Andrea (Andy) Cohen is Senior Vice President of Legal Affairs and General Counsel to the health system. Ms. Cohen had served as Acting General Counsel since March 1, 2018. Prior to joining NYC Health + Hospitals, she served as Senior Vice President for Program at the non-profit United Hospital Fund, Director of Health Services in the Office of the Mayor, Health and Oversight Counsel to the U.S. Senate Finance Committee, and Trial Attorney at the US Department of Justice, among other roles.
She also served for seven years as a Commissioner on the Medicaid and CHIP Payment Advisory Committee, Congressional advisory panel. She graduated from Harvard College and Columbia Law School. In addition to managing the duties of the Office of Legal Affairs, Ms. Cohen continues to lead our Labor Relations work.
Dr. Katz is the President and Chief Executive Officer of NYC Health + Hospitals, the largest municipal health care system in the United States, with 11 acute care hospitals, 5 skilled nursing facilities, dozens of community health centers, a home care agency and an insurance plan, MetroPlus Health.
Since his appointment in 2018, the health system has significantly expanded access to health care, including the creation of NYC Care, a universal health access program that provides care to more than 80,000 uninsured New Yorkers. He oversaw the creation of a modern electronic health record system, increased the number of nurses working in the system, developed a modern ambulance transport system, and launched new street outreach programs to improve the health of homeless New Yorkers. He also led the financial turn-around of NYC Health + Hospitals by eliminating the deficit through enrolling more New Yorkers into health insurance and appropriately billing insurance plans.
Through the COVID-19 pandemic, Dr. Katz provided strategic guidance to Mayor Bill de Blasio, while directing the public health system’s response to the surge of patients that peaked to a maximum of 3,700 patients, requiring the tripling of ICU capacity at its 11 hospitals to save New Yorkers. As the epicenter of the epicenter, NYC Health + Hospitals became the trusted care provider for thousands of New Yorkers, led the city’s Test and Trace operation, and administered more than 1.3 million COVID-19 vaccines.
Previously, Dr. Katz served as Director of the Los Angeles County Health Agency, which combines the Departments of Health Services, Public Health, and Mental Health into a single entity to provide integrated care and programming within Los Angeles. The Agency has a budget of $7 billion, 28,000 employees, and a large number of community partners. Dr. Katz served as the Director of the Los Angeles County Department of Health Services (DHS), the second largest public safety net system in the United States. During this time, he created the ambulatory care network and empaneled more than 350,000 patients to a primary care home. He eliminated the deficit of DHS through increased revenues and decreased administrative expenses, and used ACA funding to pay for a new integrated electronic health system. He moved more than 4,000 medically complex patients from hospitals and emergency departments into independent housing, thereby eliminating unnecessary expensive hospital care and giving the patients the dignity of their own home.
Before he came to Los Angeles Dr. Katz served as Director and Health Officer of the San Francisco Department of Health for 13 years. He is well known for funding needle exchange, creating Healthy San Francisco, outlawing the sale of tobacco at pharmacies, and winning ballot measures for rebuilding Laguna Honda Hospital and San Francisco General Hospital.
He is a graduate of Yale College and Harvard Medical School. He completed an internal medicine residency at UCSF Medical School and was an RWJ Clinical Scholar. Dr. Katz continues to practice as a primary care physician and sees patients at NYC Health + Hospitals/Gouverneur on the Lower East Side of Manhattan.
He is the Deputy Editor of JAMA Internal Medicine, an elected member of the National Academy of Sciences (previously the Institute of Medicine) and the recipient of the Los Angeles County Medical Association 2015 Healthcare Champion of the year.
2 long winded, specious pages were not quite enough for Andrea Cohen to successfully bullshit her way in defiance of FOIL law. Could She/They be hiding evidence that death records from the recent past 2017-2019 belie the claims of catastrophe throughout 2020? I think they're guilty of worse.
Maybe the $2 BILLION DOLLARS in federal COVID relief funds that H+H has received would need to be repaid if receipt of such funds was contingent on meeting death numbers that H+H failed to generate?
Nov 28, 2023·edited Nov 28, 2023Liked by Jessica Hockett
Jessica, Thank you for all of your work. I remember when living in downtown Manhattan in 2018 to 2020, there were massive amounts of people put up in my apartment building to put in the new system. I remember asking this lady, why all these people were here. She was from, I think, North Dakota, and lived on a farm. There was still work being done after March 2020. I met with her in her apartment well into the shut down, but they were still leaving in large groups for full days to update the hospital systems....interesting. She told me that NYC hospitals were so poorly updated technologically. She said many hospitals still did not use WIFI. It was really intense the people who came to work on the systems during the last quarter of 2019 to second quarter of 2020. I do not think it was done by the time I moved to another state in the early summer 2020.
"The agency granted my request for daily deaths in 2020, but denied the request for earlier data, saying it was stored on a legacy software system. “In order to produce that data,” wrote records-access officer Vanita Yogeshwar on October 23, 2023, “it would require the coding of new programs, and would thus require creating a new record in contravention of the requirements of FOIL"
First of all when a new EHR system is implemented all legacy data needs to be moved into that system to preserve the patient history for current providers to review -- going back AT LEAST several years. I suspect ALL or MOST of that data is somehow encapsulated in the new system thus available.
IF IT IS NOT: Then the old system's DATABASE (not "programs") is still in existence and could be queried quite easily via SQL.
IF NOT via SQL then a via RAW DATA DUMP that would have to be manipulated but that manipulation could be done not by the agency but by any competent data analyst. NOT A BIG DEAL.
That said it can be a pain to go into legacy systems but it is done routinely for any number of purposes.
Bottom line: Her canned response was just canned Bull. Vanita Yogeshwar is either incompetent, a liar or both but most probably a FALL GAL.
It seems to me that there is probably a records retention law requiring retention for a specific number of years. There would be no point in requiring the retention of records if that requirement cannot be enforced. If the records in question here were kept only on paper, they would be easily available. If they exist in an electronic database, the software constituting the database and all programs and applications necessary to access the database are undoubtedly still in existence; if they were to have been destroyed the agency would be in violation of the records retention requirements. An attorney, and a software engineer ought to be able to advise you on this
It’s too much for me to believe that when switching to new software nobody exported the old data from previous years into a format that could be uploaded into the new software. (e.g. .csv)
It would seem that having the data but not being able to retrieve it is the same as refusing to share it. I would ask that they send you the original dataset. Sure their software may have been doing "math" within the code prior to the data hitting the glass, but chances are good that the data is there and can be accessed by someone who is not employed by the state. Plus, odds are that if they can't retrieve data from 4 years ago they might be violating some compliance requirements. CMS, HIPAA, GDPR, or other...
It would be a lot of work…but you need to send an open record request to each county in NY. The data is out there and you can probably find a way to bypass the state.
Upon reflection, Covid is NOT the story of our times. The story of our times is that all the important organizations in the world are completely captured. All Covid did was prove this beyond a reasonable doubt.
This excuse sounds like total BS. Those data are in some kind of database, assuming the agency didn't delete it. The software that created and accessed that database is undoubtedly still in existence. But even if they refused to run that software, they could still provide a data dump pretty darned easily. For example, if the data were in a MySQL database, a single "mysqldump" command would obtain a readable copy of the data that they could send to you.
It's highly likely that all legacy database systems storing medical data, recently in use, will be relational databases. The query language used against such data is called SQL, sometimes referred to as 'sequel'.
A SQL statement, such as a query, is not referred to as a program. There is no set (see definition above) of instructions, and the single SQL statement required for any element of an FOI is a request, not an instruction.
Furthermore, any graphical tools allowing drag-and-drop report development will produce, in the background, a single SQL query to submit to the server.
Whilst SQL can be employed by a computer program written in another computer language, and can be enhanced with custom procedures which use procedural code (which may be called programming), a SQL query statement is itself not procedural, and it is not a program.
SQL looks a lot like English, intentionally: e.g. select * from person where dob<'01-JAN-1920'. The lay person can see that this is not a program, but a single request relating to person records, based on criteria.
Given the nature of the data you are requesting I think it almost impossible that anything procedural would be needed. There would be no programming, therefore no "new record". Even if such programming were demanded a simpler solution would always be available: to dump out raw (or raw, but anonymised) table data.
Note: whilst SQL queries have code and could be referred to as coding, they are not programs. It's bamboozlement in this case to be using 'coding' and 'programming' as if the same.
Unfortunately Jessica, there's only two ways to fish details out of such a situation.
Option 1 is to lawsuit them into compliance. It will take many years, cost a lot, and introduce a lot of headaches. I suspect you'd succeed, but will it be before the story loses prominence?
Option 2 is to make friends with someone who works at one of the hospitals (assuming you can get to New York) and see if you can ask them some informal questions to get a 'feel' of the layout. For example, ask them how the records on their system are stored; if you can get an eyewitness to testify their FOIA excuse is bullshit (maybe your contact says 'oh they keep total deaths on a spreadsheet somewhere for 2019'), you might be able to strongarm the FOIA early by making it clear they would not win a lawsuit early on.
If you can't travel, then Option 2 is to 'put out feelers' online to see if there are any disgruntled employees who still work at any of the H+H hospitals. You might not have the reach of contacts, but perhaps you can shoulder tap someone on Substack who has a bigger reach than you to give a shoutout.
I'd also suggest opening up an anonymous tips email address on Proton Mail and putting at the end of every article 'if you work for or in some capacity for H+H, drop me a line or a tip at: [insert tip-off email]'.
H+H and their government scumbags won't go down without a fight! Maybe there's a vaccine injured, disgruntled former employee somewhere who really hates them right about now who has a key piece of info you need...
Andrea (Andy) Cohen is Senior Vice President of Legal Affairs and General Counsel to the health system. Ms. Cohen had served as Acting General Counsel since March 1, 2018. Prior to joining NYC Health + Hospitals, she served as Senior Vice President for Program at the non-profit United Hospital Fund, Director of Health Services in the Office of the Mayor, Health and Oversight Counsel to the U.S. Senate Finance Committee, and Trial Attorney at the US Department of Justice, among other roles.
She also served for seven years as a Commissioner on the Medicaid and CHIP Payment Advisory Committee, Congressional advisory panel. She graduated from Harvard College and Columbia Law School. In addition to managing the duties of the Office of Legal Affairs, Ms. Cohen continues to lead our Labor Relations work.
https://theorg.com/org/nyc-health-plus-hospitals/org-chart/andrea-g-cohen
She is not your run of the mill bureaucrat.
And who is this guy?
Mitchell Katz
Dr. Katz is the President and Chief Executive Officer of NYC Health + Hospitals, the largest municipal health care system in the United States, with 11 acute care hospitals, 5 skilled nursing facilities, dozens of community health centers, a home care agency and an insurance plan, MetroPlus Health.
Since his appointment in 2018, the health system has significantly expanded access to health care, including the creation of NYC Care, a universal health access program that provides care to more than 80,000 uninsured New Yorkers. He oversaw the creation of a modern electronic health record system, increased the number of nurses working in the system, developed a modern ambulance transport system, and launched new street outreach programs to improve the health of homeless New Yorkers. He also led the financial turn-around of NYC Health + Hospitals by eliminating the deficit through enrolling more New Yorkers into health insurance and appropriately billing insurance plans.
Through the COVID-19 pandemic, Dr. Katz provided strategic guidance to Mayor Bill de Blasio, while directing the public health system’s response to the surge of patients that peaked to a maximum of 3,700 patients, requiring the tripling of ICU capacity at its 11 hospitals to save New Yorkers. As the epicenter of the epicenter, NYC Health + Hospitals became the trusted care provider for thousands of New Yorkers, led the city’s Test and Trace operation, and administered more than 1.3 million COVID-19 vaccines.
Previously, Dr. Katz served as Director of the Los Angeles County Health Agency, which combines the Departments of Health Services, Public Health, and Mental Health into a single entity to provide integrated care and programming within Los Angeles. The Agency has a budget of $7 billion, 28,000 employees, and a large number of community partners. Dr. Katz served as the Director of the Los Angeles County Department of Health Services (DHS), the second largest public safety net system in the United States. During this time, he created the ambulatory care network and empaneled more than 350,000 patients to a primary care home. He eliminated the deficit of DHS through increased revenues and decreased administrative expenses, and used ACA funding to pay for a new integrated electronic health system. He moved more than 4,000 medically complex patients from hospitals and emergency departments into independent housing, thereby eliminating unnecessary expensive hospital care and giving the patients the dignity of their own home.
Before he came to Los Angeles Dr. Katz served as Director and Health Officer of the San Francisco Department of Health for 13 years. He is well known for funding needle exchange, creating Healthy San Francisco, outlawing the sale of tobacco at pharmacies, and winning ballot measures for rebuilding Laguna Honda Hospital and San Francisco General Hospital.
He is a graduate of Yale College and Harvard Medical School. He completed an internal medicine residency at UCSF Medical School and was an RWJ Clinical Scholar. Dr. Katz continues to practice as a primary care physician and sees patients at NYC Health + Hospitals/Gouverneur on the Lower East Side of Manhattan.
He is the Deputy Editor of JAMA Internal Medicine, an elected member of the National Academy of Sciences (previously the Institute of Medicine) and the recipient of the Los Angeles County Medical Association 2015 Healthcare Champion of the year.
https://theorg.com/org/nyc-health-plus-hospitals/org-chart/mitchell-katz
2 long winded, specious pages were not quite enough for Andrea Cohen to successfully bullshit her way in defiance of FOIL law. Could She/They be hiding evidence that death records from the recent past 2017-2019 belie the claims of catastrophe throughout 2020? I think they're guilty of worse.
Maybe the $2 BILLION DOLLARS in federal COVID relief funds that H+H has received would need to be repaid if receipt of such funds was contingent on meeting death numbers that H+H failed to generate?
"Legacy records" is the new "We're hosting this information on a new website", which somehow doesn't actually host the information.
Jessica, Thank you for all of your work. I remember when living in downtown Manhattan in 2018 to 2020, there were massive amounts of people put up in my apartment building to put in the new system. I remember asking this lady, why all these people were here. She was from, I think, North Dakota, and lived on a farm. There was still work being done after March 2020. I met with her in her apartment well into the shut down, but they were still leaving in large groups for full days to update the hospital systems....interesting. She told me that NYC hospitals were so poorly updated technologically. She said many hospitals still did not use WIFI. It was really intense the people who came to work on the systems during the last quarter of 2019 to second quarter of 2020. I do not think it was done by the time I moved to another state in the early summer 2020.
This is quintessential obfuscation:
"The agency granted my request for daily deaths in 2020, but denied the request for earlier data, saying it was stored on a legacy software system. “In order to produce that data,” wrote records-access officer Vanita Yogeshwar on October 23, 2023, “it would require the coding of new programs, and would thus require creating a new record in contravention of the requirements of FOIL"
First of all when a new EHR system is implemented all legacy data needs to be moved into that system to preserve the patient history for current providers to review -- going back AT LEAST several years. I suspect ALL or MOST of that data is somehow encapsulated in the new system thus available.
IF IT IS NOT: Then the old system's DATABASE (not "programs") is still in existence and could be queried quite easily via SQL.
IF NOT via SQL then a via RAW DATA DUMP that would have to be manipulated but that manipulation could be done not by the agency but by any competent data analyst. NOT A BIG DEAL.
That said it can be a pain to go into legacy systems but it is done routinely for any number of purposes.
Bottom line: Her canned response was just canned Bull. Vanita Yogeshwar is either incompetent, a liar or both but most probably a FALL GAL.
It seems to me that there is probably a records retention law requiring retention for a specific number of years. There would be no point in requiring the retention of records if that requirement cannot be enforced. If the records in question here were kept only on paper, they would be easily available. If they exist in an electronic database, the software constituting the database and all programs and applications necessary to access the database are undoubtedly still in existence; if they were to have been destroyed the agency would be in violation of the records retention requirements. An attorney, and a software engineer ought to be able to advise you on this
It’s too much for me to believe that when switching to new software nobody exported the old data from previous years into a format that could be uploaded into the new software. (e.g. .csv)
It would seem that having the data but not being able to retrieve it is the same as refusing to share it. I would ask that they send you the original dataset. Sure their software may have been doing "math" within the code prior to the data hitting the glass, but chances are good that the data is there and can be accessed by someone who is not employed by the state. Plus, odds are that if they can't retrieve data from 4 years ago they might be violating some compliance requirements. CMS, HIPAA, GDPR, or other...
It would be a lot of work…but you need to send an open record request to each county in NY. The data is out there and you can probably find a way to bypass the state.
Upon reflection, Covid is NOT the story of our times. The story of our times is that all the important organizations in the world are completely captured. All Covid did was prove this beyond a reasonable doubt.
https://billricejr.substack.com/p/covid-is-not-the-story-of-our-times?utm_source=profile&utm_medium=reader2
This excuse sounds like total BS. Those data are in some kind of database, assuming the agency didn't delete it. The software that created and accessed that database is undoubtedly still in existence. But even if they refused to run that software, they could still provide a data dump pretty darned easily. For example, if the data were in a MySQL database, a single "mysqldump" command would obtain a readable copy of the data that they could send to you.
Come on, data feeding a spreadsheet is not that complicated.
The lawyering is hard to interpret as anything but an admission of guilt.
Keep going. 🔥
"Program of sequel code" is wrong.
The definition for 'program'.
"A set of instructions given to a computer to make it perform an operation." (From https://www.ldoceonline.com/dictionary/program.)
It's highly likely that all legacy database systems storing medical data, recently in use, will be relational databases. The query language used against such data is called SQL, sometimes referred to as 'sequel'.
A SQL statement, such as a query, is not referred to as a program. There is no set (see definition above) of instructions, and the single SQL statement required for any element of an FOI is a request, not an instruction.
Furthermore, any graphical tools allowing drag-and-drop report development will produce, in the background, a single SQL query to submit to the server.
Whilst SQL can be employed by a computer program written in another computer language, and can be enhanced with custom procedures which use procedural code (which may be called programming), a SQL query statement is itself not procedural, and it is not a program.
SQL looks a lot like English, intentionally: e.g. select * from person where dob<'01-JAN-1920'. The lay person can see that this is not a program, but a single request relating to person records, based on criteria.
Given the nature of the data you are requesting I think it almost impossible that anything procedural would be needed. There would be no programming, therefore no "new record". Even if such programming were demanded a simpler solution would always be available: to dump out raw (or raw, but anonymised) table data.
Note: whilst SQL queries have code and could be referred to as coding, they are not programs. It's bamboozlement in this case to be using 'coding' and 'programming' as if the same.
Unfortunately Jessica, there's only two ways to fish details out of such a situation.
Option 1 is to lawsuit them into compliance. It will take many years, cost a lot, and introduce a lot of headaches. I suspect you'd succeed, but will it be before the story loses prominence?
Option 2 is to make friends with someone who works at one of the hospitals (assuming you can get to New York) and see if you can ask them some informal questions to get a 'feel' of the layout. For example, ask them how the records on their system are stored; if you can get an eyewitness to testify their FOIA excuse is bullshit (maybe your contact says 'oh they keep total deaths on a spreadsheet somewhere for 2019'), you might be able to strongarm the FOIA early by making it clear they would not win a lawsuit early on.
If you can't travel, then Option 2 is to 'put out feelers' online to see if there are any disgruntled employees who still work at any of the H+H hospitals. You might not have the reach of contacts, but perhaps you can shoulder tap someone on Substack who has a bigger reach than you to give a shoutout.
I'd also suggest opening up an anonymous tips email address on Proton Mail and putting at the end of every article 'if you work for or in some capacity for H+H, drop me a line or a tip at: [insert tip-off email]'.
H+H and their government scumbags won't go down without a fight! Maybe there's a vaccine injured, disgruntled former employee somewhere who really hates them right about now who has a key piece of info you need...
Records Retention Requirements:
https://library.ahima.org/PB/RetentionDestruction