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Wednesday, September 09, 2009

Infrastructure is Simply too Large

A reader just went me a link to a Jewish Star Article regarding Hatzala of Rockaways-Nassau and is wondering why in the world they are building. The article reports that there is a quarter of a million dollar budget shortfall, the bank account is frequently in overdraft, they admit bills get paid in "dribs and drabs" and the proposed solution is none other than to fundraise(!). There is a series of parlor meetings planned naturally. The situation doesn't look optimistic with only 20% of the database having written any check in the past year.

Somehow budget shortfalls and projected budget shortfalls never seem to get in the way of building a building or taking on other large expenses. In my last post I laid out some rules of the road for board members who aren't functioning on "bitachon" alone including the rule "Cash is king and revenue is key." Unfortunately, for years the only rule of the road seems to have been "built it and they shall come."

Now we are suffering from this "build it" mentality because the infrastructure of the Orthodox community is simply too large and the foundation can't support it (period). My own community involvement seems to center around trying to fight the prevailing mentality of "build it and they will come" and "we can't afford not to." My response to "we can't afford not to" has consistently been, "nor can we afford to."

I haven't made many friends asking questions such as, "what happens if they don't come?" "Who are all of these people waiting in the wings?" "Has anyone worked up a realistic budget of the cost of the new *larger* facility and what type of increase in membership/fees can we expect?" "If we can't meet our operating costs right now, how do we expect to cover larger expenses in the future." Of course that last question just sends you back to square one. . . . . remember, they will come. I once asked someone what happens what happens when the money simply runs out and the response was, someone will step up as the community simply won't allow the institution to collapse. Well, I guess it is nice to have that sort of bitachon. But from my own perspective there is a balance sheet full of revenues and pledges that are unlikely to materialize.

The Hatzolah branch lists some very, very good reasons to build, but the bottom line doesn't support appear to support the feasibility. "In addition to the overall drop in contributions, the deficit is also attributable to the recent purchase by Hatzalah of a site in Woodmere where a new ambulance garage and training center is planned. $200,000 was raised for the purchase; another $400,000 was taken from the operating budget and only some was replaced." So let me break this down, the operating budget has a cash flow problem, but an expansion was taken on despite this and a new property was purchased. There is no guarantee that the zoning will be met, but if so, a fundraising campaign will ensue so that Hatzolah can build. And the new targets for fundraising: young people. The director states, "“If neither the community at large, nor an individual [steps up] to the plate then we will not be able to build this building.” Of course, if the fundraising falls through, the organization will still own the land and will have to maintain it unless there is a buyer waiting in the wings.

Let's make something very clear about fundraising: we are all trying to grab from the same pot. And that pot of money isn't growing! With larger families, bigger and bigger tuitions, greater debt loads from mortgages to student loans for credit card debts, lack of savings, late entrance into the workforce, and a recessions, there isn't much to grab at.

Perhaps hatzolah will be successful on collecting some of the money in the pot for themselves and their problem will be alleviated for the time being. But, another organization will soon need their own "financial rescue." I've reached the conclusion that our own infrastructure is simply too big, from the physical structures to the number of people dependent on it for their own income. But we have no diocese to order a restructuring, which is desperately needed. So, I guess we will keep grabbing from the same pot.


JS said...

This is a sincere honest question. Why does Hatzalah need to exist? If emergency medical services are already being provided by local organizations, couldn't charity money be spent on more pressing needs?

Anonymous said...

I'm less worried about Hatzolah. Many in the community do see it as "life or death" (as punned by jewish star) and there are a few members who could pay the deficit without blinking if it was do or die.

Anonymous said...

How do non-jewish ambulance corps. manage and is it always necessary to have a jewish ambulance service when every city and town (other than tiny hamlets) already have their own ambulance services? I understand that there are often serious and valid complaints about the response times of other ambulance services, but would it sometimes be better to work with the community (I'm referring here to the geographic community, not only the jewish community) to improve ambulance services for everyone in the area?

Lion of Zion said...


"Now we are suffering from this "build it" mentality"

i have a lot of complaints about my son's school, but one thing i don't complain about are the crappy facilities. i have no idea what goes on at board meetings, but i hope that improving the facilities is not on the agenda.

Commenter Abbi said...

Speaking of building, I thought of you SL when I saw this YouTube:

Lion of Zion said...


i've been thinking about hatzalah for a while. i don't like to criticize them because i think they perform an incredible חסד and members udnergo much מסירת נפש.
but is it needed?
i've long argued that jewish philanthropy needs to divest from those services that are already being adequately provided for. speaking of NYC, ems response rates have improved dramtically (ok, so i've been told) since the dark days when haztalah was founded, so why do we need it? other areas never had response issues, so why was hatzalah founded there to begin with?


"would it sometimes be better to work with the community (I'm referring here to the geographic community, not only the jewish community) to improve ambulance services for everyone in the area?"

as i understand it (confirmation please?), teaneck does not have hatzalah, but a regular community-wide volunteer ambulance corp that is heavily jewish

mrmoose said...

Hatzolah was started at a time when the NYC EMS did a very poor job of responding to calls in general and provides a valuble service in those areas where that is still the case. It seems that it has become a given in a frum cummunity of a certain size, that if at all possible, their will be a Hatolzh branch as soon as their are two shuls, a mikvah and schools.

Anonymous said...

Hatzolah is a very important organization. It is a good place. It serves a good need. However, the Hatzolah of fr/5t seems to have been run irresponsibly in the money management.

For the new property, they raised $200k, and then took 400k from the "maintenance fund" - i.e. regular expense account, to pay for it, and now say their "maintenance fund" is 250k short, well no kidding, if they would have raised the money for the land for the building, then they wouldn't be in the hole.

Its allot easier to fundraise when you say "Hatzolah has no money", instead of saying, "lets raise 600k for property to build a $1 million dollar facility".

Basically it seems that this entire deficit was made up to cause a fiscal crisis, or they just plain thought they could raise money without end forever. BUT its clear, had they not bought property, they would have $150k in the bank rather than owing $250k.

rosie said...

I also wondered why the community duplicated tax-payer paid city ambulance service and observed that Hatzolah might be providing Hebrew and Yiddish speaking service as well as being stationed outside of large shuls or social halls where elderly people are likely to need emergency service. In Crown Heights, there are ambulances parked outside of 770 especially during crowded yomtov services where the elderly could start to feel faint. It seems that Hatzolah is always busy during Tishrei but sometimes it is due to young people drinking, fighting, etc.
I would also think that in a crowded city with crowded traffic conditions, having an ambulance nearby, could improve response time. In my suburban neighborhood, it takes only minutes to get an ambulance but I would imagine that it is harder to maneuver in NY traffic. Possibly the population density in the area also demands more service.
Our family has used Hatzolah and were very pleased with the service but I also wonder if the community can continue to support it.

SephardiLady said...

I already learned my lesson when in the discussion of needs and hatzalah came up in the comments section. I was told I don't live in NY and don't understand.

If hatzalah is a question between life and death (and my NY relatives would insist this is the case), then which other function should be downsized/closed down?

SephardiLady said...

service as well as being stationed outside of large shuls or social halls where elderly people are likely to need emergency service. In Crown Heights, there are ambulances parked outside of 770 especially during crowded yomtov services where the elderly could start to feel faint

If ambulances are utilized during certain times, as mentioned, perhaps the compromise position is to hire an ambulance service just as many shuls hire security guards. Maintaining and housing the equipment is obviously very expensive.

Does hatzalah charge insurance fore their services? Someone who can brief us all on hatzalah would be much appreciated.

Lion of Zion said...


"Hatzolah is a very important organization . . . It serves a good need."


Julie said...

Teaneck has a regular volunteer corp, not hatzolah. Their response time is fantastic, and the members are incredibly dedicated. (When they sponsored a blood drive, Chopstix the local kosher Chinese takeout provided the food. Oh, I love Teaneck.)

rosie said...

I would have to ask my daughter what they did about the insurance. Basically what happened was, my granddaughter injured her eye just before candle lighting on a Friday night. The hatzolah team decided that it was serious enough to take her to a eye hospital in Manhattan. They presented her with a "boobah" (doll) to keep which soothed her and kept her busy and they gave the parents a Shabbos meal and seforim which they would have to return after Shabbos. They told them that they would have to take a taxi back home after the eye was treated and pay the driver but not accept change.
It is reasonable to expect that insurance would cover what they would spend on a city ambulance but not more than that.

Somewhat Anonymous said...

"Does hatzalah charge insurance fore their services? Someone who can brief us all on hatzalah would be much appreciated."

I believe that other than Hatzolah in Monsey they do not. They should.

SephardiLady said...

I'm under the same impression that insurance is not charged. It seems to me that if insurance would pay the organization could be more self-supporting. The klal desperately needs income sources as the pot is tapped out.

ProfK said...

It needs to be emphasized that NOT all parts of NYC have the same level of Emergency Services ambulances available as others do. Nor is the response time as good when ambulances based in one area of a community need to respond to far flung areas. SI is one such area where if it weren't for volunteer ambulance services--and Hatzolah is a key player-- residents could be dead and buried before an "official" ambulance showed up. HHC regularly short changes the Island in almost every area.

SI places Hatzolah in their top priority category and supports it generously, and often. Every shul has regular appeals and there are major fundraiser events as well. Also, accountants are active on the board and take care of the books. They don't allow for "creative" financial manouvers.

Get rid of Hatzolah? Not in SI--even our elected officials, all staunch supporters, would scoff at that.

Ariella said...

I believe the reason Hatzala came into being is that the ambulance response in NY is so slow that precious minutes, which could make all the difference in some cases, were lost. But then it became kind of a Jewish imperative in areas in which the ambulance service may not be so inadequate. The problem is if you state it as I have heard someone say, "Isn't your life (or that of your parents/children/spouse) worth $X?" Well, of course, then one would feel forced to say, "You can't put a limit on what their lives are worth." But that ignores the fact that buying a new ambulance, ambulance garage, or medical equipment is not a guarantee that the lives will be saved. And given limited resources, one has to consider how much to spend simply to improve odds.

As far as I know, Hatazala doesn't bill people. That is why some will call them even when there are other options. For example, when I had to go to a hospital on Shabbos to have a child, I made arrangements with a taxi service. But here, many would call Hatzala to deliver the woman to the hospital. I know someone in the area who called Hatzala on Shabbos because a child had a stomach ache. Look, we have loads of doctors in the neighborhood, and one could, in theory walk over to a doctor's office on Shabbos. But then they will have a bill to pay.

rosie said...

My daughter was not asked by hatzolah to show her insurance card so most likely, it would not have reimbursed them. The EMTs are volunteers and the whole thing is funded by tzedukah.

Lion of Zion said...

i've never heard of hatzalah billing insurance companies

SephardiLady said...

Thanks Ariella, rosie, and LOZ. Ariella's comment is most enlightening. I know I've seen articles/ads in NY about when it is appropriate/inappropriate to call Hatzalah. If people are using hatzalah as free medical care, perhaps a change is needed. The mitzvah of tzedakah is one of helping those without means, not those who prefer to pass the buck.

Thanks all.

Anonymous said...

have you thought about sending this blog post to the paper that printed the original article?

SephardiLady said...

Anon-Perhaps I may. But it would needed edited to be a letter to the editor. I will see what I can do once my Shabbat cooking is done. I'm also a bit under the weather right now and despite the time, I'm headed back to bed.

Anonymous said...

feel better.

the reason I ask about sending your post to that paper is simple -- I printed out your blog post and gave it to my family members, then I had them read the article in the paper. It gave them a subtext for the assumptions that underlie the article; 1- that hatzolah's building is crucial and MUST be supported , and 2- that the "emergency" parlor meetings are to be lauded because they are spreading the base of support to other sub-areas within the five towns.
Both of these assumptions (among others), as you ably point out, should be examined critically.
thank you for that.

Anonymous said...

If the folks running the parlor meetings want them to be a success, they should be prepared to answer these questions. I think the questions about insurance are very important - do they collect for covered services, and if not, why not? There are many for-profit ambulance companies that seem to make ends meet from income, which presumably means payment for services by insurance companies. If so, why can't hatzolah. Do the private companies get government payments in addition to insurance payments to make sure an area is covered? If so, does hatzolah compete for these funds? Is it eligible to do so?

Ariella said...

Mayer Fertig,who is the publisher and editor of The Jewish Star is involved with Hatzala in his own neighborhood (which is not the 5 Towns). He truly regards its expenses as crucial. He's the one I heard put it in terms of "Isn't your life (or that of your parents/children/spouse) worth $X?" in a conversation that took place some months ago.

SephardiLady said...

No wonder it sounded more like a fundraising pitch than an examination.

Charlie Hall said...

The Hatzalah strategy may sound crazy, but it has been used successfully in the past by other organizations. I used to live in a small town that had a small, money-losing hospital. The "sensible" thing would have been to close it down. But that was not what Management decided to do. Instead, they raised funds and BUILT A NEW HOSPITAL which is just as much a money-loser as the old one. But as the CEO confessed to me after he had long left the scene, that wasn't the point. The real point was that the hospital was the single largest employer in the town and to close the hospital would have been economically devastating. He created a beautiful new facility that was too valuable to close! Even had the hospital gone bankrupt, someone else would have come in and run a hospital on that site. I wonder if that may be what is behind Hatzalah's strategy here. (No wonder our healthcare system is a mess.)

Charlie Hall said...

Back to the $64 million question: I don't think it has ever been proven that you are better off calling Hatzalah rather than 911, or vice versa. Would Hatzalah participate in an outcomes study? I'd be happy to help design it. (I'm a biostatistician by training.)

Anonymous said...

I'm sorry for jumping into this discussion (very) late in the game. Hatzolah in the 5 Towns is completely unnecessary. The Five Towns is covered by volunteer fire departments each of which has their own ambulance, except for Woodmere and Inwood, which each have two ambulances. In addition to that, there are several ambulance staffed by the Nassau County Police Department that cover the Five Towns.

In addition you have two Hatzolah ambulances stationed in Woodmere, for a total of 4 ambulances in Woodmere alone (population around 17,000 according to 2010 census) and four volunteer fire department ambulances in the remaining towns. On top of that are the police department ambulances.

As someone familiar with the emergency services in the area, to me there is nothing more absurd than using community tzedaka money to fund such a redundant service. Is their response time faster? Maybe by a minute or two, but ask any EMS responder on what percentage of calls do "seconds count." Maybe 5% of calls if that.

As for Hatzolah taking someone to a Manhattan hospital b/c the case was "so severe," as mentioned above, any EMT worth hs training knows that critical calls need to be transported to the closest appropriate facility. Anything further away is malpractice and dangerous for the patient- yet Hatzolah routinely transports patients to Manhattan hospitals leaving their communities without "unprotected" while that ambulance takes a long trip. To me, that is further proof that Hatzolah doesn't even see themselves as necessary because they are willing to leave their communities unprotected.

More on this if anyone responds...we can maybe revive this thread.

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