seeing things that are not related to COVID.
9 We've had a -- some of our physicians have
10 reported that surgical centers and some dental sites
11 have seen some nurse anesthetists that are applying
12 to be the sole anesthesia provider at these
13 outpatient offices.
14 And that's not clearly what this was intended
15 to do. This was intended to be for COVID.
16 ASSEMBLYMEMBER GOTTFRIED: Okay. Thank you.
17 That's it for me.
18 SENATOR RIVERA: All right.
19 We're good in the Assembly?
20 ASSEMBLYMEMBER MCDONALD: We're good in the
21 Assembly.
22 SENATOR RIVERA: We're good in the Senate.
23 Thank you all for your patience, and for
24 being here today, and thank you for the work that
25 you do every day to keep New Yorkers healthy and
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1 safe.
2 DR. DAVID PEARLSTEIN: Thank you.
3 SENATOR RIVERA: Thank you, folks.
4 Next panel, we'll be joined by
5 Ralph Palladino, second vice president of DC37;
6 Debora Hayes, upstate area director of
7 CWA District 1;
8 And, Fred Kowal -- I hope I'm pronouncing
9 that name correctly -- statewide president of
10 United University Professions.
11 We'll wait for them to pop on here.
12 ASSEMBLYMEMBER GOTTFRIED: Uh, yes, am I --
13 SENATOR RIVERA: You are. We can hear you,
14 sir.
15 ASSEMBLYMEMBER GOTTFRIED: Okay.
16 Do each of you swear or affirm that the
17 testimony you're about to give is true?
18 FRED KOWAL: I do.
19 ASSEMBLYMEMBER GOTTFRIED: Everybody?
20 Okay. Fire away.
21 SENATOR RIVERA: All right.
22 So we have Ralph Palladino -- seems that we
23 are missing Mr. Palladino for the moment.
24 Since we have Mr. Kowal --
25 Oh, we have Debbie Hayes.
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1 Good.
2 So, Ms. Hayes, did you hear the
3 Assemblymember's question?
4 DEBORA HAYES: I don't believe I did.
5 ASSEMBLYMEMBER GOTTFRIED: Oh.
6 Do you swear or affirm that the testimony
7 you're about to give is true?
8 DEBORA HAYES: Yes.
9 ASSEMBLYMEMBER GOTTFRIED: Okay.
10 SENATOR RIVERA: All righty.
11 So until -- so, Ms. Hayes, why don't you lead
12 us off.
13 DEBORA HAYES: Okay. I can do that.
14 Good afternoon.
15 I'm Debbie Hayes, the Upstate New York area
16 director for the Communication Workers of America.
17 And I'd like to thank the Senate and Assembly
18 committee members for allowing me the opportunity to
19 testify on behalf of the 15,000 health-care workers
20 that CWA has in New York State.
21 I want to start by acknowledging, and
22 thanking, the tens of thousands of brave and
23 dedicated health-care heros in New York who have
24 been on the front lines of this devastating battle
25 against COVID-19, a battle that many of them are
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1 still fighting.
2 CWA has reached out to hundreds of our
3 members as we debrief this crisis, and they've
4 described to us the conditions that they worked
5 under through the high inpatient days of the
6 spring 2020.
7 Members told us of intense pressure for
8 caring for patients with a disease they knew little
9 about, hoping they were providing the right care and
10 treatments.
11 Members were begging for the right personal
12 protective equipment, and were just hoping to keep
13 themselves and their families safe from disease.
14 Members needing, on a daily basis, more help
15 than was available.
16 Members who wrote "goodbye" letters from the
17 dying, FaceTime-worried family members for one last
18 visit, and wrapped more bodies for the morgue than
19 many saw in an entire career.
20 Members who were forced to work, once they
21 were diagnosed with COVID-19, as long as they were
22 not showing symptoms.
23 We have a workforce that is exhausted,
24 traumatized, and suffering from posttraumatic stress
25 syndrome.
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1 Our takeaway, is that our issues must be
2 dealt with before a second surge in the coronavirus
3 is upon us.
4 Throughout the crisis we have been greatly
5 concerned for the health and safety of our
6 front-line workers.
7 While we are grateful for the
8 administration's diligent efforts to increase the
9 supply and distribution of necessary PPE at our
10 health-care facilities, even in May, three months
11 into the pandemic, many of our health-care workers
12 caring for these patients were still facing
13 shortages, and being forced to operate under the
14 CCD's supply optimization guidelines.
15 As you can imagine, this put enormous stress
16 and worry on members who, again, had that fear for
17 themselves, their patients, and their families.
18 While the pandemic stretched our hospital
19 system to a point we were not prepared for, many of
20 the issues of COVID-19 exacerbated what have been
21 longstanding issues in our hospitals.
22 In order to protect our health-care workers,
23 our hospitals, and to ensure the best quality of
24 care for all New Yorkers, we need a massive
25 investment in our health-care system, in our
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1 hospitals, and in our health-care workers; an
2 investment in the state.
3 I'm running out of time, and I want to make
4 sure that I get to a point that is of significance,
5 and that is safe staffing.
6 So while there were steps taken that were
7 necessary because of the financial toll on
8 hospitals, in order to cut costs, we now have
9 members that are being laid off and staffing levels
10 have been cut.
11 And we need more staffing, not less.
12 For over a decade we've been fighting for
13 mandated patient-to-health-care-worker ratios
14 because understaffing in the hospitals was already
15 an immediate patient crisis.
16 COVID-19 turned the crisis into a
17 catastrophe.
18 We know that people have died because we
19 didn't have enough staff to care for them.
20 The issue of understaffed and underresourced
21 hospitals is not new.
22 As a union that has represented health-care
23 workers in the state for over 50 years, we hear
24 daily from our members about the impossible choices
25 they have to make in terms of, how to do enough for
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1 patients, how to get care delivered, without enough
2 staff.
3 And (another audio/visual feed interruption)
4 a year, documenting unsafe staffing levels in our
5 hospitals.
6 I have a significantly longer written report
7 that I've submitted, and I'll stop there because I'm
8 out of time.
9 SENATOR RIVERA: Thank you, ma'am.
10 It will be in the record.
11 Now, Mr. Palladino, we did hear you there for
12 one second, but we muted you because Ms. Hayes was
13 not done.
14 So if you can figure out how to unmute
15 yourself, there should be a window appearing in your
16 screen.
17 Oh, well, Mr. Palladino went away.
18 I guess he pressed the wrong button.
19 Mr. Kowal, I'm not sure if I'm pronouncing
20 your name correctly.
21 FRED KOWAL: Sure. I can go ahead.
22 Thank you, Senator.
23 And thank you to all the distinguished
24 members of the New York State Legislature.
25 I'm Dr. Fred Kowal, president of
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1 United University Professions.
2 And that's fine, Senator. Lots of different
3 ways I've heard my name pronounced, and it's all
4 good.
5 I want to thank you, first and foremost, for
6 holding this hearing, but also for your long support
7 for UUP, for our 37,000 members, and particularly
8 the 13,000 who work at our academic medical centers
9 at the University of Buffalo, at Upstate at
10 Syracuse, at Stony Brook, and especially at
11 Downstate in Brooklyn, which, as you know, was a
12 COVID-only facility at the peak of the pandemic's
13 first wave.
14 As a matter of course, actually, Stoney Brook
15 turned into a COVID-only hospital as well, for all
16 intent and purposes, because of the caseload that
17 erupted in Suffolk County.
18 I would -- I'm submitting written testimony.
19 I really just want to emphasize a couple of
20 key points to you today. You have heard a number of
21 these themes.
22 I just want to bring them into focus in terms
23 of our members and the issues that we are facing.
24 First, I think there's no question about it,
25 we all know that there was a total lack of
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1 preparedness for the COVID pandemic that struck the
2 United States and New York.
3 In the case of the SUNY hospitals, the three
4 SUNY hospitals at Upstate, Downstate, and
5 Stony Brook, 10 years of underfunding, which,
6 basically, has been kept in place by the
7 legislature, but continuous efforts by the governor
8 to eliminate the State subsidy for these hospitals,
9 created conditions where our professionals could not
10 do the necessary work. But they did keep 3,000 of
11 COVID patients alive through the pandemic while also
12 suffering losses among our own ranks.
13 The reality is, the lack of preparedness
14 pointed out that there must be an investment in the
15 SUNY hospitals in order for us to be prepared to
16 treat patients, but then also to provide the medical
17 education.
18 For years UUP has worked with the state
19 legislature to ensure that SUNY hospitals get the
20 subsidy that they must get.
21 After all, these hospitals bear the burden of
22 fringe benefits costs and debt servicing unlike any
23 other agency in New York State.
24 Those are huge costs, the subsidy is
25 necessary.
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1 But, also, the medical education that our
2 future physicians and health-care providers are
3 getting at these medical schools has never been more
4 important.
5 What is clear we didn't have the personnel
6 necessary to treat the patients, and, furthermore,
7 the patients that we know are coming.
8 That's why, for the past two years, UUP has
9 fought hard for the development of new programs,
10 including the Medical Education Opportunity Program,
11 a version of EOP, to bring in students from
12 underrepresented communities of color into these
13 medical schools, so that they can become the
14 professionals of the future to treat patients across
15 New York where they are desperately needed.
16 We also need resources, obviously, as you
17 have heard, because of this severe lack of PPE.
18 Our union went so far as to purchase PPE for
19 our physicians and our health-care providers because
20 they were risking their lives.
21 And if it wasn't for the PPE provided by UUP,
22 by the American Federation of Teachers, by NYSUT,
23 for our front-line workers, there would have been
24 more lives lost.
25 The final point that I want to make is also
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1 on the issue of justice.
2 As much as our members put their lives on the
3 line, it is horrible that, in fact, none of those
4 workers have received any additional payment,
5 whether you want to call it "hazardous-duty pay" or
6 not, while they have seen every other hospital in
7 New York City and across Long Island pay their
8 people, and they should be paid.
9 What I am asking is whether or not we will
10 tolerate a real two-class system, where some of the
11 front-line employees get paid, but others do not.
12 We owe it to our colleagues, to our
13 health-care providers, who are saving lives.
14 We know the second wave is coming.
15 I've heard previous witnesses talk about the
16 psychological burdens.
17 We have seen it in our own members.
18 Without the compensation, without the
19 financial support and the resources, there will be
20 tragic burdens having to be borne by health-care
21 providers across this state.
22 So I thank you once again for all your
23 support over the years.
24 We need to do massive amount of work on
25 health care in New York State, facing this pandemic,
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1 and the future of health-care in New York State.
2 Thank you.
3 SENATOR RIVERA: Thank you, Mr. Kowal.
4 And last, but not least, so, Mr. Palladino,
5 there you go, you are now on.
6 Nothing is wrong. We can hear you.
7 RALPH PALLADINO: Yes, thank you.
8 Sorry for the delay.
9 Ralph Palladino, Local 1549, District
10 Council 37.
11 The Black Lives Matter protests and the
12 COVID-19 pandemic has focused the light on the
13 health-care disparities in New York City.
14 The New York City Health and Hospitals
15 Corporation plays a central role in these
16 communities, in saving lives and providing decent
17 jobs.
18 This, in turn, helps keep the local economy
19 alive.
20 The heroic work of our H&H front-line
21 health-care workers includes 5,000 Local 1549
22 clerical members, also -- who also live in the
23 communities they serve.
24 They are the first to greet the COVID-19
25 patients upon entry into the facilities.
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1 They must be recognized and rewarded
2 properly.
3 The duties and functions are key to
4 generating income for H&H and the well-being of the
5 patients.
6 [Inaudible.]
7 SENATOR RIVERA: Mr. Palladino, you have
8 muted yourself.
9 RALPH PALLADINO: Over 8,000 COVID patients'
10 lives were saved in H&H facilities after being
11 admitted and successfully discharged.
12 Overcrowding did exist in most institutions,
13 and 850 COVID patients had to be transferred because
14 of this across the system. The system was able to
15 absorb them.
16 Clericals performed registration duties,
17 taking 15- to 20-minutes' face-to-face contact with
18 patients entering the system.
19 Their work generates medical records and
20 gathering insurance information.
21 Outpatient counselors assist patients in
22 getting health insurance.
23 The current plans to open -- reopen are
24 inclusive of the needs of clerical employees.
25 They have been provided proper PPE, masks,
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1 and goggles, have been treated equally, Plexiglas,
2 and other things, to help their safety and health in
3 the crisis.
4 They also were provided child care during the
5 crisis.
6 The administration of H&H and the union have
7 been working together cooperatively, and when issues
8 have come up, we have been able to deal with them
9 internally.
10 Despite this, our members have experienced
11 depression, felt stress, burnout, and experienced
12 tears because patients were dying.
13 If not for the H&H's need for employees, the
14 employee -- employee staff, because there are staff
15 shortages, they had to take -- I'm sorry.
16 If not for -- Health and Hospitals had to
17 hire private temps to take care of the areas that --
18 because of the short staffing of the clerical staff.
19 And them doing that kind of work, our kind of
20 work, is problematic.
21 Now, H&H has experienced a $1.1 billion loss
22 due to the crisis.
23 The system had to take into account staffing,
24 supplies, and space utilization.
25 Traditional Medicaid rates were used to pay
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1 the costs of care. And, of course, we know that
2 they don't. They pay about $100 less than they
3 should be.
4 More budget cuts will be deadly for the
5 system.
6 Calls by some to reduce public services and
7 furloughing laid-off workers, especially in public
8 hospitals, is wrong.
9 The State needs to step up and help and
10 assist our public hospitals.
11 The distribution of funding has always been
12 unfair to public hospitals.
13 I've been at this for 25 years, and it's
14 always been that way.
15 Underfunded hospitals had three times more
16 COVID-19-related fatalities than others.
17 The state budget passed April 1st meant a
18 $200 million cut to H&H's budget.
19 We can expect more of a cut in the State's
20 "savings" allocation plan.
21 H&H has an administrative overhead of
22 1 to 3 percent.
23 1 to 3 percent only.
24 Over the years, the system has downsized
25 severely, cut beds, and Local 1549 has cooperated
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1 with them to streamline finances.
2 And so what the answer could be, is the fact
3 that, looking at the state of the economy, is that
4 the billionaires in New York State, since March,
5 apparently, increased their wealth by $77 billion.
6 And you're telling us that they can't -- that
7 they cannot afford to pay in taxes to help more for
8 the state economy and for health care?
9 Business journals, politicians, and pundits
10 say these rich people will leave the state if taxed
11 more.
12 Studies, like the one in Stanford, show
13 that's not true.
14 Another poll shows -- does not show that
15 people leave because of taxes; it's because they
16 seek other jobs.
17 So, in summary, H&H system holds the key to
18 lessen health disparities in the city.
19 It's been, and will continue to be, the
20 epicenter of the fight to protect the public health.
21 This is especially true, given the collapse
22 of the employer-based health-care system.
23 H&H helps those who need the help regardless
24 of their ability to pay, including immigrants.
25 SENATOR RIVERA: Mr. Palladino, if could you
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1 wrap up, since your time has expired.
2 RALPH PALLADINO: Okay.
3 And so we cannot afford to lose funding with
4 an overhead of just 1 percent.
5 We need the help.
6 Our members are asking:
7 Where is the shared sacrifice in this crisis?
8 We are not properly compensated, face layoffs
9 and disease, while the rich and corporations don't
10 even pay their fair share of taxes.
11 Thank you.
12 Sort for delay and mixups.
13 SENATOR RIVERA: You're quite welcome, sir.
14 We'll lead off in the Senate.
15 I'll recognize myself for 5 minutes.
16 Thank you all for being here.
17 We obviously had a panel earlier of workers
18 as well.
19 And this is a panel that covers workers all
20 across the state as well.
21 I wanted to give you a -- an opportunity to
22 also answer the question, I've asked it a couple of
23 times.
24 And I want you to give me a perspective from
25 the workers as it relates to the changes,
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1 particularly at the height of the crisis, so, late
2 March, early April, so first three weeks of April,
3 when there was such a need in safety-net hospitals
4 and places that take care of people who are of poor
5 working class and people of color, and these are the
6 places that were most in need where most of the
7 deaths were happening.
8 I'm just really trying to assess, since
9 this -- these hearings, as I've said many times,
10 are, both, about accountability, but
11 forward-looking, what are the things that we need to
12 do in policy-wise, the calibration that occurred
13 from the State, as far as resources to institutions
14 that required the help at the height of the crisis.
15 So from the workers' perspective, could you
16 tell me a bit about how you felt the State managed
17 that; whether they calibrated correctly during those
18 times, to make sure that these institutions had the
19 resources necessary to be able to serve the people
20 who they serve?
21 RALPH PALLADINO: One thing I would say, if
22 you don't mind, is that, if had the State had been
23 fair in terms of the way they treat the
24 New York City Health and Hospitals, and also the
25 other smaller community hospitals, over the last
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1 10, 15 years, maybe New York City Health and
2 Hospitals and these community hospitals would have
3 been able to take care of the situation much better
4 than they did.
5 The crisis hit us slowly, but fast. Right?
6 So the thing is, had we been better prepared
7 over the years, instead of cuts, cuts, cuts, cuts,
8 and pressure, and, internal, having to reorganize
9 and downsize, we would have been in a better
10 position to deal with the situation.
11 That's the only thing I can say.
12 I can't speak to particulars between the
13 State and the City and Health and Hospitals.
14 SENATOR RIVERA: Understood.
15 Any comment from either folks?
16 Go ahead, Ms. Hayes. We can't hear you. If
17 you could unmute yourself, please.
18 DEBORA HAYES: Mute?
19 SENATOR RIVERA: There you go.
20 DEBORA HAYES: The majority of the members
21 that CWA represents in health care are in the
22 Upstate New York area.
23 And the procurement of PPE was an ongoing
24 battle throughout the peak of the crisis.
25 So our facilities had people, full-time,
369
1 trying to get N95s, gowns, testing -- components
2 of the testing that needed to be done.
3 And I don't think that that ever let up.
4 I know that they were required to report to
5 the State what they had in terms of PPE, and how
6 fast they were going through what they had.
7 But I don't know that the State was ever
8 fully responsive to the needs, because we never felt
9 the kind of relief that we were looking for.
10 SENATOR RIVERA: Mr. Kowal, do you want to
11 chime in?
12 FRED KOWAL: Yes, Senator.
13 As I mentioned, the union, we had to dig into
14 our own resources to buy PPE.
15 And -- but we do -- I do know that when we
16 did reach out to the governor for assistance in the
17 case of Downstate, first and foremost, they did all
18 they could to get the PPE that was necessary. The
19 same thing with the ventilators.
20 The difficulties that we encountered, and
21 I could tell you horror stories, of trying to,
22 literally, deal with middle-level businesses who
23 were trying to find N95s anywhere in the country,
24 and for that matter, anywhere in the world.
25 We spent weeks, literally, trying to track
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1 down PPE. And we also know that the State had the
2 same difficulties.
3 This was a national catastrophe, and I think
4 what we tried to do was assist our members the best
5 we could.
6 SENATOR RIVERA: But I just -- the last thing
7 I want to do is just underline really quickly,
8 I just want to make sure, because Mr. Palladino's
9 point about the fact that there's -- this is a
10 long-term thing, that there was a long --
11 long-existing -- you know, that this is not just
12 something that happened now. There was something
13 that [indiscernible] for a long time.
14 You are all in agreement with that, I figure?
15 FRED KOWAL: Absolutely.
16 DEBORA HAYES: Yes.
17 There's no question in our hospitals to deal
18 with a surge and a pandemic to the extent that we
19 had to deal with it.
20 We have been cut so during the years, our
21 staff is so bare-boned, that a crisis like this, a
22 pandemic like this, immediately pushes you into
23 crisis.
24 And it's the workers -- the patients and the
25 workers that always bear the brunt in this
371
1 circumstance.
2 SENATOR RIVERA: Thank you.
3 My time is expired.
4 Back to the Assembly.
5 Thank you all.
6 ASSEMBLYMEMBER MCDONALD: We will to go our
7 chair, Mr. Richard Gottfried.
8 ASSEMBLYMEMBER GOTTFRIED: Thank you.
9 You know, it's striking how on so much of the
10 really compelling testimony that all of you have
11 given today, it is so strikingly tale-of-two-cities
12 different from what so many other witnesses have
13 testified.
14 One point of striking difference that I'd
15 like to explore with you, as I have with some other
16 panels:
17 All of the trade association people who
18 testified at our hearings on long-term care, days
19 ago, and today's hearing, the trade associations
20 have all extolled the efforts of the Cuomo
21 administration to reach out with them on a,
22 practically, daily basis, to consult with them, to
23 hear their input, to work things out, et cetera.
24 And it's been striking to me that none of the
25 labor unions, none of the consumer advocacy groups,
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1 have said anything like that.
2 And I assume -- correct me if I'm wrong --
3 that that's because you were not brought in for that
4 kind of constant consultation and cooperation that
5 management was offered.
6 Am I right on that?
7 RALPH PALLADINO: [Indiscernible], if you
8 don't mind, New York City is a little bit different.
9 I mean, we worked very well with the people
10 in the New York City Health and Hospitals.
11 The City administration and DC37, you know,
12 always in touch.
13 So, you know, that's a little bit different.
14 We don't really hear from the governor
15 directly in terms of that.
16 But I will say this:
17 Medicaid dollars need to follow the Medicaid
18 patients.
19 Medicaid reimbursement rates need to meet the
20 costs of care.
21 The well-off empires in New York City are
22 getting the lion's share of the money, and they have
23 for years.
24 This continues now.
25 We had no representation on the last MRT that
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1 just took place. None at all.
2 So we had no stake in terms of the direction
3 of the cuts that took place back in -- April 1st,
4 except to protest against them and advocate.
5 So, that's all I can say.
6 I am very proud of the governor, the way he
7 has acted and held things together for the state,
8 and spoke up against the Trump administration and
9 the things that they're trying to do to the state.
10 So I am not here being anti-governor.
11 My point is, that there's good and bad that
12 we need to deal with, and I should say,
13 disagreements and agreements.
14 But that's all I can say on the issue.
15 ASSEMBLYMEMBER GOTTFRIED: Thank you.
16 DEBORA HAYES: I would also say that, I have
17 looked back on the work done in New York State, and
18 am extremely proud to have been a part of the effort
19 to bring us and our rates down to where they are
20 today.
21 I speak because I feel that there will be a
22 second surge, or another pandemic, that we will have
23 to deal with, and we should be prepared.
24 I think that the workers or the unions
25 representing the workers should have regular access
374
1 to the administration because, if there's any
2 question as to what's going on on the ground, the
3 people that are delivering the care every day are
4 the ones that are going to be able to give you the
5 best information.
6 FRED KOWAL: And, Mr. Chairman, I would say
7 that, in the case of the SUNY hospitals, ultimately,
8 you know, to put it bluntly, they are the governor's
9 hospitals.
10 They are State hospitals, operated by SUNY.
11 And for the time that I have been UUP
12 president, since 2013, I have always felt that we
13 have been on our own, working with the legislature,
14 to try to defend these institutions.
15 There's been a lack of advocacy on their
16 behalf by SUNY.
17 And the governor has not been an ally and a
18 supporter of the hospitals, and I've never
19 understood why.
20 Their role is central during this pandemic,
21 they have proven their worth.
22 We need to work together to make sure that
23 these institutions continue to serve the public, and
24 last.
25 For that, we need everybody at the table.
375
1 And we are eager to work with anyone to build
2 a strong future for them.
3 ASSEMBLYMEMBER GOTTFRIED: Thank you.
4 SENATOR RIVERA: All righty.
5 We do not have members of the Senate to ask
6 questions.
7 ASSEMBLYMEMBER MCDONALD: We have one member
8 of the Assembly, and that would be I.
9 So I will just thank all of our panelists for
10 their testimony. It's been instructive. It's
11 always been collaborative and supportive.
12 It's not about bashing, but recognizing the
13 issues and recognizing solutions.
14 Fred, a couple weeks ago, Fred, we were able
15 to join a panel with the higher-ed panel. And, you
16 know, there's some consistent threads here, which
17 indicates to me that the problem is still there.
18 But the hazard pay, and you mentioned,
19 rightfully so, that the privates and non-profit
20 hospitals have paid it, although we heard on similar
21 panels earlier, it took time and effort.
22 Obviously, because it's a State-run hospital,
23 the State probably hasn't come up with that.
24 But can you give me a sense of comparability,
25 what are we talking about in regards to dollars?
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1 If you were to say, here's what they're
2 getting at other hospitals, can you quantify that
3 into what that would be?
4 FRED KOWAL: Yeah. What we can tell you, in
5 part, because of the good work that all of the
6 unions, specifically now, right now, we've had good
7 activism at Sony Brook, where, SEIU, that represents
8 the South Hampton unit at Stony Brook, and UUP,
9 CSEA, PEF, have all joined together.
10 And then, also, of course, we have very
11 strong advocates at Downstate.
12 The combined numbers look to be around
13 9,000 employees that were front line and, thus,
14 deemed to be eligible.
15 And what we are asking for is what, you know,
16 has been typical at the Northwell facilities, and
17 that is, basically, around a 2500 bonus.
18 So if you do the math, you get an idea as to
19 what we are talking about.
20 It is not an exorbitant amount of funds.
21 We are just asking for what others have
22 received in a similar sort of work environment, to
23 put it simply.
24 ASSEMBLYMEMBER MCDONALD: [Indiscernible],
25 and I thank you.
377
1 And thanks to all of you.
2 And it goes without saying, and, tomorrow, if
3 you guys are looking for something else to do, we
4 will be having a labor hearing tomorrow, which our
5 committee will be participating.
6 But, to me, you know, unions have been very
7 strong representatives of our workforce.
8 But you being able to come to their time in
9 need with PPE when it wasn't available, that's very
10 meaningful, and you've done great work.
11 Thank you.
12 And with that, Mr. Chair, I think the
13 Assembly is ready to rest.
14 SENATOR RIVERA: As is the Senate.
15 We still have two more panels, but we will
16 have the last 10-minute break of the day before we
17 power through to the end.
18 So --
19 RALPH PALLADINO: On behalf of our members,
20 I want to thank you for inviting, by the way.
21 SENATOR RIVERA: Absolutely.
22 ASSEMBLYMEMBER GOTTFRIED: You're very
23 welcome.
24 SENATOR RIVERA: Okay, folks, 10-minute
25 break.
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1 We will be back to get this thing done.
2 (A recess commences.)
3 (The hearing resumes.)
4 SENATOR RIVERA: Good afternoon, everyone.
5 There's an alarm going off behind me.
6 I don't know if you can hear it, but, it's annoying
7 me, so it might be annoying you.
8 There you go.
9 We're going to power through the last couple
10 of panels.
11 The next panel will be:
12 Catherine Hanssens, Center for HIV Law and
13 Policy;
14 Jessica Barlow, senior staff attorney,
15 Disability Rights New York;
16 And, Marcus Harazin, coordinator, patient
17 advocates program, for the New York Statewide Senior
18 Action Council.
19 ASSEMBLYMEMBER GOTTFRIED: Okay. And do each
20 and every one you swear or affirm that the testimony
21 you're about to give is true?
22 MARCUS HARAZIN: Yes.
23 JESSICA BARLOW: I do.
24 CATHERINE HANSSENS: Yes.
25 ASSEMBLYMEMBER GOTTFRIED: Okay.
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1 SENATOR RIVERA: All right.
2 Ms. Catherine Hanssens, please lead us off.
3 CATHERINE HANSSENS: On behalf of the
4 Center for HIV Law and Policy, I thank you for
5 powering through, as Senator Rivera mentioned, and
6 for the opportunity [indiscernible] --
7 (Another audio feed interruption.)
8 CATHERINE HANSSENS: I'm hearing voices.
9 Should I continue?
10 SENATOR RIVERA: You should absolutely
11 continue.
12 CATHERINE HANSSENS: The COVID epidemic has
13 laid bare what many New Yorkers living on the
14 margins already knew: That in times of crisis,
15 ad hoc decisions about who gets what care do not
16 produce equitable access to life-saving services.
17 Assemblymember Kim's earlier questions about
18 the many requests for guidance from the department
19 of health I think are completely on point.
20 When the call was for guidance on ventilator
21 access and emergency triage, Commissioner Zucker
22 refused to respond.
23 New York's guidance on ventilator
24 distribution during pandemics has serious gaps and
25 is insufficient to protect the lives of people with
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1 disabilities.
2 They address only the allocation of
3 ventilators, which are not the only form of
4 essential care.
5 COVID-19 patients living with disabilities
6 need assurances of equal access to other respiratory
7 therapies, medications, critical-care beds, and
8 staff time, which current guidance fails to protect.
9 Professional hospital associations used the
10 occasion of a major epidemic to pursue legislation,
11 giving them near total exemption from any form of
12 liability, which I think is an odd priority, in view
13 of the massive medical mistrust common among many
14 people of color who were disproportionately affected
15 by this.
16 New Yorkers need assurances that, in times of
17 scarcity, laws that prevent discrimination on the
18 basis of age, disability, race, and gender will
19 apply to the provision of critical health care.
20 The right time to fix protections for
21 vulnerable New Yorkers during an emergency is before
22 that emergency arises, and ensure that the resulting
23 policy is comprehensive and includes input from all
24 stakeholders.
25 The fact that New York avoided a
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1 ventilator-rationing crisis during the first wave of
2 COVID-19 is no reason to not act with urgency to fix
3 this now.
4 Indeed, it is likely that we will again
5 confront serious resource-allocation issues through
6 either a COVID-19 resurgence or another lethal virus
7 in the near future.
8 Seeing no buy-in or action from
9 Commissioner Zucker, we propose that the legislature
10 consider legislation, such as, codifying these
11 rights, the rights to be free from discrimination,
12 and the existing Hospital Patients' Bill of Rights.
13 Individuals must have confidence that, when
14 they enter hospitals, they will not have personal
15 ventilators taken away, or otherwise be
16 discriminated against due to disability, age, or
17 disfavored identities.
18 And, finally, the legislature should repeal
19 Article 30-D of the Public Health Law, immunizing
20 health-care facilities from liability.
21 This Emergency Disaster Treatment Protection
22 Act drastically limits liability standards to the
23 point that it is, essentially, insulating hospitals
24 and their executive leadership from criminal or
25 civil liability.
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1 Stripping patients and family members of the
2 ability to hold hospitals accountable for civil
3 rights violations and other harm is just not
4 appropriate.
5 Pandemics should not be used as a basis to
6 encourage hospitals to put aside basic standards of
7 care, which, when followed, actually insulate
8 against liability.
9 Thank you.
10 SENATOR RIVERA: Thank you so much,
11 Ms. Hanssens.
12 Followed up by Jessica Barlow from the --
13 senior staff attorney for Disability Rights
14 New York.
15 JESSICA BARLOW: Hi. Thank you.
16 My name is Jessica Barlow. I am a senior
17 staff attorney at Disability Rights New York.
18 DRNY is the designated protection and
19 advocacy system for New York State.
20 The P&A system was created in the 1970s as
21 a result of media coverage which showed the horrific
22 abuse and neglect of children and adults with
23 disabilities at the Willowbrook school on
24 Staten Island.
25 DRNY provides free legal and advocacy
383
1 services to people with disabilities in
2 New York State. And we also monitor congregate-care
3 facilities to ensure that those living in those
4 facilities are not abused or neglected.
5 I want to thank you for the opportunity to
6 speak with you about how the COVID-19 pandemic has
7 impacted the people that DRNY serves.
8 Today I will be focusing on medical rationing
9 and its impact on the disability community, and, in
10 particular, I'd like to discuss ventilator rationing
11 at acute-care facilities.
12 In November of 2015, the New York State Task
13 Force on Life and the Law and the New York State
14 Department of Health published their
15 ventilator-allocation guidelines in order to provide
16 guidance on how to ethically allocate limited
17 resources, ventilators, during a severe pandemic
18 while saving the most lives.
19 As has been said, these guidelines contain
20 serious gaps which discriminate against people with
21 preexisting disabilities, and, in particular,
22 individuals who are chronic ventilator users.
23 The guidelines explicitly state, that
24 a chronic ventilator user who lives in the community
25 and goes to an acute-care facility during a
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1 pandemic, like the current one, can have their
2 personal ventilator reallocated to another
3 individual.
4 The guidelines acknowledge that this may
5 place ventilator-dependent individuals in a
6 difficult position of choosing between
7 life-sustaining ventilation and urgent medical care.
8 And this is exactly the situation that DRNY's
9 clients are in, and it's not a difficult position;
10 it's an impossible and a terrifying one.
11 I recently spoke to a woman who is currently
12 self-isolating on Staten Island. But when the
13 pandemic began, she was in New York City, attending
14 Columbia University, where she's currently pursuing
15 her bachelor's degree in biology.
16 She lives with a neuromuscular disease which
17 is not life-shortening, but does require chronic
18 ventilator support.
19 She cannot breathe on her own at all, and
20 uses a ventilator 24 hours a day.
21 In the spring, at the beginning of the
22 pandemic, she began to hear rumblings from
23 classmates and other ventilator users about
24 New York State's existing ventilator guidelines, and
25 so she sought them out.
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1 She was horrified by what she read.
2 She knew instantly, if she was to contract
3 COVID-19, she would not be able to seek care in an
4 acute-medical facility without risking being
5 forcibly extubated.
6 The guidelines specifically contemplated
7 taking her personal ventilator away from her and
8 giving it to someone else.
9 Since this woman became a chronic ventilator
10 user more than 15 years ago, she never lets her
11 ventilator out of her or her family's sight for this
12 exact reason.
13 Even prior to the pandemic, and even prior to
14 these guidelines, she and her family have
15 experienced hospitals attempting to discharge her to
16 skilled nursing facilities instead of back into the
17 community with her personal ventilator.
18 She has always lived in fear of being
19 institutionalized, but now she also lives in fear of
20 needing medical care at all.
21 The guidelines tell her that, if she needs
22 acute care during the COVID-19 pandemic, she cannot
23 seek that care.
24 Should she go to a hospital, she will be
25 forcibly extubated, and her ventilator will enter a
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1 pool of ventilators, to be allocated according to
2 triage procedures. Her personal ventilator will be
3 given to someone else who is deemed more likely to
4 survive with a higher quality of life.
5 These fears are shared by countless other
6 individuals who are contacting our office every day,
7 and who are chronic ventilator users.
8 This is part of a national debate, and in an
9 effort to address these concerns, DRNY and other
10 organizations, and even individuals, have filed
11 complaints with OCR.
12 In many other states, these complaints have
13 reached amicable resolutions that address the issues
14 regarding rationing personal ventilators.
15 But, despite the pending claim,
16 New York State's Department of Health is unwilling
17 to contemplate a revision to its policy.
18 DOH states that's this is just guidance; that
19 hospitals don't need to follow this, and it's not an
20 official rule.
21 But the response from hospitals is,
22 essentially, how do we not follow these guidelines
23 when there's nothing else for us to follow and we're
24 facing an unprecedented crisis of life and death?
25 Everyone seems to be pointing fingers at each
387
1 when there is a community of people that needs help
2 and answers.
3 So it is DRNY's recommendation that the
4 ventilator allocation guidelines be reviewed, and
5 that these concerns be kept in mind.
6 The Task Force on Life and Law failed to even
7 consider providing guidance that would not, under
8 any circumstances, allow for a chronic ventilator
9 user to be removed from their ventilator without
10 another device being readily available for their
11 use.
12 And that is the only acceptable approach.
13 Thank you.
14 SENATOR RIVERA: Thank you so much,
15 Ms. Barlow.
16 Next we will hear from Marcus Harazin --
17 I hope that that's the corrected
18 pronunciation of your name, sir.
19 -- coordinator, patient advocates program,
20 for the New York Statewide Senior Action Council.
21 MARCUS HARAZIN: Good afternoon.
22 Thank you for inviting Statewide to speak
23 today.
24 We run a state private patients' rights
25 helpline, and a CMS-funded senior Medicare patrol
388
1 program to prevent fraud.
2 With the limited time that have I today,
3 I want to talk about a couple of recommendations,
4 specifically in the area of patients' rights.
5 Just as we learned during the recent
6 hearings, that most citizens' knowledge about
7 rights, like the access to the long-term-care
8 ombudsman program, are very limited.
9 Most people don't know that there's a bill of
10 rights.
11 So, when someone is waiting till someone is
12 in the hospital to educate them about their rights
13 is really too late.
14 So, really, really feel that now is an
15 important time to kind of go back and look at the
16 bill of rights, and look at how the State is
17 educating communities about these rights, especially
18 the vulnerable elderly population.
19 The pandemic playbook called for the
20 suspension of many rights in order to sustain the
21 health of the general public.
22 Some are really good, like dropping the
23 three-day-stay requirement for post-acute rehab, but
24 many were counterproductive. That's especially true
25 for older adults who use five times as much acute
389
1 care as other adults.
2 Those rights include: Removing explaining
3 why patients were being removed from a bed.
4 Provision of a copy of the medical record. Patient
5 visitation rights and seclusion.
6 We know that family visitation can be very
7 helpful in the process of recovery, and we know that
8 patients now know how to do this.
9 No one should be without someone to have
10 social contact with.
11 New York should convene a group to develop
12 pandemic visitation protocols and policies that
13 could be built into pandemic plans.
14 The religious views of the patient must be
15 honored, even during a pandemic.
16 For example, during last rights, the Jewish
17 ritual of watching over a body of a deceased person,
18 from the time of death until burial, should be
19 honored.
20 Also, the State needs to revise the
21 compassionate-care visitation rules for visitation
22 at the end of life.
23 Communication with families is paramount,
24 multicultural. And non-English speaking families
25 really need to be provided with information they can
390
1 understand.
2 There are models out there on how do that
3 better.
4 Too many patients were treated without the
5 family knowing which hospital they were in or
6 facility they were in, and patients died
7 unidentified.
8 We need to keep families informed as to where
9 the patient is, and the state needs a
10 patient-tracker system.
11 Discharge-planning regulations were also
12 waived, as the United Hospital Fund noted in their
13 recent reports about post-acute care and COVID.
14 We need to reinstitute many of the
15 discharge-planning requirements, including, allowing
16 families to develop care plans that meet their
17 preferences, providing information about care in the
18 community so they can make an informed decision, and
19 clarifying for families and caregivers about their
20 freedom to pick provider of choice, and a coverage
21 for that post-acute care.
22 It's also important to provide them with
23 information, that they have a contact within the
24 hospital while they're being bumped from place to
25 place, and their right to appeal their discharge or
391
1 complaint about the quality of care.
2 This is particularly important, since surveys
3 from the joint commission were suspended during
4 COVID.
5 This has been a wake-up call for health and
6 disaster planning.
7 There's -- it's a time where it's been --
8 really been -- a time there's been an insidious
9 drift away from community-based planning, to
10 top-down planning.
11 That's why the governor abandoned the
12 modus operandi, and called upon hospitals to
13 work together.
14 We believe it's time to go back to the future
15 and establish regional health-care planning, like
16 what we used to use during the health-systems
17 agencies.
18 It's also -- we also recommend that more
19 consumer representation is needed on the
20 Public Health and Health Planning Council, and that
21 CON reviews need to be expanded to include the
22 attorney general when mergers and consolidations and
23 sales are involved.
24 We strongly support the Community Voices for
25 Health Systems Accountability, who is calling for
392
1 the cessation of hospital closures and mergers, and
2 the need for community-impact assessments. We need
3 to engage the community in health-care planning.
4 Disaster plans need to be functions-based and
5 have a whole community perspective.
6 And those are disaster-planning
7 terminologies. And there are great frameworks out
8 there that, in part, New York State helped develop,
9 that are available to help walk states through how
10 to do this.
11 In closing:
12 We want to thank you for narrowing the waiver
13 of liability for hospitals.
14 Really, the ability to register
15 quality-of-care complaints, and seek legal measures,
16 to address poor care are critical parts of this
17 system of checks and balances.
18 And we look forward to working with you to
19 create solutions and action, rather than blame and
20 excuses.
21 And thank you for your work here today.
22 SENATOR RIVERA: Thank you so much for
23 testimony.
24 Now the Assembly will lead us off.
25 ASSEMBLYMEMBER MCDONALD: We'll start with
393
1 our health chair, Mr. Richard Gottfried, 5 minutes.
2 ASSEMBLYMEMBER GOTTFRIED: Okay.
3 A question for Ms. Barlow.
4 On the question of a person who has their own
5 ventilator, are you saying that the guidelines
6 contemplate taking that person's ventilator away,
7 and leaving them lying there without a ventilator?
8 Or is the issue that their ventilator would
9 be part of a pool, and the ventilator that they use
10 might be a different one from the one they brought
11 with them?
12 JESSICA BARLOW: So, kind of both.
13 So, first of all, it is fairly common, in my
14 understanding, that if a chronic ventilator user
15 goes to a hospital during a non-rationing period,
16 it's very likely that they would be transferred to a
17 hospital ventilator as opposed to their own personal
18 ventilator.
19 The reason we usually hear for that, is that
20 the hospital staff is trained to use a particular
21 type of ventilator. And for liability reasons, they
22 don't want to be messing with someone's personal
23 ventilator.
24 But the first part of your question is true
25 in a ventilator-rationing situation.
394
1 Should a person who's a chronic ventilator
2 user enter an acute-care facility, an emergency
3 room, during a rationing period, and their
4 ventilator becomes fair game for the pool of
5 ventilators.
6 And so the triage procedures are used to
7 determine whether someone else is more deserving, is
8 more entitled, under those triage procedures, to
9 that ventilator.
10 So it is, essentially, no longer that
11 person's property. It becomes a ventilator in the
12 pool, to be reallocated to someone else, which
13 could, if there are not enough ventilators, leave
14 the individual who entered with the ventilator
15 without a ventilator at all.
16 ASSEMBLYMEMBER GOTTFRIED: I think it would
17 be helpful if -- certainly to me, if you and
18 Catherine Hanssens and anyone else could identify
19 exactly where that language is in the guidelines, or
20 anything else, because I haven't -- I haven't seen
21 it. And it's -- it strikes me as not the sort of
22 thing I ever have seen in New York law.
23 So I think if you can point to that language,
24 and not just say, "well, it's in the book," but show
25 us where in the book that is, that would be helpful.
395
1 And do you think if -- if a hospital's
2 personnel feel that they are untrained in using a
3 particular variety of ventilator, but are trained in
4 using a different, I don't know, brand that does,
5 essentially, the same thing, is that a problem?
6 Wouldn't you want the hospital staff using
7 the equipment that they have been trained on and
8 know how to work?
9 JESSICA BARLOW: [Indiscernible] the first --
10 to your first point, I would be glad to have my
11 office send over the guidelines with the particular
12 portions that we believe state that a personal
13 ventilator can be reallocated, highlighted.
14 Or, I can point to it here. I'm not sure --
15 everyone probably doesn't have the guidelines in
16 front of them, so it probably wouldn't be helpful
17 for me to share page numbers right now.
18 ASSEMBLYMEMBER GOTTFRIED: [Inaudible] where
19 to find it.
20 JESSICA BARLOW: But regarding training with
21 ventilators, it's my understanding that -- and I am
22 not a medical professional, I'm an attorney -- so
23 it's my understanding that, generally, most medical
24 professionals could use, basically, any type of
25 typical ventilator, besides, maybe, a homemade one,
396
1 which is something that the ventilator community is
2 actually working on, coming up with their own, so,
3 in rationing situations, they would have something
4 to work with.
5 But it's -- it's -- from what we've heard,
6 hospitals tend to have a preference in a best-case
7 scenario, where we're not in a rationing situation,
8 that this is the one they're most familiar with.
9 But I would imagine that probably goes for a
10 lot of different types of medical equipment, in that
11 this is what our hospital uses, this is the brand we
12 use, this is the particular device that our hospital
13 has.
14 But, in a situation where doctors and nurses
15 are volunteering at other hospitals, or traveling,
16 it is my understanding that, generally, they can use
17 other types. But, if there's a preference, and that
18 opportunity is there to choose, that they would
19 choose the one that they have the most experience
20 with.
21 ASSEMBLYMEMBER GOTTFRIED: Okay.
22 CATHERINE HANSSENS: Yeah, if I could just
23 add, I don't -- the issue is not -- the issue is
24 more, there were six patients in need of a
25 ventilator, and five ventilators, including one that
397
1 was brought in by a patient, how is the decision
2 going to be made?
3 And it's not an unprecedented problem.
4 I think there was a --
5 SENATOR RIVERA: If could you finish your
6 thought, ma'am, since the time has expired.
7 CATHERINE HANSSENS: Oh, okay.
8 I'll stop right there.
9 ASSEMBLYMEMBER GOTTFRIED: Okay, but you will
10 both point out for us in this guidebook where the
11 language is that concerns you?
12 CATHERINE HANSSENS: The guidelines are
13 extraordinarily long, even though they deal only
14 with ventilator access. So it's understandable you
15 might not have seen it.
16 But, absolutely.
17 SENATOR RIVERA: I'll start -- I'll start my
18 time.
19 I'll recognize myself for 5 minutes, and say
20 that, on behalf of my colleague Dick Gottfried, you
21 just -- you -- you -- tell them, no matter how long
22 it is, he will go and he'll look through it.
23 So please let us know where those -- where
24 those guidelines are so that we can look through.
25 And if there's something we need to change, then we
398
1 will do so.
2 My question is for Mr. Harazin, actually.
3 The -- is that correct pronunciation of your
4 name, first of all?
5 MARCUS HARAZIN: Yes, that's correct.
6 SENATOR RIVERA: Okay.
7 So you spoke about, I believe,
8 certificate-of-need process, and your suggestion
9 that the attorney general be brought into the
10 process.
11 Could you tell me a little bit more about
12 what you mean by that?
13 MARCUS HARAZIN: Well, in other states -- in
14 many other states.
15 Other agencies are involved here in New York
16 who really don't do that.
17 But when you're talking about the types of
18 mergers and consolidations that are continuously
19 going on, it's really important to kind of look at
20 the overall picture in terms of the character,
21 competency, and the financial connections, and
22 possible conflicts of interests that are involved in
23 these changes, and where we're going.
24 And I think you probably heard a little bit
25 about that in the other hearing, about nursing home
399
1 mergers and privatization.
2 We're headed in a direction where, you know,
3 we're getting the massive consolidation of health
4 care.
5 I don't need to tell you that, but the
6 communities are not well-served.
7 So the attorney general's office could do
8 that type of research and look at the possible legal
9 ramifications, you know. And I think their
10 involvement is important.
11 SENATOR RIVERA: Is that something that you
12 folks have been calling for for a while?
13 MARCUS HARAZIN: Oh, yeah, yeah.
14 SENATOR RIVERA: Okay, because it must be --
15 I have not -- I do not remember having this
16 conversation about this particular, the -- this --
17 I've had many conversations about
18 certificate-of-need process, but I've never had one
19 specifically that relates to the inclusion of the
20 attorney general.
21 You're saying that there's are other states
22 in which this is a model?
23 MARCUS HARAZIN: Yeah.
24 And we would be happy to kind of, you know,
25 work with some of the other advocacy groups, to kind
400
1 look at that, and provide some recommendations on
2 how a better process can occur.
3 SENATOR RIVERA: Please do.
4 And because the -- and last question on this
5 topic:
6 You -- you -- so you've obviously -- as you
7 said, you have been trying to get this done for a
8 while, or you've advocated for it for a while.
9 Has there been vocal resistance?
10 Has there been --
11 MARCUS HARAZIN: I think this, the whole
12 planning process, now, you know, frankly, is so
13 top-down, that it's very hard to -- you know, to
14 break in.
15 And I think we know that, a good example is,
16 the Hospital and Health Planning Council, which was
17 meeting today during the day of your hearing,
18 I mean, to talk about hospitals during COVID.
19 SENATOR RIVERA: Timely.
20 MARCUS HARAZIN: Yeah, very timely.
21 But that's just a great example.
22 We need to have more consumer input there, we
23 need to kind of break it down on a regional basis,
24 and we need to kind of make the process more
25 oriented toward community need rather than, you
401
1 know, corporate need.
2 SENATOR RIVERA: Got you.
3 Thank you so much.
4 I'm not sure if either of you ladies want to
5 comment on this issue?
6 CATHERINE HANSSENS: I don't have anything to
7 add.
8 SENATOR RIVERA: All right.
9 Thank you so much.
10 That is my time.
11 Back to the Assembly.
12 ASSEMBLYMEMBER MCDONALD: And I actually have
13 a question about the ventilator, but I'm also smart
14 enough to know that two other hands are raised that
15 might know more, and I'll learn something.
16 So we're going go to Missy Miller, for
17 3 minutes.
18 ASSEMBLYMEMBER MILLER: Hi.
19 Thank you so much.
20 It's very interesting that we're discussing
21 this because, back at the end of March, I actually
22 wrote a letter to Dr. Zucker, department of
23 health, as well as the attorney general, with a copy
24 of those ventilator guidelines, because I was
25 hearing, you know, a tremendous amount of concern
402
1 from the disability community over these guidelines.
2 I never did hear from Dr. Zucker, but I was
3 assured by the governor's office that there was
4 absolutely no need for concern; that they would
5 never ration or, you know, take away a ventilator
6 from a person in need, simply based on their
7 evaluation versus a neurotypical or a more
8 physically-robust individual.
9 That that -- that -- that comparison that the
10 guidelines reference, very clearly, that there is no
11 such thing. That it would be against the Americans
12 with Disabilities Act.
13 And -- so I was -- I was verbally assured
14 that that does not happen, but I never did receive
15 any response or reply to my letter to Dr. Zucker
16 or the attorney general.
17 And, Dick, I'll send you, I have the
18 guidelines right here. I'm going to e-mail them to
19 you right now.
20 ASSEMBLYMEMBER GOTTFRIED: Thank you.
21 CATHERINE HANSSENS: Well, I mean, it's
22 interesting because, our agency, along with
23 Treatment Action Group, The National Age Treatment
24 Network, Callen-Lorde, [indiscernible], and a
25 variety of other organizations, also sent a letter
403
1 to Commissioner Zucker, the governor, and several
2 other state leaders, and we got no response
3 whatsoever, about exactly that issue.
4 And, also, I mean, the other problem is --
5 the problem is not -- there are many good things in
6 the guidelines. The guidelines are not
7 across-the-board horrible.
8 But there are -- there is the issue that
9 Jessica described in detail, and, also the fact, as
10 I mentioned earlier, there are a variety of
11 emergency services, other than ventilator access,
12 which are not addressed.
13 And, as has been reported several times since
14 the pandemic started, line physicians are being
15 asked, or being told, that they will need to make
16 decisions about who does and doesn't get care,
17 without any kind of uniform guidance.
18 And -- which is a --
19 ASSEMBLYMEMBER MILLER: Well, [indiscernible
20 cross-talking] --
21 CATHERINE HANSSENS: -- other than an unfair
22 burden [indiscernible cross-talking] --
23 ASSEMBLYMEMBER MILLER: -- triage the people
24 who would have the better outcomes.
25 CATHERINE HANSSENS: Well, that should be --
404
1 ASSEMBLYMEMBER MILLER: [Indiscernible
2 cross-talking] have a person who has a physical
3 disability, or, you know, underlying, they don't
4 have that rosie outcome as somebody who's just, you
5 know, healthy with an acute condition.
6 MARCUS HARAZIN: Well, and that depends on
7 how you define the length and nature of a "rosie
8 outcome."
9 If -- the decision should be based on whether
10 or not somebody is going to benefit from that
11 intervention. Not whether, looking at them as a
12 person who may be missing a leg because of diabetes,
13 the quality of their life, or the long-term
14 expectation because they've had perhaps HIV for
15 25 years, is factored into that decision, which is
16 why [indiscernible cross-talking] --
17 SENATOR RIVERA: Thank you.
18 Thank you, Ms. Hanssen.
19 CATHERINE HANSSENS: -- people are concerned.
20 SENATOR RIVERA: Thank you, Ms. Hanssen.
21 CATHERINE HANSSENS: You're welcome.
22 SENATOR RIVERA: Thank you.
23 Assemblymember, currently, no members of the
24 Senate to ask questions.
25 Back to the Assembly.
405
1 ASSEMBLYMEMBER MCDONALD: We will continue my
2 theory of asking smarter people to ask questions
3 than I, and that would be John Salka, for 3 minutes,
4 who actually practices in the respiratory-therapy
5 field.
6 ASSEMBLYMEMBER SALKA: Thank you, John.
7 I appreciate that, and I appreciate the time.
8 And I appreciate the testimony of this panel.
9 This is a question for Ms. Barlow.
10 If someone does come in and they're
11 ventilator-dependent, and they have the home
12 ventilator, and it's taken away to put into a pool,
13 if that particular person's status is not DNR, which
14 is a "do not resuscitate," isn't the hospital
15 committed -- just in case that person invariably
16 goes into respiratory failure, isn't the hospital
17 committed to start resuscitation proceedings --
18 procedures on that patient?
19 JESSICA BARLOW: Yes, I --
20 ASSEMBLYMEMBER SALKA: They get their
21 ventilator taken away, they go into respiratory
22 arrest, they're not a DNR, isn't the hospital
23 committed to have full measures of resuscitation
24 applied to that patient?
25 JESSICA BARLOW: Yes, but in that case, the
406
1 hospital is the reason that that person is going
2 into respiratory distress. They extubated a person,
3 who's ventilator-dependent, from their personal
4 ventilator.
5 You wouldn't take a diabetic's insulin away
6 from them and say, well, this person deserves it
7 more in this situation.
8 This is someone's personal medical device,
9 and they're dependent on it.
10 And the hospital, creating a more emergent
11 situation, and then fixing that situation, I don't
12 think that they should necessarily be praised for
13 that, though I certainly don't blame hospitals who
14 are following these guidelines.
15 Like I mentioned, they don't have anything
16 else to go on at this point.
17 ASSEMBLYMEMBER SALKA: I agree.
18 And coming from the perspective of a
19 respiratory therapist, these are incredibly
20 complicated machines, pieces of medical equipment.
21 And unless you have a thorough orientation to
22 a different -- or, a particular type of ventilator,
23 I don't know of any clinician, at least that holds a
24 license in New York State, that would chance trying
25 to run something that they haven't been thoroughly
407
1 acquainted with.
2 So to put these ventilators into a pool, and
3 not orient those who are going to be running the --
4 this particular piece of equipment, is a recipe for
5 disaster.
6 And, personally, I would refuse to do it.
7 So it's something that I think is unrealistic
8 to expect a medical professional to do.
9 And to ask a clinician to play God, by taking
10 a ventilator away from someone who is
11 ventilator-dependent, is just -- it's -- that's --
12 that's just -- that's just wrong. That's just
13 absolutely wrong.
14 And I'm looking forward to reading guidelines
15 myself, so that I can relay this to other
16 professionals -- other health-care professionals
17 that I know.
18 And thank you very much for your time.
19 JESSICA BARLOW: Thank you.
20 ASSEMBLYMEMBER MCDONALD: And I will just
21 close with my own comments on this issue, if it's
22 okay with you, Senator Rivera?
23 SENATOR RIVERA: Indeed it is.
24 ASSEMBLYMEMBER MCDONALD: Jessica, I -- thank
25 you for bringing this up.
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1 As I'm listening to this, I'm saying, well,
2 wait a minute.
3 This is more than likely -- first of all,
4 these ventilators you just don't get off the shelf.
5 They're not cheap. They are an individual's
6 personal property. Their insurance probably paid
7 for it.
8 And as John pointed out, very well, is that
9 clinicians don't like to jump to other pieces of
10 equipment, particularly if they're not familiar with
11 it.
12 It's not in the best interests of anybody;
13 number one, the patient; and, of course, the
14 clinician; and then, of course, the organization.
15 So I just want to say thank you for bringing
16 this up.
17 Missy, I know you're going to send those
18 guidelines to Richard.
19 And I'd hope you share them with me as well,
20 because I just find it hard to believe that,
21 although I recognize there could be a crisis, that
22 people's personal property would be taken away from
23 them at a moment when they're in desperate need.
24 And with that, I will cease my comments, and
25 thank the panel for their participation today.
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1 SENATOR RIVERA: I will echo those thanks,
2 and wish you a very good rest of your day.
3 As we --
4 ASSEMBLYMEMBER GOTTFRIED: Senator?
5 SENATOR RIVERA: Yes.
6 ASSEMBLYMEMBER GOTTFRIED: I would just like
7 to stress, the guidelines document is a very thick
8 book.
9 And I just want to reiterate what I said
10 earlier: If you just say, well, here's the book,
11 it's in there somewhere, that's not going to do me
12 any good.
13 What I need people to do is say, look on
14 page 28, about halfway down the page. That's where
15 the paragraph is that concerns us.
16 JESSICA BARLOW: I could point you to
17 pages 5 and 6, and pages 40 through 42.
18 Those are the pages that we cited in our OCR
19 complaint.
20 So, just off the top of my head now, those
21 would be the most relevant.
22 ASSEMBLYMEMBER GOTTFRIED: Put that in an
23 e-mail to me.
24 JESSICA BARLOW: Sure. Absolutely.
25 SENATOR RIVERA: You got a second round
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1 there, Dick. Doesn't usually happen.
2 ASSEMBLYMEMBER MCDONALD: Oh, well, been here
3 50 years, you get a little benefit once in a while.
4 Thank you, folks.
5 Now we move on to our last, but certainly not
6 least, panel, and that is:
7 Dr. Erik Larsen, assistant director of
8 EMS and emergency preparedness for the White Plains
9 Hospital;
10 Dr. Miao Jenny Hua --
11 I hope that I to pronounced your name
12 correctly.
13 -- a doctor in New York, New York;
14 And, Janet Menendez, a resident of
15 Morningside Heights, New York.
16 ASSEMBLYMEMBER GOTTFRIED: And, for the last
17 time in this hearing, do each of you swear or affirm
18 that the testimony you are about to give is true?
19 DR. MIAN JENNY HUA: I affirm.
20 JANET MENDEZ: Yes.
21 ASSEMBLYMEMBER GOTTFRIED: Okay. Thank you.
22 SENATOR RIVERA: Ms. Mendez, and, do we have
23 Dr. Erik Larsen?
24 ASSEMBLYMEMBER MCDONALD: He's listed.
25 I just don't see him yet.
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1 SENATOR RIVERA: I don't see him.
2 Since I'm not seeing him, I will --
3 OFF-CAMERA TECHNICIAN: He's working on
4 turning on his video.
5 SENATOR RIVERA: Okay.
6 Dr. Hua, why don't you lead us off.
7 DR. MIAN JENNY HUA: Sure.
8 Thank you, committee members, for the
9 opportunity to speak.
10 I'm here representing myself, although,
11 through the months of February to June, I worked as
12 a resident physician in the internal medicine
13 department at Mount Sinai Hospital on the upper east
14 side of Manhattan.
15 As a front-line physician, I was working
16 12-hour shifts, 7 days a week, every other week, on
17 the COVID-19 ward, while the City was reporting
18 5,000-plus new cases and 600-plus deaths from COVID
19 every day.
20 This experience taught me one key lesson:
21 Hospitals, the majority of them private, did
22 not respond to the pandemic as if it were their task
23 to suppress it.
24 Existing inequities were magnified as a
25 result.
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1 As Governor Cuomo congratulated his
2 constituents about bending the curve and preserving
3 the health-care infrastructure, the unmentioned cost
4 was the record-shattering death toll.
5 Over two months in spring, New York City's
6 COVID-19 death toll exceeded that of the 1918 flu
7 outbreak.
8 The preservation of the infrastructure thus
9 came at the expense of human lives.
10 According to data from the New York City
11 Department of Health and Mental Hygiene, only around
12 26 percent of COVID-19 patients were hospitalized at
13 the peak of the initial surge in early April.
14 In late April, when I was working in the
15 emergency department at Mount Sinai, most patients
16 symptomatic with COVID-19 were still being turned
17 away even when they tested positive.
18 This included many among the old and frail at
19 high risk of dying, but did not show a low oxygen
20 saturation level at the time of presentation.
21 Stringent admission criteria is a holdover
22 from pre-pandemic practices.
23 We can see from federal data that, over the
24 past 20 years, the number of emergency department
25 visits has steadily risen, even though the
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1 percentage of those visits leading to an admission
2 have declined. But there's a huge problem with
3 hospitalizing the bare minimum in the midst of a
4 pandemic when not limited to the individual lives at
5 stake.
6 Sending patients back into the community
7 assumes from the outset that hospitals have no role
8 in interrupting the virus's chain of transmission.
9 Because the negative COVID-19 was not
10 necessary for discharge in New York, many patients
11 leaving the hospital returned to endanger those
12 close to them in their community, with devastating
13 consequences, especially in nursing homes and
14 low-income communities of color.
15 The contrasting measures taken at Wuhan are
16 instructive.
17 Three years ago I lived in Wuhan, doing
18 research as a medical anthropologist, at a hospital
19 that would go on to become the largest coronavirus
20 treatment center in China.
21 According to local government data that my
22 contact sent me, by late February, hospital capacity
23 in Wuhan had expanded enough so that 95 percent of
24 all COVID-19 patients were hospitalized.
25 This number is concordant with research data
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1 that the U.S. CDC cites from China.
2 COVID-19 patients in New York were sicker
3 when they were admitted, and only 26 percent were
4 admitted, and spent less time in the hospital
5 compared to their counterparts in China, where the
6 medium length of hospital stay was around 10 days,
7 in comparison, in New York, COVID patients were
8 discharged after a median of 4 days.
9 As we know, since late March, there have been
10 no new cases of COVID reported in Wuhan.
11 In fact, I think the peak of the -- at the
12 peak of the pandemic, there was a surplus of beds in
13 some hospitals around New York City. And
14 Mount Sinai Hospital on the upper east side was one
15 of them.
16 During April, I remember walking through
17 hundreds of empty beds in the lobby before starting
18 my 12-hour shift on the COVID ward. These beds were
19 set up in anticipation of an even bigger surge of
20 patients that never came.
21 At the same time, Black and Brown patients
22 who flocked to public hospitals in Bronx and Queens
23 died in disproportionate numbers.
24 We know this well.
25 Colleagues of mine, who had the misfortune of
415
1 being assigned to work at Elmhurst, recall having to
2 take care of dozens of COVID patients who would all
3 be dead within days.
4 One resident admitted eight patients from the
5 emergency department overnight, to have four die by
6 the morning.
7 So this is the biggest problem: The
8 hospitals in New York have not responded to the
9 pandemic as if it were their task to suppress it.
10 Ignorance is no excuse.
11 By mid-February, I was speaking personally
12 with leaders at Mount Sinai Health System about the
13 necessity of preparing for the pandemic, referring
14 them to my contacts at Wuhan for front-line
15 expertise.
16 They did not take me up on my offer, even
17 though they told me that they expected the
18 coronavirus to enter into endemic transmission.
19 In other words, hospital leaders were fully
20 expecting that the virus would not be contained.
21 Instead of training front-line staff
22 immediately on PPE precautions and infection-control
23 protocols, hospital leaders' response was to
24 downplay supply shortages.
25 Instead of operating as an essential layer of
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1 a public-health infrastructure, hospitals acted like
2 businesses trying to control costs, and the
3 government did not step in to tell them to act any
4 otherwise.
5 The consequence has been disastrous by every
6 meaningful metric.
7 Thank you.
8 SENATOR RIVERA: Thank you so much, Doctor.
9 Followed by Dr. Erik Larsen, assistant
10 director of EMS and emergency preparedness at
11 White Plains Hospital.
12 DR. ERIK LARSEN: Okay.
13 Hello, and thank you for inviting me to this
14 hearing.
15 First of all, I just want to say, my comments
16 are not the official line of the -- or, I'm not
17 officially representing White Plains Hospital.
18 I am also a chief medical officer for HHS,
19 the assistant secretary for preparedness and
20 response. And I've done disaster response for
21 30 years, including a number of major disasters,
22 including "Hurricane Katrina," earthquakes in
23 Pakistan, and Haiti.
24 And I'm going to talk about two things today.
25 I want to focus on EMS (emergency medical
417
1 services), which I think is a key part of the whole
2 hospital system, and the fact that EMS has never
3 really been considered, right from the beginning,
4 the third uniform service, along with police and
5 fire. It's never gotten that type of support.
6 And it is a mish-mash of volunteers, paid
7 private services, some public municipalities, and
8 you know, big systems, like New York City, which is
9 a public entity.
10 So because of that, it's the poor stepchild.
11 So these agencies, unfortunately, we're not
12 equipped with PPE. They had to get it themselves.
13 They were not appropriately trained because
14 it costs money and time to train people.
15 And so, for this reason, many of the -- in
16 the early parts of this pandemic, the EMS folks took
17 a heavy hit. And I saw a number of our services in
18 the area of White Plains.
19 We were, actually, sort of ground zero for
20 the pandemic in New York State, in that the first
21 patients appeared here in early March.
22 So, anyway, with that being said, it is very
23 important that EMS gets supported. That we -- it's
24 not even mandated in New York State that a town
25 needs to have EMS.
418
1 They have to have fire, they have to have
2 police, they have to have sanitation, they have to
3 have a highway department.
4 You do not have to have EMS. There's nothing
5 about that.
6 So, unfortunately, they are the poor
7 stepchild.
8 So, we need to really support them because
9 they are key in the hospital system. They bring
10 patients to the hospital who are in acute distress,
11 and they do all this transferring that folks have
12 been talking about throughout the hearings today.
13 The second thing I'd like to talk about is
14 acute -- the -- the alternative care centers.
15 So we were involved in the alternative care
16 center here in Westchester.
17 Suddenly, we start to see at the end of
18 March, it was March 27th, I happened to drive by and
19 noticed that they were rebuilding the Westchester
20 County Center, and, all of a sudden, these
21 structures were going up.
22 There had been no consultation whatsoever,
23 that I know of, between the department of health --
24 the local department of health here, EMS agencies,
25 departments of emergency service agencies in
419
1 Westchester County, any of the hospitals, any of the
2 hospital administrators, myself, and a number of
3 other local experts, about consulting on whether to
4 build this alternative care center.
5 So they went ahead, started building this,
6 what was -- I was told, is -- was a
7 30-million-dollar project in the Westchester County
8 Center, which included three tent -- four tents, and
9 an inside structure, that were supposed to be
10 ICU-capable.
11 Who made that decision?
12 Who decided what the needs were?
13 It was very unclear to me.
14 One thing that was very clear was, although
15 they were building this 30-million-dollar project,
16 one of the things -- the only thing we knew about
17 COVID back then for sure, that we all agreed on, is
18 that everyone needed oxygen.
19 And here we were going to build an
20 ICU-capable unit that was not even going to have a
21 central oxygen supply.
22 So I got involved, and probably added another
23 $5 million, when I said, we need to add, basically,
24 liquid oxygen, the same types of systems that
25 hospitals have.
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1 So the other thing that was key was, it was
2 never clear who was going to staff these. Okay?
3 And so the question of volunteers came
4 forward in this volunteer list.
5 We tried to make sense out of the volunteer
6 list. We tried to go through the volunteer list and
7 pick people out.
8 There were a number of key things that were
9 never answered:
10 Who was going to staff it?
11 Whether people are going to get paid; whether
12 they're not going to get paid.
13 Who was going to cover malpractice for them?
14 More importantly, who was going to cover
15 workman's [sic] compensation, should they get hurt,
16 or get COVID, most likely?
17 How were they were going to be
18 [indiscernible].
19 All these type of questions were never
20 answered for us.
21 And, luckily, we plateaued, and, basically,
22 these facilities were being -- have -- were shut
23 down and mothballed.
24 So what we really need is a clear
25 understanding of what these missions are -- you
421
1 know, what these alternative care centers are
2 supposed to be, who's supposed to staff them, and
3 how we were going to supply them, all the ancillary
4 wraparound services.
5 All that type of [indiscernible] was never
6 answered.
7 SENATOR RIVERA: Thank you, Mr. Larsen.
8 And last, but certainly not least, we are
9 joined by Janet Menendez, resident of
10 Morningside Heights.
11 Good afternoon, Ms. Mendez.
12 Go ahead.
13 JANET MENDEZ: Thank you, Senator and
14 Assemblymember, for the opportunity to testify.
15 My name is Janet Menendez, and I'll be
16 testifying on my experience as a COVID-19 survivor,
17 treated at Mount Sinai's Morning Height [sic]
18 Hospital.
19 On March 25th I was hospitalized at
20 Mount Sinai Hospital after having worsening COVID-19
21 symptoms for two days.
22 At the time, tests was not publicly
23 available.
24 Upon admission to the emergency room,
25 I tested positive for the virus, and for pneumonia.
422
1 Within just an hour, I was put on a
2 ventilator and induced into a coma that lasted over
3 two weeks.
4 While in intensive care, my family authorized
5 the use of trial drugs and several options doctor
6 recommended to them.
7 I was discharged on April 19 -- I mean,
8 April 13, making the totality of my hospital stay
9 19 days.
10 Only a day after I was discharged, I began
11 receiving calls, asking how I was going to pay for
12 the care that I just received.
13 I then also began to receive several bills in
14 the mail.
15 My first bill I received was in the amount of
16 $31,000.
17 However, because I could not work due to my
18 immobility, I decided to try to focus on my recovery
19 rather than on the medical bills.
20 The next bill, however, was too large to
21 ignore.
22 I received a bill of $401,000, with the
23 hospital financial assistant [sic] benefit of
24 $326,000, and that still left me with more than
25 $75,000 to cover on my own.
423
1 In the coming weeks I received several
2 additional bills, ranging from $40 to $1,000.
3 I also had several different departments
4 calling me, with little to no details on specific
5 procedures being charged for -- for the totality of
6 my medical debt.
7 On the bill [indiscernible] it read, "medical
8 cardio care," with different charges, ranging from
9 41,000 to 82,000 dollars, or, pharmacies, for
10 another $42, with no breakdown of what medical --
11 what medicines I received and how much each cost.
12 I obviously will not know the type of
13 procedures being charged for because I was
14 unconscious for the majority of my hospital stay.
15 After receiving several medical bills,
16 I contacted Community Service Society, who helped me
17 determine what my employer insurer was still active,
18 and Mount Sinai did not have the correct insurance
19 information.
20 As a result of this, I was being charged as
21 if I was uninsured and, thus, sending me bills
22 directly.
23 This entire process has been confusing,
24 because even though I am covered by my insurance
25 plans, I still have so many additional charges that
424
1 discourage me from receiving care.
2 Although this means that I'm in the process
3 of fighting the charges alongside with CSS, I am
4 still responsible for the annual out-of-pocket
5 maximum contribution for network care, which is
6 $10,000.
7 It is still difficult for me to understand
8 how a person like myself, who has worked mostly
9 paycheck to paycheck in the hospitality industry,
10 will be able to pay off this debt, especially in the
11 middle of a pandemic that has caused so much
12 unemployment and loss.
13 I was at least lucky enough to have my
14 insurance coverage plan overlap with my hospital
15 stay.
16 But many others who have lost their coverage
17 due to the unemployment, or those who not even
18 qualify for health insurance because of their
19 immigration status, this makes me lose confidence in
20 the actions of this state.
21 We have to be bold, and continue to push for
22 expansion of health-care options for
23 undocuments [sic], reform medical-bill practice,
24 and, ultimately, create a single-payer system in
25 New York State so that the health-care decisions are
425
1 not driven by the ability to pay.
2 Thank you.
3 SENATOR RIVERA: Thank you, Ms. Mendez.
4 I will be leading off questioning,
5 I recognize myself for 5 minutes.
6 Well, Ms. Menendez, I will tell you,
7 obviously, I'm very happy to see you, although we've
8 not met in person.
9 For full disclosure, Miss Menendez is the
10 sister of one of my staffers. And we are so happy
11 to see you healthy, and, kicking ass.
12 So thank you so much for being here and
13 sharing your experience with us.
14 You -- so at this moment, you have -- there's
15 still an outstanding bill of about $75,000 that you
16 say that you have, that you are responsible for,
17 according to the hospital?
18 JANET MENDEZ: Well, when they sent me the
19 bill for 75,000, it was when they believed I didn't
20 have health insurance.
21 SENATOR RIVERA: Okay.
22 JANET MENDEZ: So after once, I called the
23 hospital and gave my medical insurance. They
24 processed it, but because the way they --
25 Mount Sinai bills, they go by different departments.
426
1 So those send me one bill. Then they'll send
2 me another bill. And then another bill will say, oh
3 no, I didn't have your insurance, or, I had the
4 wrong number, or, I have the wrong social. And then
5 the process will start all over again.
6 SENATOR RIVERA: And this is -- and this
7 was -- and this was while you were recovering, after
8 being -- after spending two weeks in a coma, and
9 then 19 extra days.
10 How much longer were you in the hospital
11 after you came out of the coma?
12 JANET MENDEZ: I believe like a week and a
13 half.
14 SENATOR RIVERA: Like a week and a half.
15 So you were convalescing, obviously,
16 recovering from this.
17 And you have -- and I know because my
18 staffer, obviously, is incredibly smart, and,
19 obviously, loves you very much.
20 And she had to spend all sorts of time on the
21 phone, trying to clarify a lot of this stuff.
22 Do you feel that -- let's say that the
23 situation was different, and it's possible for many
24 other people who are not here today, who do not have
25 someone like a family member who is -- who has the
427
1 ability and the time to be able to go and make all
2 these calls, and everything.
3 How do you feel -- do you feel that those
4 folks are being protected right now?
5 JANET MENDEZ: They're not, because the
6 reason why I keep doing the interviews, I keep
7 pushing my name around, is so that people that don't
8 have the knowledge or don't have the help like I do
9 with my sister, could get some information and fight
10 for this.
11 We're supposed to be receiving so much help.
12 Where's this help?
13 Where was this promise that we didn't have to
14 pay for hospitals if we got COVID?
15 So why are they sending me a bill so high?
16 So imagine if a person with a single home,
17 that are singles, they have to pay, because most of
18 them don't have insurance because it's really
19 expensive.
20 So they don't have insurance, and now they're
21 stuck with this bill.
22 When are they going to pay?
23 Now they're in debt. They're probably
24 college students, they have college debt.
25 And this debt keeps getting bigger and
428
1 bigger.
2 So when are -- when are they going to help
3 us? How do they expect us to pay?
4 SENATOR RIVERA: Got you.
5 So -- and -- and I should say that there
6 is -- there is a piece of legislation -- or, pieces
7 of legislation that we have started, that my
8 colleague and I in the Assembly, we're trying to
9 push, to make sure that we can actually address this
10 and resolve this.
11 Thank you so for bringing your experience.
12 Ms. -- Dr. Larsen, I wanted to just, for
13 the end here, when you -- your discussed the
14 situation when there was -- in Westchester, there
15 was a -- there was this -- this thing that was --
16 that -- this center that was put up very, very
17 quickly because they were kind of -- they thought
18 that they might need it.
19 Ultimately, it was not needed, which is
20 obviously a good thing.
21 But your concern about their lack of
22 outreach, meaning the State, do you feel that your
23 involvement -- because you say that you weren't
24 involved before, but you eventually got involved
25 because you said, you're going to need oxygen, so
429
1 you're going to need to spend this extra money to
2 make sure that it's ready to -- if you're going to
3 use it, it needs to have oxygen.
4 Do you feel that that involvement may have
5 changed the way that the State does it in the
6 future, since we're talking about what we can do,
7 going forward, if such a situation were to happen
8 again?
9 DR. ERIK LARSEN: Well, I would hope so.
10 You know, again, the whole question, I mean,
11 the Army Corps of Engineers was the, you know,
12 building agency. They had subcontracted this.
13 Look, they did a record job of creating
14 something like this.
15 But the question was, why wasn't the medical
16 community consulted?
17 CEOs of hospitals weren't consulted.
18 Doctors, nurses, folks, were not consulted about
19 this.
20 For instance, here's a hospital in
21 Mount Vernon, and I think people talked about it in
22 earlier testimony, that, basically, is being closed
23 down; a hospital structure, with everything intact,
24 that, if they had taken --
25 SENATOR RIVERA: There was no discussion
430
1 about using Mount Vernon Hospital in their excess
2 capacity, perhaps, since it was there?
3 DR. ERIK LARSEN: Not to my knowledge, and
4 I've explored this.
5 I know hospital administrators, you know, had
6 raised this. Multiple people had raised this issue.
7 And here they were, building a -- you know,
8 first of all, taking a public building in the county
9 that may or may not need to be used in the future,
10 building a tented structure.
11 It was all very well put together, although,
12 like I said, here this was built to be an
13 ICU-capable facility, had people on ventilators --
14 would have people on ventilators, but had no oxygen
15 supply.
16 SENATOR RIVERA: Thank you, sir; thank you,
17 Dr. Larsen.
18 That's my time.
19 Back to the Assembly.
20 We will move to our chairman of the health
21 committee, Richard Gottfried, for 5 minutes.
22 ASSEMBLYMEMBER GOTTFRIED: Thank you.
23 Quick question for Janet Menendez.
24 The 10,000 that you said you were responsible
25 for, I didn't catch, was that because Mount Sinai
431
1 was in-network or not in-network.
2 JANET MENDEZ: So the -- we're still fighting
3 with the charges, because a lot of the cardiologist
4 charges were put out-of-network.
5 So we're fighting that, putting them
6 in-network.
7 But the 10,000 is my out-of-pocket deductible
8 that I have to pay with insurance that I have.
9 ASSEMBLYMEMBER GOTTFRIED: Okay.
10 All right. Thank you.
11 And for Dr. Hua, I'm not sure what public
12 policy you're suggesting we adopt.
13 If someone shows up at an emergency room with
14 symptoms of COVID-19, what should that hospital be
15 required to do at that point?
16 Because you said many of those patients would
17 just be sent home.
18 Should something different be done; what
19 would that be?
20 DR. MIAN JENNY HUA: Thank you for the
21 question.
22 So I'm not in the position to offer
23 prescriptive guidelines, because I think these
24 guidelines actually take a lot of expert
25 deliberation to come up with.
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1 However, one of the chief problems is that,
2 there was no such guidelines to -- there were rules
3 of thumb, in other words, that operated to,
4 basically, whether someone had to be saturated to
5 such an extent that they would need supplemental
6 oxygen for an extended period of time.
7 Sometimes if they'd be saturated, but did not
8 have an oxygen saturation below 90 percent, they
9 were still deemed safe to go home.
10 And we know that, eventually, there were lots
11 of deaths at home reported because patients did not
12 de-saturate either at the time when they presented
13 in the emergency room, and later on, because of
14 [indiscernible] injury to their heart, had some kind
15 of an arrhythmia, and passed away that way.
16 So there was definitely under-admission due
17 to the fact that people were using the most basic
18 sort of rudimentary objective, but not necessarily
19 sensitive, admission criteria for patients.
20 And so, you know, in terms of the individual
21 lives at stake, I think many lives were lost that
22 way.
23 On the other hand, there is also the issue of
24 just enforcing, or at least giving people the
25 opportunity to engage in self-isolation and
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1 self-quarantine, which many patients did not really
2 have adequate, a safe, stable location in place,
3 especially patients already experiencing unstable
4 housing.
5 You know, I admitted patients from the
6 emergency room who went in and out of quarantine
7 somewhere upstate in a hotel, and there was nobody
8 to really tell him to stay in quarantine.
9 And I know even -- I think now, with the
10 contact-tracing program, there's not a sufficient
11 logistical consideration for how people who test
12 positive ought to separate themselves from their
13 loved ones.
14 And also -- so I think, you know, obviously,
15 the makeshift hospitals, the field hospitals,
16 whether it's the Javits Center or Billie Jean King,
17 could have been utilized a lot better. We know
18 their initial criteria was far too stringent in the
19 beginning of April.
20 So I think there are countless policy options
21 in terms of how to better utilize space, especially
22 for patients who were relatively asymptomatic.
23 I think we were kind of lulled into a false
24 sense of security with the 80/20 breakdown, in terms
25 of 80 percent having, basically, no symptoms, or
434
1 minimal symptoms, but, you know, with a disease that
2 we know so little about, even to this day.
3 And, also, in the period when it was so
4 possible to contain the pandemic by actually
5 suppressing the number of cases and the number of
6 transmissions, I think we really missed an
7 opportunity.
8 ASSEMBLYMEMBER GOTTFRIED: From your
9 description of Wuhan, it strikes me that they didn't
10 have guidelines to apply either, except, if you show
11 up with what looks like COVID, we lock you up.
12 DR. MIAN JENNY HUA: Well, that's -- I would
13 correct that.
14 ASSEMBLYMEMBER GOTTFRIED: [Indiscernible.]
15 DR. MIAN JENNY HUA: Yeah, right.
16 So, that's not entirely true.
17 So I would have to look back, but, at some
18 point, it was the state council. So there was much
19 more nationwide guidance.
20 So the state council issued clinical
21 guidelines. It's not something I would expect the
22 U.S. to be able to implement.
23 But they actually did guidelines, and, yes,
24 they were much more aggressive about implementing
25 lockdown measures.
435
1 But, of course, there are many alternatives
2 to that.
3 Japan, for instance, have a mandatory
4 hospitalization policy without the similar level of
5 stringency or, you know, draconian enforcement
6 involved.
7 ASSEMBLYMEMBER GOTTFRIED: Do you know
8 anything about other countries; Taiwan,
9 South Korea --
10 DR. MIAN JENNY HUA: Well -- so -- yeah, so
11 I think this is going to be an ongoing conversation,
12 and the time is up.
13 But -- so I'm not sure about their
14 hospitalization policy, but I don't think they
15 really had that many cases.
16 Taiwan, for example, really didn't have that
17 many cases for it to be a huge issue. I think they
18 were fully capable of hospitalizing everybody who's
19 infected.
20 ASSEMBLYMEMBER GOTTFRIED: Got you.
21 Thank you, Doctor.
22 SENATOR RIVERA: Thank you, Assemblymember.
23 ASSEMBLYMEMBER GOTTFRIED: Okay. Thank you.
24 SENATOR RIVERA: Recognizing
25 Senator James Skoufis for 5 minutes.
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1 SENATOR SKOUFIS: Thanks very much.
2 And thanks to each of you, especially our
3 patients waiting till the evening to speak with us.
4 Dr. Hua, you're obviously -- you're critical
5 of the lack of preparedness that existed here at
6 hospitals, especially, you mentioned training, you
7 mentioned PPE procurement.
8 Given what was happening in the weeks and
9 months ahead of the virus getting here, in places
10 like Wuhan, if you can look into your crystal ball,
11 can you give a sense of, you know, if we did pay
12 better attention, if we did prepare to the extent
13 practicable, what the world would have looked like
14 in New York, in lieu of what actually did happen
15 over the past five months?
16 DR. MIAN JENNY HUA: Thank you for the
17 question.
18 I think if everything sort of -- everything
19 that you want to be in place, all of the well-formed
20 plans, we know there were drills since 2009 --
21 I think Commissioner Zucker was reporting on that
22 this morning -- that was supposed to prepare
23 New York City for the kind of crisis that we saw
24 with the coronavirus, if all those plans had,
25 indeed, done what they were supposed to do, we
437
1 should be able to have a situation where we have a
2 few dozen cases a day.
3 What we see in a lot of European cities,
4 where the curve really has bended to the point
5 that -- you know, we have seen that in New York, so
6 let me correct myself, that it's a national issue
7 that kind of expands beyond the borders of New York.
8 But I think, you know, the death toll in
9 Wuhan, for instance, they had 30,000 cases,
10 4,000 deaths.
11 So the death toll in New York is many times
12 that. It's, twenty, thirty thousand.
13 So I think that is really one of my major
14 concerns in terms of a second surge. You know, no
15 one can say, but I think we have to be on guard for
16 that.
17 And I know that kind of exceeds the
18 jurisdiction of municipal and state government.
19 But, nationally, we can certainly, you know,
20 picture a very different scenario.
21 SENATOR SKOUFIS: Sure.
22 And do you have faith that, if a second wave
23 is awaiting us in a few months, or, quite frankly,
24 the next pandemic a year from now, five years from
25 now, whenever it might be, do you have faith that,
438
1 in your experience, here in New York, that the
2 lesson was learned, and that the preparedness will
3 be in place, given what transpired over these past
4 five months?
5 DR. MIAN JENNY HUA: I do not see evidence
6 that the lesson has been learned, insofar as I don't
7 sense that the administration at Mount Sinai
8 Hospital was prepared to evaluate what they did
9 wrong, nor was there really an effort to even talk
10 about this precise issue that I just brought up in
11 front of you, which is, that we really
12 under-admitted, that the hospitals were functioning
13 on an individual-by-individual basis in the midst of
14 a pandemic, when they were supposed to act more as a
15 part of the public-health infrastructure.
16 There's no notion of what it means for a
17 hospital to act like it's part of a public-health
18 infrastructure. No conversation about equitable
19 distribution of beds, resources, drugs, across the
20 private and public system; ask for PPE supply.
21 You know, and I think that -- you know, I was
22 part of the effort, with residents, in late March,
23 early April, to start GoFundMe campaigns, to pay
24 for PPE, before Warren Buffet flew in, you know, the
25 PPE supply to Mount Sinai Hospital.
439
1 And after that, we've seen a somewhat more
2 stable supply.
3 But I really, you know, don't see a
4 public-health mandate that affect the hospitals,
5 insofar as they could be mobilized in time for a
6 second surge or for a similar pandemic outbreak.
7 SENATOR SKOUFIS: I'm curious, have you had
8 these types of conversations with anyone at
9 Mount Sinai on the administration side?
10 What --
11 DR. MIAN JENNY HUA: Yes.
12 SENATOR SKOUFIS: -- what were they --
13 DR. MIAN JENNY HUA: So I'm -- I've actually
14 resigned from my residency program, so you can maybe
15 gather from that how well the conversations went.
16 But I was trying to raise alarm, starting
17 with the -- actually, the head of infection control,
18 Dr. Bernard Camins, starting in mid-February.
19 And actually, you know, spoke with, whether
20 they be, you know, program administrators, program
21 directors, on the issue PPE availability, residents
22 training in terms of PPE.
23 And it really seemed like, on the one hand,
24 there was this -- you know, there was a disconnect
25 in which, on the one hand, they registered the
440
1 dangers of the coronavirus. And that, you know,
2 Dr. Camins told me that this was going to become
3 an issue -- you know, likely going to go into
4 endemic transmission.
5 But on the other hand, by the time we saw any
6 training or any systemic education on what to do
7 about COVID, it was already sort of in the full
8 swing of the outbreak.
9 SENATOR SKOUFIS: Mr. Chairman, if I just
10 ask one very brief question to follow up:
11 Your suggest -- you suggested, Doctor,
12 that -- you already said the conversation didn't go
13 well, you subsequently resigned.
14 Is the implication there that there was
15 retaliation for --
16 DR. MIAN JENNY HUA: So I wouldn't go as far
17 as to claim that.
18 I -- you know, I went as far as writing open
19 letters, and sort of gathering support from my
20 resident colleagues. And I felt a lot of support,
21 actually, from my co-workers and colleagues.
22 And there was not individualized retaliation
23 per se, but I just felt like all of these gestures
24 were not actually efficacious, or was not
25 accomplishing what I had hoped we would be able to
441
1 do.
2 So that's why I'm kind of outside of the
3 hospital structure, and trying to work within civil
4 society to do something.
5 SENATOR SKOUFIS: Okay. Thank you again.
6 SENATOR RIVERA: Thank you, Doctor.
7 And thank you, Senator.
8 Assembly.
9 ASSEMBLYMEMBER MCDONALD: It looks like
10 Assemblymember Tom Abinanti wants to be heard for
11 3 minutes. A final 3 minutes.
12 ASSEMBLYMEMBER ABINATI: Here we go.
13 Thank you.
14 Thank you all for joining us, especially --
15 well, it's not 9:00 like the other night, so...
16 At any rate --
17 ASSEMBLYMEMBER MCDONALD: Not yet, Tom.
18 ASSEMBLYMEMBER ABINATI: -- I have a couple
19 of areas that I want to cover quickly.
20 The first area is: Did more people die than
21 should have died?
22 We have been talking about, you know, people
23 taking victory laps about what a great job we did,
24 and yet it seems to me an awful lot of people died
25 in New York.
442
1 Could we have done something better?
2 And should we be doing something better in
3 the future?
4 I'm asking, basically, for a summary of, you
5 know, you kind of touched on this by the questions
6 from my colleagues just before this.
7 In very simple terms, can you give me a quick
8 answer:
9 Did too many people die?
10 Should we have done something different?
11 And what should we do in the future to make
12 sure this doesn't happen again?
13 And my second question is something I've been
14 dealing with all day long:
15 Did we treat people with special needs, with
16 disabilities, with the inability to communicate on
17 their own behalf, advocate on their own, properly
18 during this entire pandemic in the hospitals?
19 Anybody who wants to respond.
20 DR. MIAN JENNY HUA: So, I mean, I could sort
21 of take a stab at the question.
22 So to the first question, I think the simple
23 question is, yes, definitely, more people died than
24 was needed.
25 We know many people died at home.
443
1 Overall death rate was four to six times what
2 you expect, you know, compared to previous seasons,
3 in New York City. And it was a sustained death rate
4 for, you know, multiple weeks, and capacity could
5 have been opened up.
6 There were many things we could have done
7 differently.
8 As for how patients were treated on the
9 ground, it's very difficult to say.
10 But I think, given the restrictions of the
11 pandemic moment, allocation of compassionate care
12 was definitely hindered.
13 You know, there are no regrets in terms of
14 how I interacted with my own patients.
15 But I could see how there was burnout among
16 residents. How, you know, people talked about how
17 they really didn't feel like they were providing
18 standard of care, especially at institutions like
19 Elmhurst, in which there were -- because of various
20 shortages, in which people died because standard of
21 care was just not met. So, it was death from
22 negligence.
23 ASSEMBLYMEMBER ABINATI: Dr. Larsen, do you
24 have a comment?
25 DR. ERIK LARSEN: Yes, quickly, just that,
444
1 look, as an emergency doctor for 30-plus years,
2 look, prevention is always the best route to go.
3 And you can prevent people, you know, whether
4 it's accident prevention, or whatever.
5 If we had, as a society, shut things down
6 quick quicker, immediately realized the whole
7 face-mask issue, and really emphasized, through all
8 kinds of [indiscernible] education, the importance
9 of all this, and spent our money there, we could
10 have prevented a lot of the stuff coming into the
11 hospital.
12 Once you got into the hospital, we were
13 learning about this disease as quickly as we could,
14 by treating it, and also reading whatever primitive
15 literature was starting to come out from the
16 countries that had already dealt with it.
17 So we were trying to learn.
18 I'm not sure if we could have corrected
19 things once people made it to the hospital, but we
20 certainly -- and we've learned.
21 We've learned, and I think the outcomes are
22 better now. And this has been demonstrated around
23 the country, I think.
24 But the other thing is, is that if we had
25 gotten to the prevention -- preventative measures,
445
1 these common basic things, and we had, you know,
2 closed down our society, tightened up, and really
3 educated, we could have prevented a lot of this.
4 Gotten masks out there, gotten handwashing,
5 you know, education out there; gotten all those
6 kinds of things out there, we could have really
7 prevented a lot of the folks even ever coming to the
8 hospital or ever getting the disease.
9 SENATOR RIVERA: Thank you, Doctor.
10 And thank you Assemblymember.
11 There are no further senators asking
12 questions at the moment.
13 I believe we have --
14 ASSEMBLYMEMBER MCDONALD: We have a question
15 from our ranker of Health, Kevin Byrne, 5 minutes.
16 ASSEMBLYMEMBER BYRNE: Thank you.
17 I don't think we're going to use the full
18 5 minutes here, but, I wanted to thank you all, and
19 thank all the previous witnesses for their
20 testimony.
21 Again, it's been a long week with these
22 legislative hearings, and all your time is extremely
23 valuable to us.
24 Dr. Larsen, you made some comments
25 regarding EMS.
446
1 And one of the things I find interesting is,
2 these hearings are very important.
3 EMS does kind of fall through the cracks
4 sometimes, and it's not intentional.
5 That's not a criticism of my colleagues or
6 anything like that, but, where does it fit?
7 You know, we had a hearing on adult-care
8 facilities. Now we're having a hearing on
9 hospitals.
10 EMS certainly is a very important part of the
11 health-care system. You're going to and from
12 hospitals, also to and from adult-care facilities,
13 and, yet, maybe we don't talk about it quite enough.
14 I have to imagine many of the same challenges
15 that our front-line heroes in the hospitals and
16 adult-care facilities had, EMS had as well,
17 including personal protective equipment.
18 But are there any other specific challenges
19 or things that you could highlight, with the
20 remainder of my time, about EMS, and how we could
21 better equip and plan ahead should there be a second
22 wave?
23 DR. ERIK LARSEN: Uh, yes.
24 One of the things that's important is, how we
25 do sort of the -- you know, sort of distributing the
447
1 load.
2 So, you know, EMS systems, if we incorporate
3 some of this, we can try -- and we've got honest
4 participation from the hospital systems, and they
5 can have input and say, look, this is how many
6 patients have arrived, this is how many patients we
7 have on ICU, this is how many patients, you know, we
8 have in ICU beds, on ventilators, in our emergency
9 departments, that we can load-distribute these
10 patients a little bit better, that may be helpful.
11 But we have to have the support for those
12 ambulances to, you know, go out of their district,
13 go farther, go to another -- you know, go to another
14 municipality where there's another hospital that is
15 less crowded.
16 So that needs support, and it needs to be
17 engineered, and it needs to be carefully planned,
18 and it need resources.
19 And it's very hard, when you've got a
20 combination of volunteer services, paid services,
21 municipal services, to get all these services -- you
22 know, because it's so chaotic, as to how the
23 services are structured, it is very hard to get them
24 to interact and work so that we can do that load
25 distribution.
448
1 Okay?
2 We have some things in place to do that, but
3 we need a lot of support to do that.
4 And, again, I cannot emphasize the PPE
5 aspect.
6 It's got to go, you know, kind of across the
7 board, because these folks have no idea what they're
8 getting into when they arrive in a patient's door,
9 responding to a 911 call. And they are as
10 vulnerable as -- like I said, they are as vulnerable
11 to injury and disease and problems as police and
12 fire.
13 And they've never been given that kind of
14 status, they've never been given that kind of pay,
15 they've never been given the kind of support that
16 they need to have a real career, so that you have
17 people who are not working three different EMS jobs
18 just to stay alive.
19 ASSEMBLYMEMBER BYRNE: Thank you.
20 You know, I think one of our colleagues --
21 and I hope I'm not misstating this. Someone will
22 correct me if I am. -- maybe Mr. Billy Jones has a
23 legislative proposal to make it an essential
24 service. It's something that's been discussed,
25 I think, in the past.
449
1 And I completely agree with you as far as
2 exposure and risks.
3 You know, the one benefit, possibly, when
4 you're in the hospital, and someone is diagnosed
5 with COVID, you know what you're dealing with. They
6 have probably been isolated, and you have that
7 information.
8 But if you're an emergency first responder
9 going into a home, you have no idea. They could be
10 calling for chest pain, and, all of a sudden, it's
11 something very, very different, and you've already
12 been exposed. And then you don't want to bring that
13 back to your family and your loved ones.
14 So I appreciate your comments, sir, and thank
15 you very much.
16 That's all.
17 SENATOR RIVERA: Thank you, Assemblymember.
18 And we have no one in the senate, but -- late
19 hands, late hands.
20 ASSEMBLYMEMBER MCDONALD: There are more
21 members in the Assembly than there is in the Senate.
22 So let's hear from our ranker,
23 Brian Manktelow.
24 ASSEMBLYMEMBER MANKTELOW: Thank you.
25 This will be very quick.
450
1 Dr. Larsen, I want to -- I really appreciate
2 your comments.
3 Being in a rural area, having a town
4 ambulance that I was in charge of for nine years,
5 county EMS, some of your things are so valid.
6 And even, you know, having an ambulance
7 stationed at a fire department is hard in our rural
8 areas because they're not always able to bill.
9 So I will be touching base with you again on
10 this, making sure they are prepared for the next
11 pandemic, the next issue that comes up.
12 I just really want to thank you, and
13 everybody else that testified today, that you
14 brought great things to the table.
15 It was good to hear from everybody.
16 And we, as legislators, now need to take that
17 back and take action.
18 So thank you, all.
19 DR. ERIK LARSEN: I appreciate that.
20 Thank you.
21 SENATOR RIVERA: We don't have any questions
22 in the Senate.
23 Assembly?
24 ASSEMBLYMEMBER MCDONALD: The Assembly rests.
25 SENATOR RIVERA: Are you sure?
451
1 I'm going to wait for 5 more seconds, because
2 there might be one more assemblymember that throws
3 their hands up late, as they usually do.
4 ASSEMBLYMEMBER MCDONALD: No, I don't think
5 so. I think we're good to go.
6 SENATOR RIVERA: Yeah, so, with that, I will
7 say to the panel, thank you so much for being with
8 us this afternoon.
9 Enjoy the rest of your day.
10 That is the last panel, and the last of the
11 three hearings that we have held.
12 And for anybody counting, we broke 31 hours:
13 10 hours in the first one, 13 hours in the second
14 one, and 8 hours in this one.
15 So I will just repeat one thing, just
16 procedurally, for everybody.
17 Remember, that if you have questions for any
18 of the panelists, from the commissioner, on to the
19 last ones that we just saw right now, that you
20 believe have not been answered, please get us those.
21 In the Assembly, they go to my colleague in
22 the Assembly, Dr. -- uh, Doctor -- Dick Gottfried.
23 And, if not, in the Senate, they come to me.
24 We will be putting those together, and we
25 will making sure that they get sent out in an
452
1 official capacity, to, hopefully, be answered within
2 a three-week period.
3 I want to thank, on the record, all of the
4 staffers who, behind the scenes, made sure that this
5 happened, from the Senate and the Assembly.
6 There are a lot of folks out there.
7 There's the person that manages the time
8 clock. The person that manages, this; the audio,
9 the thing, the other thing, the other thing.
10 Without these folks, we would not have been
11 able to do it.
12 So thank you, all of you.
13 I will thank Stanley because he's the Senate
14 dude, and I know him personally.
15 But there's a lot of other folks whose name
16 I do not know, who are also -- and making sure that
17 we actually made this happen.
18 So thank you for all of you.
19 And, lastly, I will just say, that this was a
20 very -- even though it was 31 hours, it is
21 eye-opening.
22 There are still questions that need to be
23 answered.
24 It is -- as I said right at the beginning,
25 this is both about accountability and establishing
453
1 better policy for the future, so that we can avert
2 unnecessary debts.
3 I'm hoping that you all felt that we had that
4 type of interaction with people so that we can have
5 that information to do just that.
6 And I will pass it off to, the last word from
7 my colleague in the Assembly, Dick Gottfried.
8 ASSEMBLYMEMBER GOTTFRIED: Yeah, well, first
9 of all, I just want to echo what -- all the thanks
10 and -- that Gustavo spread around to all the staff
11 and witnesses.
12 Today's hearing was really exceptional.
13 I think we all learned a lot.
14 We all picked up a lot of questions we're
15 going to have to pursue.
16 On the -- just one technical point, on the
17 question of sending us follow-up questions.
18 And those of you on the Assembly side, you've
19 gotten an e-mail from me on the point.
20 But, if you can put your questions into an
21 attachment -- into a -- you know, a document you
22 attach to an e-mail, preferably one attachment per
23 witness who you want your questions to go to,
24 I think that would make it a lot easier for us to
25 send the questions out to the appropriate witnesses
454
1 and, hopefully, get answers.
2 And, thank you, all.
3 SENATOR RIVERA: All right.
4 And with that, I will say, thank you to all
5 of you that hung out for this long.
6 And for those out in the public, because
7 I know that there's like three people still
8 watching, thank you so much.
9 Enjoy the rest of your week, and your day,
10 and be safe out there.
11 Thank you, folks.
12
13 (Whereupon, the joint legislative virtual
14 public hearing concluded, and adjourned.)
15
16 --oOo--
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