Does Maimonides Need Saving?
By Reuvain Borchardt
Anyone reading a community newspaper during the past few weeks has seen ads to “Save Maimonides,” inviting readers to share stories of alleged mistreatment at Brooklyn’s largest hospital.
The ads have been signed by community activists who say they are looking to make changes to improve Maimonides Medical Center.
Is Maimonides understaffed, with patients waiting hours and days for services? Is going to the emergency room an intolerable experience? Is it necessary to have “pull” to get decent service? Are the executives guilty of financial mismanagement? Or does the hospital have solid outcomes in patient care? Are the executives doing an admirable job while working under difficult circumstances? Are the financial losses due to this community hospital having a large clientele of money-losing Medicaid patients?
We discussed these issues with a co-chairman of the Save Maimonides campaign, as well as two top officials at Maimonides, so that readers may hear from both sides in what has become a hot topic in the Brooklyn community: Does Maimonides need saving?
Interview with Mendy Reiner, Co-Chairman of Save Maimonides
Hamodia: Anyone who has read a Jewish publication recently has seen these full-page ads to “Save Maimonides.” Tell us about this campaign.
Reiner: The Save Maimonides campaign started out similarly to the Renewal Organization that I founded 17 years ago. At the time, when I saw the need for an organization to help people with kidney transplants, I reached out to Reb Shlomeh Mayer, who was involved in chessed for many years and who was also on the leadership of the wonderful organization Chai Lifeline, and I asked him for advice and support. Now with the Save Maimonides campaign I reached out to him again. He is co-chairing the Save Maimonides initiative.
Maimonides is the only hospital in our neighborhood. It’s roughly the size of Cornell, with many departments. But the hospital has declined over the years to the point that it’s not properly servicing the communities it was built to service. The care is terrible, the facilities are falling apart, doctors are leaving and they are constantly short-staffed. It’s so bad that most community members fortunate enough to have private insurance are going to other hospitals; people who don’t have private insurance are scared to be at this hospital. Our campaign is simple — we want to bring in experts that can fix Maimonides and make Maimonides a world-class hospital that the communities can start using again.
What specifically are people’s fears about Maimonides, which causes them to go to other hospitals?
Horrible outcomes, neglect and lack of basic services like air-conditioning in rooms.
Since the start of this campaign, we have received over 1,200 calls, hundreds of emails and complaints directly onto our website, which show that there is a lack of leadership in the hospital, and that this needs to be addressed to make this a better hospital.
What we are seeing is that when you have a patient in the hospital for several days, they will at some point have a terrible experience. Sometimes they can have a decent experience in one department, but then when they are transferred into another department they may have a horrible experience there.
What sorts of horrible experiences are people having?
Patients being put into wrong departments, wrong floors. Waiting around for 72 hours in the emergency room until they get placed into a room — and the rooms are available, there just isn’t manpower to transfer patients upstairs from the ER, or to clean the rooms to prepare for the new patient. A great many complaints center around there being a major shortage in the hospital of nursing and nursing support staff, which is a direct result of mismanagement.
The “horrible outcomes” you mentioned would seem to be about the quality of the medical care, a separate issue from the understaffing of nurses and long waiting times.
No, they are directly linked, because if there isn’t proper staffing, people are going to get hurt.
For instance, there is a nurse that we’ve spoken to who told us there is outright negligence in terms of the number of nurses there are per patient. If a floor requires one nurse for six patients, but there are in fact two nurses to 30 patients, that is outright negligence and unacceptable. And there is no way that a hospital can service a patient properly under these conditions. Nurses can’t give 400% of what they’re already giving. They’re already giving 110%.
So the complaints are not about the staff themselves, who you say are doing the best they can, but about the staffing levels.
Sometimes, there is an overworked staffer who may react sharply or improperly to a patient or family member who is complaining about lack of care, and the complaint will be against the staffer, but the source of the problem obviously is the understaffing. You have to understand that the staffers themselves are exhausted and frustrated by management, which seems to only look out for themselves — instead of hiring staff, they’ve given themselves million-dollar raises.
Since COVID, the hospital executives have taken multiple millions of dollars in raises — while the hospital is losing money every single day. They could have used that money to hire over 200 nurses or other support staff. That’s why the staff is angry, as well.
If there is a patient that has to use the bathroom and due to lack of staff, is sick of waiting and just gets up on their own and goes to the bathroom and falls and gets hurt, that is unacceptable and that’s on management.
Beyond the waiting times and understaffing, once someone gets to see the doctor or have their procedure done, what about the quality of the actual doctors and medical care?
The actual doctors are not causing the problems, and many are very good. But if you’re short-staffed and you don’t have a decently staffed recovery room, that leads to bad outcomes.
So whatever the complaints are, you’re saying it basically really all boils down to the staffing levels.
And staffers are complaining of being pressured by the executive leadership into doing things like managing a floor with inadequate backup.
We have been collecting many stories from staff, and I would call them horror stories. One after another they are saying, “We are understaffed. We just cannot do this on our own.”
Of course, the mismanagement also means that the facilities are disgusting. Floors are dirty, bathrooms are broken, air conditioners don’t work and medical equipment is broken.
When local politicians recently sent Maimonides a letter requesting an open dialogue with the community, instead of saying, “We’re here and ready to listen,” they basically said we were attacking the hard-working frontline workers.
That is a complete distortion of our complaint. Our complaint is that the management of the hospital is not performing for their patients and they’re taking money for themselves instead of using it to hire more staff.
Can you tell me one or two specific stories staffers told you?
I’ll read you some submissions we got today. One says, “We are dangerously understaffed.” Another says, “We are understaffed and overwhelmed.” Another one says, “We need a cleaner, safer … environment to work in. We are tired, exhausted, overworked, overwhelmed, and underpaid and it’s time for change.” Another one writes, “We are understaffed all the time and overworked. Many staff members are at risk of burnout and this leads to high turnover rates. The patients are at risk and do not get the attention and care that they should. This needs to change.” Another one says, “Place needs revamp; it’s full of toxic people. Everyone is complaining, no one is doing anything, the only thing you hear is I’m handing in my notice and I’m leaving. No motivation.”
What is the ultimate goal of the Save Maimonides campaign?
The ultimate goal is to improve the quality of care at Maimonides. The way we do that is by having some sort of financial oversight of the hospital, bringing in independent consultants to make sure that the hospital doesn’t continue to squander their money, and that resources are properly allocated.
We have already brought on consultants to “Save Maimonides” to make this campaign as successful as possible, and we’re hiring top consultants to come up with a clear plan for how the hospital can improve. There are many places where the hospital can improve and should improve. We are hearing reports of shocking mismanagement in the financial part of the hospital.
We want to bring in independent consultants to make sure that the hospital turns around. We are speaking to several firms.
Maimonides has been around for decades. What happened now in 2022 that made you guys start this campaign?
This campaign definitely could have started five or 10 years ago, as the hospital has been going into decline. But when the hospital loses money year over year over year, and people are not being serviced, it’s time for a change. When the hospital goes to the government for bailouts year after year for tens of millions of dollars, shouldn’t we as a community have a say in the matter as to what we need out of the hospital?
I think the biggest red-flag was that the hospital hired a CEO with no medical, government or community experience. Ever since then the hospital has gotten worse and worse and went from making money every year to losing crazy amounts of money every year.
And to be clear, this is not merely a Jewish campaign. We will be rolling out shortly leaders in the Asian, Hispanic and African-American communities who will be joining us. Our ads in the Jewish papers have featured the names of mostly Boro Park Jewish activists, but we will be placing ads also, for example, in Asian papers, with Asian leaders who want to fix the hospital, as well.
Are there any Rabbanim whom you ask she’eilos to, or who would publicly support your campaign?
I personally visited probably over 40 Rabbanim before I started this campaign to make sure that they are hearing what we are hearing about the terrible conditions at the hospital. Just about every single one heard that the hospital was terrible, and they encouraged me to do it.
Even assuming that the complaints are correct, shouldn’t a daas Torah be consulted and be supporting the campaign, saying this is the proper way to go about things?
No question about it, a daas Torah has been consulted. We are in close contact with daas Torah. And people looking to get involved in the campaign should consult their daas Torah.
Daas Torah has been extremely, extremely supportive of this campaign.
But did a single Rav say you could put his name on it this publicly?
I didn’t ask anyone yet to publicly do it. That’s because we want to put out a letter with many Rabbanim from many different communities. That letter will be coming in the next few weeks.
When a letter came out recently from the politicians asking Maimonides CEO Ken Gibbs to do a town hall meeting with the community, I asked the hospital for a response, and they issued a statement that said, in part, “These false allegations are part of a targeted smear campaign by individuals who have previously sought control over the hospital board.” Is it true that some people behind your campaign previously sought control over the hospital board?
That’s another misleading push from the hospital to distribute outright lies about our campaign. My campaign has not received $1 from anyone who has been previously involved in the hospital.
Or previously tried to be involved in the hospital?
Absolutely not. That’s another false allegation of the hospital trying to smear this into a takeover of the hospital.
I’m not looking to take over the hospital. I don’t have the ability to take over the hospital. I’m not trained to run a hospital. But what I do know is that when something is broken like Maimonides is, we reach out to consultants that are experts in this field and ask them to join and help us fix the hospital. And instead of spreading false allegations, the hospital should embrace us and say, “Please come and help us.” The fact that they’re lying proves that they’re just trying to cover up their own mismanagement.
One of the names on the ad is Lazer Scheiner. I presume that he’s giving funding for the campaign. Is it not true that he in the past tried getting on the board or getting some influence in the hospital?
Lazer Scheiner has not given any funds whatsoever for this campaign, but is one of the many askanim supporting our efforts to save Maimonides.
Whether he’s there as an activist or as a philanthropist, is it not true that he previously tried getting on the board and making some changes in the hospital and was rebuffed by the hospital?
My understanding is that other board members asked him to be involved as a philanthropist and he said he would gladly raise tens of millions of dollars for the hospital if they would agree to have independent governance and oversight — and they turned him down.
So is it your goal to get rid of Ken Gibbs and the Maimonides leadership, or would you guys be happy with them staying as long as they allow this independent oversight?
Reiner: Let me make it very clear: my only goal is to bring in competent people to help the hospital. I have no ill feelings towards Ken Gibbs, I have no ill feelings toward the board or any others. I just feel that the bottom line is patients are suffering at Maimonides. We are not getting a hospital that we could be getting. Do you know that some floors of the hospital have broken air conditioning? Isn’t this something that should be addressed? Do you realize that patients are sitting in 90 degrees on the floors that have broken air conditioning? This is outright unacceptable.
People in our community care very much about Maimonides because this is the hospital of the community. But do you have a way of comparing it with other hospitals — do you know that they have better nursing levels?
I’ve been talking to a lot of people recently who have seen these Save Maimonides ads, and one person said to me, “Yes, Maimonides is terrible, but they’re all terrible.” This guy tells me he knows someone who underwent brain surgery in a major hospital in Manhattan, and afterward you can’t get off the bed because of seizure risk, and for two hours he was ringing the bell because he had to go to the bathroom, and nobody came to help him.
Are you saying that Maimonides has to be fixed regardless of what’s going on anywhere else? Or are you saying that you know that other hospitals are better?
Absolutely. Maimonides is ranked the lowest. If you go to our website you can see, it’s not our stats and figures. According to US News & World Report, the overall satisfaction with the hospital is the lowest. Willingness of patients to recommend the hospital — the lowest. Satisfaction with doctors and the doctors’ communications — the lowest. They’re literally on the bottom of the New York State Health Department’s list of patient satisfaction. So they can turn around and spin their numbers whichever way they want. But if you go onto government figures, the hospital is rated the worst of the worst.
And no doubt anybody can have a bad experience in any top-of-the-line hospital. Things happen, and negligence happens. But the question is are we getting nine out of ten happy patients or are we getting nine out of ten angry patients? And in Maimonides it’s the nine out of ten that are disappointed with the service.
The frum community seems to have a lot of influence in Maimonides. One thing that a lot of people speak of positively is the end-of-life care. Some Manhattan hospitals would send elderly or terminally ill patients to hospices, but Maimonides will try to keep them alive as long as possible. We have halachos of end-of-life care, and it seems that Maimonides is the best in that regard.
Is there any fear that this public campaign may turn Maimonides against the frum community, that hospital leadership will say, “Why should we be amenable to these issues if you guys are so against us?” Is there any concern that this could backfire in hurting the community or making the board or the staff resentful of our community, resulting in patients from our community being treated badly?
I’d like to focus my campaign on the ones that are alive, and making sure that we have less end-of-life issues due to bad treatment at the hospital. If we are trying to focus a conversation on making Maimonides a quality hospital, there is no question that there are topics that are uncomfortable, but the overall discussion needs to be had, and changes need to be made. And if the hospital is willing to play that type of a game, we don’t belong there to begin with.
What type of game?
That because we’re bringing to the forefront areas where the hospital needs to be improved, that they’ll punish the community — I wouldn’t put Ken Gibbs on a level like that.
A level like what, to take revenge?
I mean, if we’re talking of a person taking revenge, obviously we’re not talking about a sane or normal person. So, I wouldn’t go down that low to say that anyone at this hospital would turn around and say, “Let’s punish the community because they aren’t happy with how we’re running it.” That would be borderline criminal behavior.
Okay, so you are not concerned that it’ll backfire in that regard. But before embarking on this public ad campaign, did you try to get personal meetings with Ken Gibbs and the board?
We have in the past reached out to many people involved in the hospital and had many issues and reports back from people that work in the hospital. But I did not reach out directly to Ken. I don’t really know Ken.
You mentioned financial mismanagement. I want to get into that now. First of all, there was a report in The New York Post a few months ago about how the hospital is losing money but Ken got a big salary hike. Did you or anyone associated with your campaign have anything to do with that Post article?
No. But that’s certainly an important story, and that’s why CBS, The New York Post, Crains and others have covered it.
Give me some hard figures as to why you think the hospital is losing money and why you think that this is due to mismanagement?
There’s no question that it’s due to mismanagement, because if I own a business, and my business loses money, there’s no way that I’m giving myself a raise; I’ll be the first one thrown out of the door.
When the executive branch gets a raise of $10 million collectively, and the hospital loses $100 million — that alone is mismanagement. There’s a lot more to it, through the investigative work that we’re doing as we speak, whether it’s sloppy buying, sloppy shopping and not putting into place efficiencies — all that is where the hospital loses millions of dollars a year. There’s no question about it that a top health-care consulting firm can come in and turn this place around as long as management would be open to fixing the problems in the hospital other than just to protect their jobs.
Are you alleging that it’s just sloppy work, mismanagement of the hospital and people giving themselves big fat raises? Or are you actually alleging criminal activity, like stealing money?
I wouldn’t say criminal to this point.
Are there any actual members of the board that you feel are as upset as you guys are about this and are supporting, albeit secretly, your campaign?
I have not reached out to any of the board members at this point to join the campaign. We are open to meetings, we are open to having discussions, and I think the work needs to be done through the proper channels. I’m not here to reach out to board members at this point and try to create machlokes on the board.
There were a lot of complaints about Maimonides, and in general a lot of crazy stuff was going on in hospitals, during COVID. But this campaign is not specifically a response to COVID, correct?
Correct. Although we had horror stories in Maimonides during COVID, I’m not looking to focus this campaign on COVID in and of itself. I think the stories about COVID are also terrible, but this campaign is focused on the future.
An official in the hospital was talking to a friend of mine casually — this is long before the Save Maimonides campaign — and he was mentioning how the government lowered Medicaid reimbursement rates and that’s why the hospital is struggling so much financially. Do you believe there is any truth to that?
There are two things I’d like to point out. The hospital claims they are losing money due to the drop in reimbursements, and that the customers with private pay insurance are going to Manhattan. But that is the very reason that we need to turn this hospital around. If this hospital was a five-star hospital with proper care, we wouldn’t be going to Manhattan. I used the hospital myself and I had a bad experience. So that is the last time that I would use the hospital, unless there is an acute emergency.
We have a saying in the community: “We are all born in Maimonides and we all die in Maimonides, but for everything in between we go to Manhattan.”
Is there anything else specifically about the finances that you want to add?
The particulars are that the hospital is failing and the hospital is struggling and we need change in the hospital. Change starts with better financial management. It’s outrageous that management spends millions on themselves instead of the quality of care for patients.
Let’s say right now Ken and the other top guys say , “Okay, Mendy, tell me right now what you want, and I’ll do it.” What would that be?
“Ken, you seem like a nice guy, but you clearly don’t know how to run a hospital. Let’s bring in the professionals.”
Meaning independent auditors?
Independent auditors, independent hospital experts and consultant from the top 10 hospitals in the country. Let’s all work together with the best of the best health-care experts to make this hospital a five-star-place.
And as long as they do that, you’re fine with the board members and Gibbs keeping their jobs?
Perfectly fine, as long as they are publicly committed to turning the hospital around, agree to a public plan for doing so, and independent oversight to make sure it gets done.
I’ve heard people say that even when people do get good care there, it’s because they have pull. They come to the ER, and the first thing they do is call this patient rep or that patient rep or this askan or that askan and they get cared for more quickly. But people without pull get left behind. Do you hear that, too?
Yes. I’ve been on my tours seeking out Rabbanim and askanim, and it’s unfortunately very true. 30% of our community knows who to call in the hospital. But the average guy that walks into the hospital that has an issue and doesn’t know who to call, is in trouble. An 80-year-old that has a sick wife that can’t be with them and only has one daughter that can’t be there 24/7, there is no question that patient is suffering.
That’s the most painful part of what we are doing, because people are always like, “Sorry Mendy. I agree with you, but I don’t want to speak out because I have someone who I can call.”
Let’s speak up for the 70% of the community that doesn’t have who to call. Those are the ones suffering. I’m going to Manhattan if I need a hospital, I’m not staying in Brooklyn, I’m not staying in Maimonides. But think about those that have no other choice. Think about those that don’t have insurance to go to Manhattan, or the Manhattan hospitals won’t take them because they only have Medicaid and Medicare.
Let’s speak for those that are not heard.
Anything else you want to add?
That is why I’m asking for the community to come together. This is a time where we need to stand up and we need our voices to be heard and have real long-lasting changes in the hospital.
You know the famous speech “I Have a Dream” by Martin Luther King, Jr. Well, I have a dream for this hospital to be a hospital where community members don’t have to go to Manhattan. Community members can walk on Shabbos to their parents, to their mother or father in the hospital, to the young baby that was just born in the hospital. Where we can work with all of our neighboring communities and rebuild what was once a great hospital in Brooklyn.
Interview with Ken Gibbs, President & CEO of Maimonides; and Eugene Keilin, Chairman of Maimonides Board of Trustees.
Hamodia: The past few weeks, everybody’s seen these full-page ads for “Save Maimonides” alleging horror stories and mistreatment at the hospital.
Does Maimonides need saving?
Gibbs: No, but it is functioning in a broken reimbursement model. The hospital sector across the nation, across the state, is challenged.
In particular in New York state, though my sense is [this is also] around the country, those hospitals that treat patients who are insured by Medicaid, less well-to-do patients, the reimbursement system has been broken for a long time — and the [COVID] pandemic shattered it.
The reimbursement from Medicaid had dwindled down to 67 cents on the dollar; in the last year it jumped down further to 61 cents on the dollar. So half our patients have — to say an inadequate reimbursement to us for the services we provide is a total understatement. So we have been working closely with the state to address that. But the spirit of the statement “save Maimonides” is off, absolutely and completely.
In what way is it off?
Gibbs: In the face of the incredible challenges that we are dealing with, namely the pandemic and the broken reimbursement system, we are focused on outcomes — and we deliver incredible outcomes. There is a very diverse set of sources to measure quality in health care. The gold standard from our point of view is the federal government, which has access to the most information, and they measure what they call “risk adjusted mortality.” We call it “survivability,” but it is the outcomes: Do you leave a hospital alive when you have a real challenge? And for the most recent four years those numbers have been available, we have been in the top 10 in the country. And if one’s trying to evaluate statistical measures, you sometimes look at who the other institutions are to see whether they match a sense of reputation. In this instance, our company is the Cleveland Clinic, Cedars Sinai, Mass General, New York Presbyterian. So from that point of view, to say “save Maimonides,” or frankly to attack the quality of care, is misplaced at best.
Let me ask you about another metric: According to the New York State Department of Health, Maimonides is last in patient satisfaction.
Gibbs: Yes, we have work to do on patient satisfaction. We have prioritized clinical outcomes. We are always working on patient satisfaction.
Let me give you one example: the emergency department. Folks complain about their waits in the emergency department. That’s their personal experience. We have to pay attention to that, we have to do better. But I will let you know that if you look at national benchmarks for urban hospitals, we do not do poorly in terms of wait times and the other comparable metrics like door to doctor. So while a person, totally understandably, is frustrated for waiting, the reality is the waits are not out of line with what to expect from an emergency department.
And on top of that, in spite of what was going on with the pandemic surge — which we are really not done with yet — we kept making progress in the following ways: We actually raised funds in August of 2020, and we are expanding, and the construction has begun, with the first pediatric emergency department in the borough — a project that will create two and a half times the space in the emergency department.
But that’s an area where our patient satisfaction scores are low. And we have been underfunded and haven’t been able to invest in facilities, which have a tremendous impact on patient experience.
It seems you’re saying that the hospital care is not that bad. Then to what do you attribute being dead last in patient satisfaction, in the state?
Gibbs: I just went through an example of patients being frustrated, who may not have the context for their experience.
Patients in other hospitals have more context and are rating the other hospitals higher?
Gibbs: In certain ones, for sure.
As far as the reimbursements: Save Maimonides says that, yes, Medicaid reimbursements are low, but other hospitals are able to compensate for that by getting the more lucrative private-insurance patients, and that if Maimonides were to improve in their care and in the quality of doctors they had, people would be coming there more for surgeries, rather than going to Manhattan.
How do you respond to this argument that if there were better doctors for the higher-end surgeries, Maimonides would be getting the lucrative reimbursements from private insurance?
Gibbs: The notion that [Manhattan hospitals have] better doctors, I believe, is patently false.
And look at the reimbursement. I can think of one Manhattan hospital in a recently published study whose commercial rates are what’s measured as three and a half times cost, and our Medicaid patient is at 60% of cost. Now spend 10 years getting reimbursed at under 20% of what someone else is getting reimbursed. Do you think they have been able to invest more in the accoutrements of care to attract patients for elective surgery?
And it becomes a vicious cycle, because the patients then know them for their inpatient care, [while] they know us for the emergency department. Patient satisfaction, by definition, is lower in an emergency department than it is in an elective procedure.
And then on top of that, we sit between Sunset Park and Boro Park, the two highest-Medicaid-concentration ZIP codes in Brooklyn. Approximately 70% of all hospital admissions from those two ZIP codes are on Medicaid.
Keilin: We are in the top 10 in the country for survivability. We don’t do that with poor doctors. We do that with superb doctors who are stars in their field.
There are two questions here. One is the quality of care and the second is the patient experience. We do not give any ground to anyone, including the best Manhattan institutions, when it comes to quality of care. When it comes to patient experience, we have real problems that have to be solved. We do work on them every day.
Are you disputing the notion that if someone in the Boro Park or Sunset Park community has a difficult, complicated surgery and needs a really good specialist, they will prefer to go to Manhattan?
Keilin: What I’m disputing is their awareness of the quality of care that they could get in Maimonides.
Maimonides is well known for its cardiac care. But what about, let’s say, a difficult cancer?
Keilin: If you go down the key specialties — stroke care, cancer care, orthopedic care — we’re not No. 1 in all categories, but we are at the top of all categories.
Gibbs: There are some people who go to Manhattan. And by the way, if we had a billion dollars to build a brand new building, I think there are people who are going to Manhattan who would stay in Brooklyn. We don’t have that billion dollars. The reality is a building is a draw.
The main complaints seem to center around the understaffing — that patients wait endlessly for service, and if they don’t have a visitor with them to go and tell the nurse, “My relative needs something,” the patient can ring the bell or call for the nurse and it takes an endless amount of time for someone to come.
Is Maimonides understaffed?
Gibbs: We are not understaffed, but we are not meeting our staffing objectives. There is a national nursing shortage, and there is a local nursing shortage, and we are hiring as rapidly as we can.
We hired 200 full-time nurses over the last nine months. We are racing to deal with the national challenge. We had an open house yesterday. We got 60 nurses; I believe we’ve made offers to 50 of them.
During the omicron crisis, when we had 250 patients in-house, we had 250 staff out. When staff are out, it usually means that the people they work with are also affected. So that meant particular units which have specialized capabilities were devastated in a rolling fashion.
So there’s no appreciation in that critique for what the industrywide challenges have been. And the work that has been done here by the staff, which was categorically, across the board, criticized, gave no reflection for the effort, heart and soul that was put in here.
The Save Maimonides people don’t criticize the work of the staff themselves; they just say that there’s not adequate staff.
Gibbs: Their material attacks the quality of the whole organization.
You mentioned a lack of staffing due to COVID, but community members I spoke with said that they always felt there was understaffing.
You said you’re “not understaffed” but then said you’re “racing” to hire more staff.
Gibbs: We’re not understaffed from the point of delivering quality care. We are understaffed from point of view of the patient experience.
Is patient experience not a part of quality care?
Gibbs: But we focus on the outcomes.
I’ve heard from people that there’s been a serious problem with air conditioning breaking down this summer in Maimonides. Is that true?
Gibbs: I’m not aware of a serious problem. But it could be that there are instances where the air conditioning hasn’t worked.
Do you consider that related to quality of care?
Gibbs: It depends on the actual substance of the temperature, the duration and everything else.
Keilin: Again, the distinction is between the medical care and the patient experience. The medical care is superb. The patient experience is mixed at best. We acknowledge that and we are working at it in every way we can within the limits of the funding model.
Save Maimonides argues that the staffing level actually affects patient outcomes, because things happen when there aren’t proper staffing levels; like if someone has to wait hours for a nurse to help them go to the bathroom, they may just get up from the bed and go themselves, and fall.
Keilin: We’re not disputing patient experience. But the other side of that is that the statistics show what the outcomes are. Those are also not debatable.
Gibbs: You may have had an interview [with Save Maimonides], but the material in the public domain is critical, and doesn’t draw this distinction.
We are a hospital, and what is being run is a political campaign. And in American culture, some people have made their peace with inaccuracies … pushing them into the media.
Can you point to a specific inaccuracy or two in the campaign that you want to correct?
Gibbs: I’ll give you just one thing that has been repeated in the media that was extremely painful for my family and that is factually inaccurate: the insinuation that I wasn’t at the hospital during the pandemic, when in fact I didn’t see any members of my family for months. And that’s a kind of personalization, meaning, it’s my job to take the slings and arrows of outrageous fortune, but what’s being done here is a manipulation to try and create a result. It’s similar to the attack on quality care, which is the biggest headline, and it’s just inaccurate. It’s conflating different things, and discouraging patients from coming to the hospital.
What is the staffing ratio of nurses to patients, compared to what it was – forgetting the heavy pandemic time — to 2019, 2018 and 2017?
Gibbs: You can’t make comparisons like that. Different units have different staffing levels. All the units have different purposes. And the mix of patients at different points in time have meant the types and sizes of units have changed over time.
What about the hospital overall?
Gibbs: We can calculate something that would be totally meaningless in terms of the number of nurses to a number of patients, but depending on the acuity of those patients, and the nature of their challenges, it’s just meaningless.
You said it depends on each department. So can you compare the staffing levels in each department to what it was in 2019, 2018 and 2017?
Keilin: I think it’s a useful question, an important question. We’ll try to get back to you with specifics about that. [Ed.: At press time, we had not received any further information from Maimonides.]
But it’s also a question of context. Ken said it before, but it’s important to remember: There is a national nursing shortage and there is a national staff shortage. Partly that’s the result of inflation. Partly that’s the result of the pandemic. Partly it’s a result of the number of medical professionals who are burned out. We are not immune to that. No hospital is immune to that. And the numbers may reflect that.
There’s definitely a national shortage. But in order to compete, executives will often say, “Okay, I have to offer more money, more compensation, because it’s my job to fill out my staffing levels regardless.” Have you done that?
Gibbs: We’re doing what we can. You do remember what we said about Medicaid reimbursement.
Considering the financial problems that are going on in Maimonides — let’s say because of Medicaid, or whatever the reason is — how do you explain getting a significant raise recently, Mr. Gibbs? [Ed.: A New York Post article in February reported that “Gibbs saw his compensation skyrocket from $1.8 million to $3.2 million from 2019 to 2020.”]
Keilin: He didn’t get a raise, he didn’t get a bonus. In 2020, here’s what happened. Known facts. When he was engaged as the CEO of the hospital, we entered into an employment agreement with him and we divided his compensation into two parts. There was a part that was paid currently, every year. And there was a part which was deferred, at our request, and for our benefit, until he had completed five years as CEO. 2020 was the fifth year. He was still the CEO. Pursuant to his contract, the deferred compensation was paid to him. That deferred payment was a one-time event. But it was an event in which he was paid compensation, which he had agreed to delay.
Gibbs: Those who are knowledgeable know that is a standard structure in hospital senior executive compensation.
Regardless of whether it’s a raise, is such compensation appropriate for a hospital that’s losing so much money?
Keilin: Thank you for asking. We keep very close watch on the compensation of chief executive officers and other senior staff of other hospitals. Ken Gibbs’ compensation is in the middle of the range of CEOs of hospitals of comparable size and comparable funding. And it is well below the compensation of hospitals, say in Manhattan, that provide a similar level of clinical care but have a very different funding model.
Do you consider yourself to be a “safety-net hospital”?
Gibbs: We do and we don’t.
We do from the point of view of mission, and from the point of view of reimbursement model. We have had the good fortune to be able to build a level of tertiary care services and teaching program that tends to be unusual for safety-net hospitals.
Is it true that every other safety-net hospital CEO in New York City makes less than Mr. Gibbs does?
Keilin: I’m going to stand with what I said before, which is that his compensation is well within the range of CEOs of hospitals of comparable size and comparable funding.
Gibbs: I’m not familiar, necessarily, that I have in my head every one, but size, scale, and complexity should be analyzed — meaning there are a lot of things that go into compensation.
Are the financial problems entirely due to the low Medicaid reimbursement, or does the executive leadership feel it bears any responsibility for the financial problems of the hospital, which was making money a few years ago and now has been losing?
Gibbs: First of all, it wasn’t making money a few years ago. There was a long string of one-shots being used. The funding model has been broken for a long time, and the institution has scratched and clawed to drive forward for a very long time in a very difficult circumstance.
Secondly, you pinpointed the reimbursement, which is a critical thing to pinpoint. However, you left out the pandemic, and the impacts on the hospital sector writ large from the pandemic, and the factors in the economy. The broken supply chain, the inflation, the shortages in the workforce, the changes in care models, and staffing challenges created by the pandemic have driven up costs all across the board in the hospital sector.
And for us, on top of that, part of how the challenges historically were handled were through volume growth. But Maimonides — like comparable hospitals — has experienced patient-volume reduction over the past two years. The reduction in non-COVID patients has outweighed the increase in COVID patients. But Maimonides has also had revenue decline on one hand, and cost growth on the other. That tends to be a recipe for poor financial performance.
I will say this: I wish we had done better, and I wish we were doing better, and we are working hard to do better. This is an incredibly challenging environment. And the people throughout this organization have done a phenomenal job in responding to the challenges. But I’m accountable, and I do not believe we have been perfect. We have work to do, and we have made changes, and we will be continuing to make changes to do the best we can with the hand we’ve been dealt.
And, by the way, we really appreciate the support from the community people who have supported us on the ground as an institution. We also appreciate the work of the people in state government and the community people who’ve constructively engaged with the state, because the challenge that they face with regard to the hospital sector is extraordinary and unprecedented and getting worse.
Keilin: Just as there is a national staff shortage and as a consequence, a statewide and local staff shortage, there is also a national and for sure a statewide problem for hospitals like Maimonides. It’s easy to focus on Maimonides because there is currently a campaign focused on it. But Maimonides is not alone in having financial problems. Those problems are so widespread in the state of New York, and so serious, that the state Legislature this year, in an extraordinary action, passed a supplemental funding program — for hospitals liked Maimonides, but including Montefiore, which is one of the great hospitals on anybody’s list of hospitals in New York — an extraordinary funding program of billions of dollars to help redress the financial problems that were caused and are continuing by what Ken said.
Yes, we do have financial problems, but we are not alone. And we have been particularly successful at managing ourselves in that circumstance.
Individual doctors can choose — as many top doctors do — to only take private insurance, which has more lucrative payouts than Medicaid. So if you attracted top doctors who only take private insurance, wouldn’t that help the hospital’s bottom line?
Gibbs: Maybe, but by the way, we actually have a mission function here. We actually are here to provide quality to all patients, to provide great outcomes to all patients. So we are very careful in how we set our priorities to make sure we deliver the same great outcomes to all comers.
Are you implying that you would not take doctors who won’t accept Medicaid?
Gibbs: I’m not implying that. I’m just saying that I’m not sure that we would build a whole business model based on that.
How much money did the hospital lose in 2021, and through June 30 of this year?
Gibbs: It’s not public information yet.
Now I want to ask about optics and perceptions.
There’s a feeling in the community that some people know when you go to the hospital you call this prominent person or that patient rep, and you get care; but the people who don’t have “pull” languish.
What is your response to that perception?
Gibbs: I think that perception is unfortunate.
Do you think it’s a misperception? Or do you think it’s a fair analysis of the state of things in Maimonides, that you need pull to get care in a timely manner?
Gibbs: I don’t think that’s accurate. And I think our outcomes prove that that’s not accurate.
Continuing with this focus on the perception: Regardless of what the facts are, there’s no question about it, everyone will tell you, even before the Save Maimonides campaign, that Maimonides had an image issue. Just walk the streets, talk to people, they say they have problems with Maimonides. Do you agree that Maimonides has a PR problem? And if yes, what, if anything, are you doing to address it?
Gibbs: The clinical leads here have always made the point that we are one of the best-kept secrets in Brooklyn, in terms of the quality of the outcomes and the fact that folks didn’t recognize it.
And we have never really spent much money on advertising. We started to change that, but it’s a paltry sum compared to what the standards in the industry are, in terms of getting the word out about the quality of care. Also, we have been making investments in facility changes as best we can, scratching and clawing. And so, for example, we opened the doctors’ pavilion, so that patients can see our specialists, where over 30 specialties now are in the same building, and patients can get coordinated care in a very modern setting where they used to be separated with poor flow in terms of exam rooms and inefficiencies in brownstones throughout the neighborhood. So that is one example.
We hope, probably in the first quarter of next year, to have an off-campus emergency department in Bay Ridge open, which should be an incredible experience. I mentioned that we made the investment in 2020, construction is underway on a plan to expand the emergency department two-and-a-half times. What this does, one of the critical aspects of an experience in an emergency department is whether you have privacy or not. By having more space, we can very significantly change the patient experience. Those changes are underway. The reality is that [if] someone walks into a brand-new building, they feel very differently about the image of the institution. Our front door, quite significantly, has been the emergency department.
Our environmental team says it’s hard to clean age. If it looks old, it just looks old. The feedback we have gotten, and the patient volume, has grown rapidly in the doctors’ pavilion.
Prior to becoming CEO, Mr. Gibbs had been a board member, but he hadn’t run a hospital or had medical management experience. In retrospect, Mr. Keilin, do you believe it was appropriate for Mr. Gibbs to have been installed as CEO?
Keilin: Ken’s been a superb CEO. The board had the advantage of knowing Ken as a director, a trustee and the chair of the board before he was hired as the CEO. He had the advantage of knowing the hospital, how it ran, what its problems were, the people who are important to it. He has the full support of the board, and he certainly has my support and confidence.
During the last few weeks, since the Save Maimonides ad campaign started, has anyone from Maimonides leadership met with either people from the Save Maimonides campaign, or other people in the community who are not part of Maimonides, to discuss complaints?
Gibbs: We’ve been very clear that we wanted to meet. The message that came back when we were first aware of the campaign was they didn’t want to meet. We’ve been very clear that we want to know what their plan is, what their proposal is, and what they constructively have to say. They have not made any of that available.
Since the Save Maimonides campaign started asking people to write in complaints about the hospital, they say they have received over 1,200 complaints, and complaints from staff saying things like we’re understaffed and it’s impossible to work under these conditions. What is your response to this volume of complaints?
Gibbs: We would have to see them to understand it. But we get complaints directly ourselves. We have a totally organized feedback system. And we work to address concerns as best we can.
Mr. Gibbs, you said you’re not sure what Save Maimonides’ goal is. The person I interviewed said what they’re looking for is to get audits of the finances and independent oversight to suggest improvements. Would you consider that?
Gibbs: My response is I would greatly appreciate if they’d talk to us directly.
Keilin: I would add, first of all, the finances of the hospital are audited by a national firm of independent auditors. I’ve been on many boards, and I don’t know a board that has more financial information than the board of Maimonides does. We get detailed financial reports at every board meeting, at every strategic planning committee meeting, which is held between board meetings, and at monthly meetings of the Audit and Finance committee.
I don’t know a CEO of any institution who is as open to suggestion and criticism as Ken is. I don’t know a CEO who is more open with his board about what’s going on in the institution, what worries him about what’s going on in the institution, what plans he has to deal with what’s going on in the institution. The problem of financial and operational oversight is not a problem for Maimonides.
Mr. Gibbs, you said that you wished Save Maimonides reached out to contact you directly. If they’d be interested, you would be willing to sit down for a meeting with Save Maimonides?
Gibbs: We’ve been clear [that] if they were coming to the table to present a plan, or a proposal, or improvement, we very much want to hear it.
A source told me Maimonides is considering filing for bankruptcy. Are you considering it, or have you had any discussions about it?
So you’re saying Maimonides will not be filing for bankruptcy, period?
Gibbs: One cannot say never in the next 40 years. But no, there is no plan, no discussion, no intent.
What about in the next two years?
Gibbs: No plan. No discussion. No intent.
Do you have a final comment?
Gibbs: Maimonides is a community asset with a long tradition of serving the community. It delivers incredible outcomes. And it is unusual that we’re an institution with this funding model, that it is capable of delivering this level of excellence, and that it has built a level of scale, such that there is a range of services available to the community that are unmatched.
We are a destination center throughout the borough. And by the way, half the borough is on Medicaid. And to your point about a funding model: half the commercially insured patients in the borough go to Manhattan. So the borough as a whole funding model is totally challenged.
We appreciate the relationship we have with the Orthodox Jewish community, and with all the communities that we serve. And we are here every day, 24/7.
The folks who were here during the pandemic truly were heroic. In 30 days, the whole hospital changed in a period where there was no knowledge about the nature of this disease. And we went from Patient One, to having an in-house census of 471. Everybody’s job changed. What happened was tragic. The effort was incredible. Our hearts go out to everybody who had losses, the communities around us and this nation. The wounds of this pandemic still have not healed.
The health-care sector, including everybody here, is striving to get to a place where we feel the human bonds connecting. And we will not rest; we drive forward.
And I turn to a quote from our namesake Maimonides in a treatise of asthma — treat the patient, not the disease from which they are suffering — which speaks to the notion that we have to connect with the humanity of everybody we deal with. That is the effort of this institution.
As far as I’m concerned, however we fall short, that is my responsibility. But whatever we accomplish, the team here is incredible.
And it is really unfortunate that there is a political attack with misinformation aimed at this institution, and the impact it’s having on the community. The good news is that we continue to provide the care every day. And we intend to continue to serve people every day, from all these communities with that same heart, and that same effort, whatever gets thrown at us.
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