A Clash of Cultures: One of the sessions at the recent 91st National Convention of Agudath Israel of America

agudah_logo-150x150Woodcliff Lake, NJ – A loved one has been admitted to the hospital, and you are unsure whether he is receiving appropriate medical care. A close relative is undergoing emergency surgery on Shabbos. How can we ensure that someone can accompany him or her and have appropriate accommodations? A patient’s family needs help in deciding if they can take their loved one home, and need advice. These are just a few of the many issues that the Jewish community liaisons in New York’s hospitals deal with on an ongoing basis.

At this year’s annual Agudath Israel convention, a presentation was given that described many of the challenges that arise for the frum community in the context of a hospital setting. The panelists, who are intimately involved in this area, each gave examples and guidelines of what to do, and just as importantly, what not to do when seeking serious medical treatment. The increasingly important role of Jewish community liaisons in the hospitals was explained at length.

In a follow up conversation with Agudath Israel this week, Israel Rosman, a pioneer in Jewish patient-hospital relations, summed it up: “In today’s health care system, we can get good care, and we can get bad care. It is every person’s responsibility to make sure that they receive good care the right way…”

We asked Mr. Rosman for his impressions of the medical sessions at the conference. “I think there were two tremendous accomplishments,” he shared. “Firstly, the initial session, which was comprised of over 30 liaisons from throughout New York and the Tri-state area, provided a forum to discuss new ideas of how to introduce the intricacies of the health care system to the heimish community. Secondly, we met with rabbonim, who confront and deal with hospital related issues, to discuss the role of Jewish liaisons as a part of the hospital team.”

 

Mr. Rosman likewise expressed hakaras hatov to Mr. Daniel Czermak, President of Leisure Chateau and Acute Care Health System in Lakewood, who felt that community liaisons needed more exposure to the myriad issues that exist within this arena, and as a result, generously sponsored the sessions at the Agudath Israel Convention.

Speakers at the Friday morning session were Rabbi Gedaliah Weinberger, Chairman Emeritus of the Board of Trustees of Agudath Israel of America; Rabbi Boruch Ber Bender, President of Achiezer Community Resource Center; Solomon Rosenberg, Program Director, Office of the President, Montefiore Medical Center; Israel Rosman, Senior Patient Liaison for NYU Medical Center; Dr. Howard Lebowitz, Chief Medical Officer, Acute Care Health System of Lakewood; and Rabbi Shmuel Lefkowitz, Vice President for Community Affairs – Agudath Israel of America.

Rabbi Gedaliah Weinberger introduced the session by sharing some of his profound knowledge of the health care system. With 35 years of experience working within the health care system and directing Agudath Israel’s Chayim Aruchim program, Rabbi Weinberger had much wisdom and experience to share with his audience.

Rabbi Weinberger noted the special resources of the Jewish community that provide critical services from “before the cradle until after the grave,” from help with infertility issues, to the Chevra Kadisha, often at reduced or no cost. “Chayim Aruchim has become part of that continuum of care in the later stages of life, in terms of advising people in the end of life situations,” he explained.

While emphasizing the quality and professionalism of New York’s health care institutions, many of which are rated among the best in the world, Rabbi Weinberger pointed out the relative lack of cultural sensitivity to the Jewish Orthodox community that is still apparent throughout the system. He stressed the importance of family members actively advocating for the patient. He explained that doing so can often spell the difference between life and death.

Nevertheless, the community must also be aware that there is a clear distinction between the right and wrong way of relating to medical institutions. This is where the hospital’s Jewish community liaisons step in. Although some of the liaisons are paid employees of the hospitals they service, their mission to help the Jewish community goes well beyond the scope of their employment contract.

Rabbi Boruch Ber Bender explained that experienced community liaisons perform a vital service for Klal Yisrael, guiding patients through a complicated and often confusing system, preventing each person from having to reinvent the wheel for his or her personal situation. “Klal Yisrael works best when we work together… when we can use each other’s kochos (strengths),” he said. It is crucial that the public is informed about the work of the Jewish community liaisons since they have laid the groundwork in many hospitals. Hospitals can then ensure that Jewish patients receive the necessary services from within the system. He emphasized that if we work within the system that already exists, volatile situations can often be easily corrected –, and the community liaisons can make that happen.

The third speaker, Solomon Rosenberg, community liaison at Montefiore Medical Center described how he relates to his hospital administration. “I explain to them that we are not giving Jews anything more than any other patient in the hospital – it is that a Jew who walks in has less than others in the hospital. He doesn’t have his religious environment, his shul, his kosher food, and as a result, he may feel uncomfortable. My job is to bring him on par with others in the hospital. And that they understand.”

Mr. Rosenberg detailed just a few of the many types of calls he receives daily. Calls range from the ridiculous, to life-and-death situations.  He pointed out that the favors and special treatment that individuals sometimes expect, for example, having a doctor waiting to receive them in the emergency room when they arrive at the hospital with a broken bone, border on chillul Hashem. “Emergency rooms work on a triage priority basis. If you are kept waiting, you should daven and thank the Aibishter that your condition, though painful, is not serious enough to be seen right away!”

Israel Rosman, community liaison at NYU Medical Center, emphasized that the health care system is changing at an incredibly fast pace, and community liaisons are becoming increasingly necessary in helping the Jewish community navigate the system.

“Hospital liaisons can be compared to a manual of a complicated machine,” he explained in a follow-up conversation. “You would not touch a machine’s parts if you knew that one wrong move could damage the entire machine. The liaisons know exactly which tape to cut, the red tape, yellow tape, and green tape. They encounter challenges every day that shape them and make them even more capable to do their work. Trust the liaison when you do not know how to proceed in a medical situation. When you take things into your own hands and get someone from the outside involved,you are going to harm yourself, and there is often  a point when you will not be able to fix it.”

In his talk, Mr. Rosman related a poignant story which illustrated the wrong way of approaching the health care system. A young man was, r”l, undergoing chemotherapy for leukemia. He suddenly began experiencing abdominal pain and was taken to the hospital. The medical team immediately suspected that he could be suffering from a perforated intestine, a possible side effect of chemotherapy, and conducted appropriate testing. The testing confirmed their suspicion and called for emergency surgery. When Mr. Rosman was informed of the situation, he immediately contacted a doctor who has performed hundreds of such surgical procedures. The doctor rescheduled his office appointments and rushed to the operating room to perform emergency surgery. A short time later, Mr. Rosman got a call from the surgeon. “Israel, something is terribly wrong. There is a rabbi in the room telling me not to go through with the surgery. He thinks a different surgery in this case is more appropriate.  This patient has about an hour to live, unless I begin this procedure.”

Mr. Rosman could not believe the information he was hearing. He immediately called a rabbi, a medical askan from the chassidus that the patient belonged to. “Do you know that this patient’s life is on a clock?” Mr. Rosman asked.

“No…” replied the askan. “I was not aware. I made some phone calls…”

“Did you speak with a doctor?” “I missed the doctor,” he said. After a few more calls, the rabbi finally said, “Yes, let’s go ahead with the operation right away,” but by that time, the patient was fighting a very tough battle for life.

There is a time and a place for second opinions and considering alternative options, but when life and death decisions need to be made, trying to circumvent the health care system can, unfortunately, often result in death. Liaisons can serve a crucial role in guiding patients through the complex system, as well as by giving practical advice based on their vast experience in the field.

During his follow up discussion Mr. Rosman expressed his utmost confidence that the health care session, which was geared to the general public, had a strong impact on all those in attendance.

“We came away with new perspectives on how to address the issue properly. Collaborating over shared experiences and exchanging pertinent information helped cultivate a feeling of team work and unity. Additionally, meeting many of the doctors, with whom we consult regularly but have never met personally, was very beneficial to cultivating the ongoing professional relationship we value.” Mr. Rosman concluded.