NEW YORK – The Coalition to Preserve Maimonides today released numerous documents showing mass opposition — among 34,000+ Brooklynites, as well as a bipartisan coalition of elected officials from the New York State Senate, New York State Assembly, and New York City Council — to the current proposed plan to merge Maimonides Medical Center in Brooklyn with NYC Health + Hospitals (NYC H+H). Additionally, the Coalition has found numerous instances of Maimonides withholding information and underestimating the cost of a merger with NYC H+H by hundreds of millions of dollars each year, risking a future closure of the beloved community hospital. The release of the documents comes ahead of tomorrow's meeting of the New York State Public Health and Health Planning Council (PHHPC), where the proposed transaction is expected to receive further consideration.

The documents released today paint a sharply different picture from the one Maimonides leadership has presented publicly. Together, they raise serious questions about whether the proposed transfer has been subjected to an independent and transparent examination of all viable alternatives, whether the financial assumptions underlying the transaction can withstand expected changes in federal Medicaid funding, and whether the communities, patients, physicians, and employees who depend on Maimonides have been fully heard.

The Coalition is not asking the state to reject the proposed transaction without consideration. Rather, it is calling for a full, independent, open-books analysis with no predetermined conclusion before a century-old nonprofit community hospital is permanently transferred to government ownership.

“Maimonides belongs to the communities that have depended on it for generations,” said Joel Rosenfeld, director of government relations, Bobov Community. “Before the state makes a permanent and irreversible decision about its future, the public deserves to know that every viable alternative has been honestly considered. We are not asking anyone to choose a particular outcome in advance. We are asking for the facts, the books, and an independent analysis before Brooklyn gives up control of one of its most important community institutions."

"This should not be a question of whether someone supports or opposes a merger in the abstract. The question is whether Maimonides and the state have done the independent work necessary to determine that this is actually the best option for Brooklyn,” said Marty Waisbrod, board member, Maimonides Medical Center. “If joining NYC Health + Hospitals is the right answer, an honest and transparent analysis should demonstrate that. But we should not make an irreversible decision first and ask the questions later."

30,000+ BROOKLYNITES AND BIPARTISAN GROUP OF ELECTED OFFICIALS REPRESENTING MAIMONIDIES PATIENTS CALL FOR INDEPENDENT REVIEW

The Coalition submitted more than 34,000 signatures to the PHHPC from community members opposing the proposed merger until a full and independent analysis is conducted. The signatories are calling on the state to examine all realistic options for stabilizing Maimonides, including remaining independent under new leadership, joining another nonprofit health care system, becoming part of NYC H+H, or pursuing another viable alternative.

The Coalition also released a letter from a bipartisan group of elected officials representing Brooklyn communities served by Maimonides. The letter — signed by New York State Senators Stephan Chan and Sam Sutton; New York State Assemblymembers Lester Chang, Simcha Eichenstein, and Kalman Yeger; and New York City Councilmembers Simcha Felder and Susan Zhuang — does not ask the Public Health Council to approve or reject the transaction, but, instead, calls for a "full, independent, open-books analysis" of Maimonides' financial condition and every viable path forward before a permanent decision is made.

The elected officials warn that the public has not been provided with a comprehensive independent analysis comparing the alternatives and explaining why the proposed transfer is demonstrably the best option. They urge the Public Health Council to insist on "open books, full access to relevant financial and operational information, and no predetermined outcome."

“As representatives of the people, we cannot stand silent as the fate of our community’s decades-old primary medical center is determined without considering the ramifications of the decision,” said New York State Assemblymember Simcha Eichenstein. “We urge the members of the Public Health Council to consider an independent analysis of the financial challenges at Maimonides and to explore other viable options to achieve our goals. The community depends on Maimonides for health care and we cannot let them down.”

"We need to ensure the Maimonides remains a local, community hospital. This takeover by NYC H+H is filled with overinflated promises without evidence to back them up," said New York City Councilmember Simcha Felder. "Only a truly independent and honest process can determine if this, or another plan, is best to accomplish financial stability and a high standard of care for our neighbors."

FINANCIAL ANALYSIS RAISES QUESTIONS ABOUT LONG-TERM COST OF PROPOSED TAKEOVER

Among the documents being released is an analysis from independent health care experts challenging the financial assumptions behind the proposed transaction. According to the Coalition’s estimations from publicly available financial documents, under NYC H+H’s management, the required financial support from New York State will far surpass the initial $2.2 billion currently committed by the state. The analysis concludes that — given already announced changes in federal Medicaid funding by the Trump administration — the required financial support from New York State will increase every year and, beginning in year four, will exceed $350 million per year. The concern is particularly acute as federal changes to Medicaid funding threaten to place new financial pressure on public hospital systems and the safety-net institutions that rely heavily on Medicaid reimbursement.

The analysis raises a fundamental question: If the proposed transfer is being justified as a financial rescue, what happens if the public hospital system that takes over Maimonides faces an even more difficult financial environment in the years ahead? Marrying an already money-losing hospital to a health system that is expected to lose large sums of money given changes to Medicaid funding will not only make operations at Maimonides financially infeasible, but will force NYC H+H, over time, to close hospitals or slash services — leaving Maimonides positioned to absorb the brunt of the cuts.

The Coalition argues that this previously unreported cost makes an independent comparison of alternatives even more important. Before permanently transferring Maimonides, regulators should determine whether changes in management, billing, operations, purchasing, technology, or a partnership with another health care system could place the hospital on a sustainable path without exposing it to the risks identified in the proposed public-hospital model.

“A hospital's financial problems do not disappear simply because its name changes or because ownership changes hands. The underlying assumptions have to work,” said Scott Phillips, founder and senior managing director, Healthcare Management Partners, LLC. “Before regulators approve a permanent transfer, they should understand what happens when the projected Medicaid revenue changes, what the hospital's real operating costs will be, and whether there are less risky alternatives that can preserve this institution for the long term."

PATIENTS AND PHYSICIANS WARN OF A POTENTIAL EXODUS

The Coalition also today released survey results showing significant concern among the people who use and work at Maimonides. One survey found that more than half of respondents who currently use Maimonides indicated they would seek health care elsewhere if the hospital became part of a government-run system. A separate survey of physicians found that nearly half of the responding doctors indicated that they could leave Maimonides if the proposed merger proceeds. The physician survey was conducted despite reported efforts by hospital leadership and department chairs to discourage or limit physician participation, according to doctors surveyed.

The potential loss of physicians raises concerns about continuity of care for thousands of Brooklyn patients, many of whom have longstanding relationships with their doctors.

"A hospital is not simply a building and a balance sheet. It is doctors, nurses, patients, families, and relationships built over decades,” said Dr. Israel Zyskind, community pediatrician. “If physicians leave and patients follow them elsewhere, the consequences could fundamentally change Maimonides long before anyone acknowledges that the model is failing."

"Hospitals are built on relationships, not balance sheets. Across corporate medicine, health care has degenerated into a transactional, soulless business — yet Maimonides has always maintained its heart through the deep bond between its physicians, the hospital, and the community,” said Dr. Jonathan S. Leibowitz, community physician. “If leadership continues to misunderstand these vital connections, they will drive doctors and patients away, sacrificing the very soul of Maimonides long before anyone at the top admits the merger strategy failed."

COURT REJECTS EFFORTS TO KEEP KEY DOCUMENTS SECRET, BUT MAIMONIDES CONTINUES TO WITHHOLD INFORMATION

The legal process surrounding the proposed transaction has already exposed serious questions about transparency by Maimonides during this process. The courts previously ruled that the proposed transaction could not bypass the public review required under New York law. The transaction was subsequently delayed after the New York State Department of Health required a Health Equity Impact Assessment before the proposal could proceed.

In the current litigation, Maimonides also sought to have key documents, including materials related to the Certificate of Need process, sealed from public view. The court denied those efforts.

Yet, Maimonides subsequently filed a Certificate of Need containing hundreds of pages of redactions, prompting plaintiffs' attorneys to challenge whether the hospital had ignored the court's decision and its obligations of transparency.

"There is simply no legitimate reason to ask the public to trust an irreversible decision while withholding the information necessary to evaluate it,” said Chaim Fischer, board member, Maimonides Medical Center, and coordinator, Boro Park Hatzoloh. “If this transaction is truly the best path forward, Maimonides and its supporters should welcome transparency. They should not be fighting to keep the underlying facts from the people whose hospital is being given away."

PROPOSED STRUCTURE RAISES QUESTIONS ABOUT WHETHER NYC H+H CAN OPERATE A MUNICIPAL HOSPITAL THROUGH A PRIVATE COMPANY

The Coalition also raised serious legal concerns about an unusual corporate structure contemplated under the proposed transaction. Under the current plan, Maimonides employees would not simply become employees of NYC H+H, even though the hospital would be operated as part of the city's public hospital system. Instead, according to documents submitted in connection with the proposed transaction, the hospital's workforce would be employed through a separate private entity with no meaningful assets of its own. That raises a fundamental question: Can New York City operate what is, in substance, a municipal hospital while placing its workforce in a private-sector corporation and using government officials to control and manage that private entity?

The Coalition contends that this arrangement could leave thousands of health care workers in a precarious position. Rather than becoming employees of the public hospital system, workers could find themselves employed by a separate entity without the assets or institutional protections of NYC H+H itself. If the hospital or the broader system later faces financial difficulties, the Coalition argues, those workers could be especially vulnerable to layoffs or other employment actions.

 The proposed arrangement also raises questions that New York's highest court addressed nearly three decades ago. During the Giuliani administration, New York City attempted to lease operational control of several municipal hospitals — including Coney Island Hospital — to private entities. The New York Court of Appeals rejected the effort, holding that the New York City Health and Hospitals Corporation Act required NYC H+H itself to operate the hospital. The court concluded that municipal hospitals were intended to remain a governmental responsibility and that NYC H+H could not use its contracting authority to divest itself of its statutory obligation to operate the public hospital system.

The Coalition is calling on the Public Health Council and state regulators to conduct a full legal review of the proposed corporate and employment structure before approving the transaction.

"NYC H+H's use of a shell corporation to employ every single employee, from nurses, to technicians to aides, is not only a blatant violation of law, but also will make Maimonides the weak sister of the entire system, especially vulnerable to cuts when they inevitably come,” said Martin Bienstock, Bienstock PLLC. "The question is not merely who owns the building or what name appears on the sign. The question is who actually employs the workforce, who controls the hospital's operations, who bears the financial obligations, and who is accountable to the public. Before this transaction is approved, regulators must determine whether this structure complies with the law and whether it is being designed to circumvent protections that would otherwise apply to employees and a public hospital."

BROOKLYN HAS SEEN WHAT HAPPENS WHEN A COMMUNITY HOSPITAL IS LOST

For many Brooklyn residents, the proposed transaction raises memories of Long Island College Hospital (LICH). LICH was once a major Brooklyn community hospital. Its closure ultimately left Brooklyn with one fewer hospital, while much of the valuable property associated with the former medical center was later redeveloped into condominiums.

The Coalition says it is not predicting that Maimonides will become condominiums tomorrow. But it argues that Brooklyn should not permanently give up control of a major nonprofit health care asset without first understanding the long-term consequences of doing so.

Maimonides serves one of the most diverse patient populations in the country, including Orthodox Jewish, Black, Latino, Caribbean, Muslim, Asian, Russian-speaking, and immigrant communities. For many of those communities, Maimonides is more than a health care provider. It is an institution that has earned trust over generations and developed expertise in serving patients with distinct cultural, religious, and language needs.

"Our communities cannot afford to lose another hospital and be told afterward that there was nothing anyone could do," said Bishop Chantel Wright, Reach Covenant Ministries. "Maimonides has served generations of Brooklyn families, and has employed thousands, including so many women of color. We have a responsibility to ensure a forensic examination is completed and the hospital’s future is decided openly, honestly, and with the needs of every community and health care worker at the center of the process."

COALITION CALLS FOR FACTS BEFORE A PERMANENT DECISION

The Coalition continues to argues that the central question is not whether NYC Health + Hospitals could operate Maimonides, but whether anyone has conducted a truly independent analysis demonstrating that transferring Maimonides to government ownership is the best available option.

The Coalition is calling on the Public Health Council to require a full review of the hospital's finances and operations, determine what specific changes would be necessary to return Maimonides to long-term financial stability, compare the proposed transfer with other potential partnerships and management structures, and make the underlying findings available to the public.

"There should be no predetermined outcome and no fear of the facts," said Chaskie Rosenberg, community activist. "Before Brooklyn permanently transfers a century-old community institution, the state must ensure that the decision is based on a full, independent analysis — not on secrecy, assumptions, or the failures of the management that brought Maimonides to its current financial condition."

ADDITIONAL DOCUMENTS RELEASED TODAY

The Coalition is making the following additional documents available to the public:

Supplemental Objections to the Certificate of Need

Affirmation of Pessie Schlafrig (Lev Medical Resource)

Affirmation of Rabbi Zishe Ausch

Healthcare Management Partners’ Presentation