Public hearing on Burdett Birth Center’s proposed closure - written testimony

Jacob King / Albany, New York

Closing this center would cause needless harm and deny access to a crucial service. Please do not let this facility close.

Morgan Benson / Cobleskill, New York

Burdett Birth Center is one of a kind. They offer compassionate, safe, and family-centered care. They offer birthing options
that are not available at other birthing locations within the Capital District. Most importantly, they made me feel the love
and support necessary to successfully deliver my son. Because of Burdett, I can move through life with a birth story that
continues to empower me and make me feel like a stronger woman.

Carmella R. Mantello / Troy, New York

I am pleased to join you to bring attention to this important issue. I want to thank Attorney General James for holding this
hearing and focusing efforts on how we can save the Burdett Birth Center

As Troy Council President, as a woman, a mother and one of the only city-wide elected officials who has given birth at
Samaritan, I have a unique perspective on this issue.

Simply put, the closure of this birthing center is unacceptable, unwarranted and must be rejected by your administration.
It will reduce access to maternity care for black and brown women. And I believe its closure will ultimately contribute to the
growing rate of maternal mortality in this nation. Recent statistics released by the March of Dimes reveal a troubling trend
in the United States. Despite already having the highest maternal mortality rate among developed countries, there was a 4
percent reduction in the number of hospitals offering labor and delivery services from 2019 to 2020.

In New York we are spending more money than ever on Medicaid reimbursements for hospitals. An additional billion
dollars in federal funds for upstate hospitals was recently announced. The effort to close this center reeks of bottom line
accounting balanced on the backs of women in need. It might look good on paper, but it hurts real people.
Finally, we demand transparency with respect to this decision. The choice was made in secret, with no opportunity for the
Burdett community to provide input or be part of the decision-making process. The shutdown would have a significant and
detrimental effect on Troy, a city already facing severe underservice. A majority of Burdett’s patients, 51%, rely on Medicaid,
and this closure will disproportionately harm working class families and those that are Black, Indigenous, and people of
color.

Troy is on the verge of an amazing REBIRTH. Access to quality health care and the Burdett Birth Center is an essential
ingredient to that success.

Thank you for the opportunity to testify.

Resident / Poestenkill, New York

I had my son at Burdett Birth Center in 2021 after a week-long induction that had complications and resulted in a cesarean.
I chose Burdett Birth Center because it is the only birth center in the county, and traveling to another birth center while
in labor would be dangerous due to the distance and traffic. I also have concerns that the remaining birth centers are
overcrowded. Taking away the only birth center in the county, especially one that primarily serves underserved populations
is a disgrace. What else are we supposed to do? Having access to safe, reliable, and nearby birth care is a human right.

Resident / Troy, New York

Access to maternal healthcare is crucial to the health outcomes of all members of the community. Taking away the only
maternity care in the county would actively worsen the health of the population as a whole.

Resident / Troy, New York

Closing BBC will be incredibly detrimental to maternity care in the entire capital district.

Resident / Mechanicville, New York

Closing Burdett will be dangerous for the residents who need care. There are so few healthcare facilities with this level of
care in the area.

Kathleen Combs / Troy, New York

In January 2001, I was 34 weeks pregnant for my now 22-year-old daughter. I was cooking breakfast for my 1.5-year-old son
at about 10:30 when my water broke. From there the contractions were happening extremely fast and extremely strong.
The firemen showed up to bring me to the hospital via ambulance. I was supposed to got to albany medical center, but
when the paramedics assessed me I was crowning. There was no way I was going to make it to AMC or possibly any
hospital for that matter. When paramedics got to me it was about 11 am. They made the quick decision to hopefully get me
to Burdett to deliver my baby. We pulled into the hospital at 11:07, my baby girl was born at 11:17am with a tight knot and the
cord wrapped around her neck. There wasn’t even enough time for a doctor to deliver my baby. A nurse (Jean Rodino), who
I am beyond thankful for, delivered my baby girl. If Burdett was not open at that time, there is a chance my daughter would
not be here today at 22 years old, as a labor and delivery nurse.

Resident / Castleton, New York

The idea that women’s health and maternity services is yet again being cut by a so called, not for profit company is
disgusting. The maternal morbidity and mortality rates in the US are some of the highest in the world and our health
care companies are continually allowed to close maternity services leaving more women and babies at risk of becoming
another statistic. It always comes down to the money! SPHP states they care about the poor but this act is a blatant
demonstration that this isn’t true. When SPHP wanted to build a new parking garage and pavilion tower at the Samaritan
campus, they found the money…where there was a will so they found a way! For women and this community SPHP needs to
realize how important women’s health is, they need to find a way.

Amy Cerqua / Waterford, New York

Some parents do not have transportation and will have to travel farther for care. This is unfair to them

Resident / Troy, New York

Samaritan Hospital Birthing Center is a necessary part of the medical care provided to Rensselaer County residents. Many
residents reside in rural areas and Troy is the closest hospital. When time is of the essence, women should not have to risk
their or newborn lives by driving past a hospital that could provide the services needed.

Resident / Albany, New York

I was only 20 years old when I gave birth to my first living child, it was one of the most traumatic events of my life as I
already had a fear of hospitals due too early childhood trauma, I was sexually assaulted repeatedly by the doctor who
delivered my daughter and there was not a single staff member at Cooperstown hospital that listened to my needs. So I
was rightfully terrified when I transferred to Capital region midwifery at 30 weeks pregnant with my second living child.
I had just moved to Albany and Capital region midwifery was one of the only providers who did not do home births as
midwives. I have far too many possible complications to do a home birth so I was incredibly relieved when Capital region
midwifery midwives were some of the most compassionate women I had ever met.

Burdett was the only hospital that they had the ability to deliver at back in 2018, when they were still working out of a
beautiful home, had just a few nurses and only four midwives. While I had only met with Pamela once, she and nurse Jackie,
who still works at Burdett, ensured that I was able to listen to my body, do what it was telling me and safely deliver my child
with no trauma to me or my baby.

Things at Burdett have changed a lot since 2018 when I gave birth to my final child and second son in February of 2023, I
was the only patient there as most hospitals were on divert due to lack of staffing.

Because of my work in child welfare I refused to be diverted to AMC or St Peters hospitals because I routinely run into issues
of unknowledgeable and ignorant doctors f that victimize mothers time and again. Burdett was and continues to be my
safe place where my babies were safely delivered and my bodily autonomy was respected.

Losing Burdett would be devastating for Rensselaer County as well as Albany County and all other surrounding counties
where mothers make the choice to go to Burdett because it is safer and more welcoming than other hospitals in the
area. Nurse Jackie, Nurse Cherish, Nurse Sarah and Nurse Jill as well as the probably 10 other nurses that I met or assisted
me throughout both of my son’s births in the 24 hours that I stayed after each birth insured that I was as prepared for
motherhood as I could be. Losing this facility will not only be devastating but it will victimize the poor and underserved
in this community. It will mean more child welfare reports that could be handled by the hospital because they do not
actually rise to any level of neglect, it will mean more women giving birth on the side of the road or in their homes because
they could not make it to a hospital that was 40 minutes away, it will mean more dangerous births because moms with
complications may choose home births due to not having a reputable facility nearby, but most of all it will mean more
babies and harm’s way because there is no facility with compassionate, warm, knowledgeable staff to help them in their
first moments of life.

As a mom, as an aunt, as a friend to other mothers and mothers to be I am absolutely devastated that this closure would
even be considered because it directly places mothers and future mothers in harm’s Way.
Thank you for taking the time to review this.

Liliya Sandul / Waterford, New York

This is the closest birth center and this is very important especially when you are in labor. Very nice and professional
personal service. This center is so comfortable that I felt like I was home. I felt really taking care of myself every time, and
you can believe me because I have 11 children, and also I have experience in comparison. Also have a lot of relatives (sister-in-
law and nieces) who were there and want to have their babies in the future there.

Resident / Lenox, Massachusetts

I work for NYS and am planning to move to be closer to work. I am expecting a baby boy this February, and with all the
uncertainty that being a first-time parent brings, the uncertainty of not knowing if I will be able to deliver at Burdett’s (a
highly respected birth center, known for low interventions but connected to a highly respected hospital with NICU care
should it be needed), is an enormous added stress. It’s something I worry about all the time. I do not want to have my baby
anywhere else, and I certainly don’t want to have him in an unfamiliar hospital, with unfamiliar staff, that would be severely
overburdened with other patients forced to deliver their babies elsewhere due to Burdett’s closure. Please, please keep this
birth center open.

Resident / Troy, New York

The Burdett Birth Center has an admirably low rate of C-sections, and this should be a model for other facilities. Rensselaer
County has a large population, and needs to have the birth center to ensure the health of mothers and children. Closing
the birth center would demonstrate that Saint Peter’s has a flagrant disregard for public health.

Resident / Melrose, New York

Burdett Birth Center is a vital asset to the community. Located for easy access and availability, where personalized and
informed care is the standard. Patients can have anything from basically a home birth experience, complete with water
birth, to an epidural, a c-section, or everything in-between. Midwives and Physicians working in harmony. The loss of BCC
would be a great loss to the community. Besides transportation issues and inconveniences, it would impact women’s health
care in general. Healthy moms and babies need to be prioritized. Women’s health should not be based on profit, but on the
greater need of women and the community. Please keep Burdett Birth Center open for the community it serves.

Clara Hunt / Rensselaer, New York

I had the pleasure of serving as Vice President at Samaritan and retired in Dec 1999. It was a caring and professional
hospital in all aspects

We were there to help the people in our community. Closing Burdett Birthing is no way to provide service for those who
need it. Has the hospital lost the number one reason to be here? Do they care?

It is not the hospital I worked for and I hope the issue is resolved with the need of our community a number one item

Malaina Saha / Wynantskill, New York

If Burdett Birth Center were to close, we would not only lose a trusted institution but also a haven for mothers-to-be seeking
unparalleled care. It’s a place where the birth experience is transformed into something beautiful, safe, and empowering.
We can’t afford to lose such a valuable resource in our community.

My experience at Burdett Birth Center was nothing short of life changing. From the moment I stepped through their doors,
I felt the warmth and expertise of their exceptional midwives. Choosing Burdett was an easy decision for me due to their
remarkable track record of low c-section rates, their midwifery-led model of care, and their convenient location. But it was
the trust I placed in them that truly set them apart.

However, the thought of Burdett Birth Center closing is deeply unsettling. The ramifications of such a loss would be
profound. Firstly, it would be a loss for expectant mothers who, like me, have come to rely on Burdett for its unparalleled
care. The void left by its closure would be felt not only in the community but in the hearts of all the mothers who have
birthed there.

For me personally, the closure of Burdett would mean I wouldn’t choose to have more children. Their location and
midwifery model of care were integral to my decision to expand my family. Losing Burdett would mean losing the
opportunity to have another child under the same supportive, empowering, and safe environment that I cherish.

In conclusion, Burdett Birth Center is not just a healthcare facility; it’s a lifeline for mothers-to-be, a beacon of trust, and
a source of empowerment. Its closure would be a devastating loss for our community, leading some like me to forgo the
dream of expanding their family. We cannot afford to let such a vital institution disappear. Burdett must continue to thrive
and serve generations to come, as it has served me and countless others.

Resident / Troy, New York

The Burdett Birth Center is a crucial resource for Rensselaer County and the Greater Capital Region. Having this resource
available to me early in the pandemic eased my pregnancy and anticipated birthing experience immensely. I have long
wanted to have a home birth when I had kids. However, living in an upstairs apartment and being low income and on
Medicaid at the time of my first pregnancy made that option entirely out of reach. I was thrilled to have heard from
community members about their fantastic birthing experiences at Burdett. I was told it was everything one might desire
about a home birth: comfortable, quiet, minimal interventions, non-medical pain management options, patient centered
care. Burdett Birth Center makes midwifery care available to low-income people and tenants when paying for a private
midwife for a home birth is a difficult or impossible option. I am steadfastly in support of Burdett and the care it makes
accessible. I dearly hope this precious resource remains a birthing option both for myself personally, as well as all those in
the area for whom it makes midwifery care accessible, especially tenants and low-income folks.

Kristoph DiMaria / Troy, New York

Do not close Burdett Birth Center. We know firsthand how much this place has meant and continues to mean to so many
in this area and beyond. It empowers, I was to practice this kind of care as well as provides the confidence for new, and
experienced parents to like to have their children. We know that closing this center would mean so much difficulty and
danger to the most underserved of us. We know who suffers most because of the systems that surround us, and without
Burdett, that suffering will exponentially increase. We strongly urge all parties in this decision to seriously consider the
ramifications of creating a birth healthcare desert, in which many would be forced to travel longer distances with much
less certainty. We know that there would be greater risk involved in people making sure that they are heard, and that their
needs are met. Do not close Burdett.

Lynn Swett / Malta, New York

My second child was born very quickly and would have been delivered on the roadside if we’d needed to drive to Albany!
Please don’t devastate the community.

Amy Cole / West Sand Lake, New York

I am a naturopathic doctor that provides medical care in Bennington, VT. I also offer naturopathic wellness consultations
in Albany, New York. I grew up in Rensselaer County so I am very familiar with the area. I worked as an OB tech for BBC about
16 years ago for a few years. I was a pre-med student at the time and I also did internships at the local hospitals in
Albany. After moving back to the area, after completion of naturopathic medical school, I chose to have my children at
BBC because I saw the difference in care between BBC and some of the other local hospitals. I saw the care was more
personalized at BBC. The patients all seemed very comfortable there and the staff was beyond amazing. I also had
phenomenal care while at BBC. At the time of my children’s birth, I lived in Albany County and still made the trip to BCC for
my deliveries as I knew that is where I would get the best care for my needs. For my first delivery, I was planning a regular
vaginal birth. Things were not going as planned and I needed to have an emergency C-section. While it was a scary
situation, I knew I was in the best hands with the nursing staff as well as the providers that were taking care of me. For my
second, I returned to BBC and had a VBAC. Another potentially stressful situation, but again, I knew I was in the best care
and that was comforting. I now live in Rensselaer County and it pains me to see the possibility of this closure. Not only
for the amazing employees that have kept this the great facility it is, but for the residents of this county to have to make a
further drive for potentially lesser care for their individual needs. Working in Bennington, I see many people from Rensselaer
County. They will need to decide to make a longer trip to either Albany or Southern Vermont Medical Center for their care
while BBC is right around the corner. I truly believe shutting down BBC will have a major impact on the already deficient
healthcare situation we have in this state, especially for those residing in Rensselaer County. I am so grateful for the time I
had with the staff at BBC when I was employed there as a young student. I learned a lot of compassion and thorough care
from all the staff members at BBC that I carry with me to this day.

Resident / Troy, New York

I got very sick with a stomach virus two days before my due date. I was unable to keep down any liquids or solids for over
24 hours. I had planned to give birth at home. My midwife sent me to Burdett Birth Center to receive IV fluids and check
the baby’s vitals so that I could have the strength and opportunity to give birth at home. Going to Burdett felt safe -- my
midwife had relationships to the nurses and midwives on staff, and called ahead to explain the situation. I was cared for
with respect to the fact that if nobody at risk, I would be free to go home to give birth.
I don’t believe I would have had the same opportunity in safety and without pressure in a different circumstance. If I had
been sent to a less holistic birthing hospital or an emergency room, I know (based on countless experiences my friends and
family member have recounted) that I would have been pressured to stay and give birth in the ER. I experienced a minor
complication after going home where my baby wasn’t coming out totally straight, and I was pushing for 6.5 hours (3+
hours longer than the average first time vaginal birth). My midwife, who is over 30 years experienced, knew that I wasn’t at
risk, and was able to guide me to a successful and healthy birth. Again, if I had been in the ER, I would have been pressured
to take synthetic hormones to speed things along, or into a C-Section. I’m not being dramatic -- we know, statistically,
that this is what happens in hospitals that do not provide holistic and women-centered care, especially to BIPOC women,
especially to black women in the United States.

I had a privileged experience of being able to give birth the way I wanted to, in a way that was the most healthy and safe
for me and my child. Keeping Burdett Birth Center open will help to ensure that for the women in our community — many
of whom do not have the privilege to pay for a home birth midwife out of pocket or to have insurance that covers it — have
the option (which should be their right) to have holistic maternal care. The US has the highest maternal death rate in the
western world. We have the technology and resources available to save lives, yet the hospital system continually treats the
birth experience as a time suck and liability instead of considering the needs and health of people giving birth. Please don’t
take away this holistic resource from our community.

Forcing women to give birth in the ER, with doctors and nurses that aren’t specialized in birth, because it’s the only option in
our community, is unconscionable.

John J Frank / Troy, New York

The closing of services by large corporations for purely profit reasons is detrimental to lower-income families and
people. Lower-income people most time do not have transportation to care longer distances from their homes of places
of employment. The is creating a hardship of unnecessary time (for travel) and cost again for the distance to the
other hospitals. Whatever happened to the NON-profit hospitals? Now one of the first things your asked is do you have
insurance? I even had a representative from Samaritan ask me for the co-pay before I even went to the hospital for my
colonoscopy. Which I knew there wasn't one because it’s paid for by Medicare and my Advantage plan.

Cherie Plante, MS, CRC / Troy, New York

When I was a young case manager, one of my clients chose to give birth at what was then Samaritan Hospital. My client
loved the at-home feel of the maternity section of the hospital. She was happy that her baby could stay in the room that
was furnished with a comfy rocker and was decorated like a home not a hospital. She was a teen mom and she felt they
were respectful of her birth plan.

Elizabeth Madigan / Ballston Lake, New York

Both my son and I may not have been here today if it were not for Burdett Birth Center. I was able to be seen, inpatient,
and the process of induction was able to be started right away. Traveling further than Troy was not a viable option. This
location is key to the health and well-being of all local expectant mothers. Burdett was not in my original plan but when
it became an emergent situation I was so grateful to have this location as close as it was. If I had the option in the future,
Burdett would be my first choice given my experience. I am grateful for the care my son and I had received.

Nora McDowell / Troy, New York

My name is Nora McDowell and I live in Troy, New York. I am commenting from my experience as a Troy woman that Burdett
Birth Center is protecting lives for many in the City of Troy and beyond — especially our most historically marginalized
neighborhoods and communities.

I birthed my children at St. Mary’s Hospital in Troy in 2002 and 2006 and I remember the importance of having the Troy
hospital with midwifery care and C-section surgery services in my home city. This was vital to my health, my babies' health,
and our family finances at a very precarious time. I was sad to see St. Mary’s close in 2011 but I trusted in the process of
combining with Samaritan Hospital and appreciated the keeping of the midwifery model of care along with obstetrics and
gynecology services in a Troy hospital.

As a neighbor and a board member of the Boys & Girls Club of the Capital Area I worry for the girls and women in our
poorest neighborhoods having compromised reproductive services and birth services in our city. I also see this as a gradual
loss of more health services leading to eventual closure of the emergency room, mental health services and Samaritan
Hospital. Save Burdett. Save Samaritan. Otherwise poverty = death in our city of Troy.
Many struggling families in Troy don’t have cars.

Women will have expensive costs of rides to hospitals , if they can get one. Extra rides may be needed if contractions don’t
continue and they are released from the hospital. That happened to me. At least then the hospital was nearby.
Women need all reproductive health services available, including tubal ligations at the time of C-section if they choose that.

St. Peter’s Hospital doesn’t provide that need. If reproductive justice and procedures and services are not available to poor
women, it doesn’t really help that they are legal in New York state.

The office of the mayor sent an email asking that we fill out a survey to #SaveBurdettBirthCenter .

I did that survey for my past self that needed nearby maternity services, new baby support and well woman care after
surgery and for the girls and women that will need that in Troy and Rensselaer County in the next decades.

People are concerned about the negative and life-threatening impact that closing Burdett Birth Center would have on not
just mothers, but our city and surrounding counties in the event of other medical emergencies and fire response. I also
worry about the potential loss of more services such as crisis mental health, emergency room, opioid overdose treatment,
hospital-based gun-violence-prevention programs and the eventual loss of Samaritan Hospital all together in Troy, New York. Troy
needs a Good Samaritan. We need Burdett Birth Center now and in the future.

Keep #BornInTroy possible.
Peace! Nora McDowell

Robin Stokes / West Sand Lake, New York

Burdette Birthing Center is the most caring and beautiful place I’ve ever given birth. I had two children in Colorado and
nothing compares to this center. If it closes, you would be doing a severe injustice to this community.

Victoria Robert / Troy, New York

I am deeply concerned about the impact the closure of Burdett Birth Center would have on myself, close friends, and
neighbors. I am a resident of downtown Troy hoping to expand my family in the future. As someone with a chronic illness
who’d have a high-risk pregnancy, access to safe evidence-based midwifery care is literally life or death for me.

Resident / Niskayuna, New York

I strongly oppose the closing of the Burdett Center. There is no other place in the Capital Region where more natural options
are available to women during child labor and childbirth. I have always wanted to have a water birth and was so excited
when I found Burdett Center in 2021 when I was expecting my second child. From prenatal care to postnatal care, I have had
great experiences with Capital Region midwifery and knew giving birth at the Burdett Center was going to go above and
beyond my expectations. I unfortunately had my son early in another state, but once I found out I was expecting again, I
knew I needed to go to Burdett Center! When I found out that there was a possibility of closure, I was heartbroken. Burdett
Center has served so many families and I hope they can serve mine as well.

Meagon Nolasco / Cohoes, New York

I work for The Pride Center of the Capital Region and Burdett Birth Center, and the LGBTQ+ community members who use
this resource fall into the center’s catchment area. LGBTQ+ birthing individuals are not able to walk into any medical
establishment and know they will be treated in an affirming, safe, and competent manner. Burdett Birth Center provides
this atmosphere for LGBTQ+ folks in the region. The Pride Center uses this center as a resource for those in the LGBTQ+
community of Rensselaer County because we know our clients will be treated respectfully at this center. Closing this
resource would impact all marginalized communities in this county, including the LGBTQ+ and BIPOC communities.

Bridget Cully

My name is Bridget Cully, and I’d love to share the stories of the births of my sons James and Johnny.

I was pregnant with my first son, James, in February 2019 when, for reasons unknown, my water broke at 18 weeks exactly.
Being a nurse, and happening to work at the time at Burdett Birth Center, I knew what this meant. We tried for 10 days to
see if my waters would repair or replenish and give me a chance of my son surviving, but on March 7th, 2019, we were left
with no choice but to induce my labor, as I was dilating on my own and was at risk of severe infection. James Adam was
born still at 11 pm, among my coworkers, friends, and colleagues, in my workplace, a day that should have been so happy
for me to welcome my first child into the world. But I can’t imagine spending the worst day of my life anywhere else than
with the best people in the world to care for me. I doubt I would have received such kindness, compassion, and respect as I
did with BBC, having worked there or not. It’s the reason I still felt ok to return to work there, nearly six weeks later, delivering
babies when I should have been able to bring mine home.

The infertility process and miscarriages that happened between the death of my son and the birth of my living child
would have been impossible if not for the wonderful people that I worked with being supportive of my every need. Without
question, these people gave me space to grieve, to process my pain, and to openly discuss my child, which is not something
that feels safe in the “outside world.” This place seemed to attract the types of providers and nurses whose philosophy is
deeply rooted in compassion and caring, understanding and support, and these people carried me through the toughest
times of my life.

In contrast, the happiest day of my life was also spent at Burdett Birth Center. On February 27th, 2021, after an impossibly
hard physical and emotional pregnancy, I gave birth to my son Johnny. My room was decorated with tea lights. I was able
to bring my son James’ urn and a picture of him and held him when it felt right to grieve what I would never have with him. I
was given space to feel whatever I needed to feel about my birth. Mostly, I felt at peace. I knew I was in the hands of some of
the most talented and amazing people, so I didn’t need to fear for what would happen: I had gotten through it before with
them, and I’d get through anything with them again. Luckily, everything went without complication, and I was able to give
birth to my rainbow baby.

Without the people that worked at Burdett Birth Center in the past and today, I would have given up years ago on my
pursuit to start my family. I could not have coped with what I went through if not for all of them. The closure of this facility
means so much more to me than the end of an era. It’s the closure of the only place that I ever held my son James. It’s the
closure of the only place I would ever feel comfortable bringing any of my children into the world. It’s the loss of all of the
memories over 7.5 years of the people I worked with, the patients I served, and the memories I made. Burdett Birth Center
provides an invaluable service to its community, as we all know, and closing this facility is personal for me as well as many
other people who have birthed there. I’m proud of this community for fighting for the patients and employees of this
priceless community hospital. Let’s keep fighting!

Thank you,
Bridget Cully

Lisel Martel / Troy, New York

My husband and I chose Burdett Birth Center because of the atmosphere and approach to the birthing process. My doctor
has been delivering there for decades and does not have an overly interventionist approach to labor and delivery. We loved
the fact that the center is set up so that you don’t have to be moved around throughout the course of L&D. The staff are
extremely supportive and attentive without being overbearing or pushy. I felt like our birth plan was respected and I was
able to have as natural an experience as possible, despite having to be induced due to gestational hypertension. Because
of the expertise and care of my physician and the L&D staff, my recovery was very easy and I was able to focus on bonding
with our son. I have every intention of delivering my next child there as well.

David L. Bach / Troy, New York

My concern with the proposed closing of the Burdett Birth Center, in Troy, is the impact it will have on the women and
families living in, or near, poverty within our communities. Marginalized populations are disproportionately [affected], any time vital
health services are reduced (or in this case eliminated) in their immediate communities. As a nonprofit provider in the
community, we have a role in assisting families navigating gaps in services, and with this proposal that role is to assist the
community in maintaining this critical service, here in Troy. As an executive of a nonprofit, albeit a smaller one than St.
Peter’s Health Partners and Trinity, I understand the pressure to manage budgets and making decisions that aren’t always
popular. However, the weight of any decision in the nonprofit sector must always be anchored to the mission from which
we are obligated to deliver. Maternity centers should be mission critical for all hospitals and health centers, especially those
operating as nonprofits. As an integral community provider in Troy, I believe the testimony gathered here and on 9/18,
coupled with the work NYS DOH, local and state politicians, and other advocates are doing should open broader dialogue
with Trinity around solutions for maintaining birthing services in Troy. If Burdett were to close, the impact is not only on
those in and around Rensselaer County, but the residents of the communities who still have maternity services, as there will
be greater stresses placed on those centers, thus reducing access for everyone and ultimately decreasing the safety and
quality of giving birth in the Greater Capital Region of this state.

Emily Zini / Rensselaer, New York

The midwives and nurses of Burdett Center are all very knowledgeable and incredibly kind. It would truly be a shame for the
to be closed due to budget cuts.

Resident / Canaan, New York

As an employee of St. Peter’s Health Partner’s and birth worker at Burdett Birth Center (BBC) for more than a decade, I have
first-hand experience with the population we serve. This population is majority low-income, Medicaid-insured and a mix
of racial and ethnic minorities, LGBTQ+ people, rural, urban, and people with disabilities. If closure of BBC is permitted by
the Department of Health, our patient population would not have timely access to evidence-based, culturally appropriate
obstetric care. Transportation to other hospitals in Albany, Niskayuna, and Saratoga is difficult for the Rensselaer County
population we serve. Many do not own their own vehicle, Uber/Lyft can be cost-prohibitive, the buses can take over an hour
to get to the other hospitals, and the Troy Fire Department’s EMS service is under-staffed and overburdened. In addition,
the closure will cause significant pressure on other labor and delivery units, as well as emergency services in the Capital
Region. There is not enough capacity in other area hospitals to absorb 800-1000 more births per year. Nor are there enough
health care workers to attend them. If our remaining maternity wards are overloaded, the pregnant people of the Capital
Region will be placed at grave risk — potentially frustrating the state’s goal of reducing maternal mortality.

The model of care at BBC is an interprofessional collaboration between obstetricians and midwives that demonstrates
dynamic, equitable, accountable, and respectful care for birthing people and improves obstetric health outcomes. BBC’s
collaborative care model achieves the triple aim of healthcare in the U.S. by improving the health of populations, reducing
per-capita costs of health care, and improving the experience of health care. Despite this proven safety, savings, and
satisfaction, St. Peter’s Health Partners has decided to close this important institution in the community. Unfortunately,
this model of care does not exist in the Capital Region at any other maternity center. We have the lowest maternal and
infant morbidity and mortality rates in the region. Patients seek out the midwives model of care at BBC because it
minimizes unnecessary interventions; monitors not only the physical but psychological and social well-being of the parent
throughout the childbearing cycle; provides education, counseling, prenatal care, hands-on assistance during labor
and delivery; [provides] postpartum support; and collaborates or refers for obstetrical care when necessary. Our staff nurses have
extensive knowledge of normal labor and how to support birthing people with low-intervention birth and this is rare: Other
maternity units in the region do not have nursing staff that have been trained in the midwifery model of care. We also offer
hydrotherapy during labor, and we are the only hospital that offers water birth in the Capital Region and one of 40 in the
U.S. Water birth has been found to contribute to no anesthesia use in labor, less lacerations, and higher satisfaction rates
among patients.

It took many years to create and perfect BBC, and it is difficult to watch it be dismantled by a big healthcare organization.
BBC embodies St. Peter’s mission. By “living our values” BBC has historically stood with and served those who are poor,
especially the most vulnerable. It’s a shame that St. Peter’s has forgotten their mission and want to close the doors to this
specialized maternity unit.
*Please read at forum*

Rozara Madeline Sanders / Albany, New York

When I heard about the proposed closure of Burdett, my heart sank. As a birth doula, I have seen firsthand the difference
in experiences between Burdett and the other hospitals in the area. Those facilities are staffed with wonderful nurses and
providers, but the culture of Burdett is impossible to recreate in a large hospital environment. At Burdett, physiological birth
is prioritized and the midwifery model of care promotes the birthing process exactly how nature intended it. As someone
who required a Caesarean birth, I know that an unmedicated birth is not possible for everyone. However, surgical birth in this
country is approaching an average of 30%, with St. Peter’s Hospital seeing a roughly 40% C-section rate for Black birthing
people, compared with roughly 20% at Burdett in 2022.

Not only would this proposal close the only facility that practices the midwifery model of care in the Capital Region, it would
also eliminate the only birthing facility in all of Rennselaer County. Burdett also serves residents in the Albany, Columbia,
and Greene Counties. Data from the Save Burdett Birth Center Coalition found that 22% of households in Troy do not have
a car. The CDTA does not run 24 hours, so if a birthing person goes into labor at night, their options are to take a costly
Uber or call an ambulance. EMS services in Troy are already stretched thin, operating with only four ambulances. This puts
everyone in need of EMS services at risk for higher wait times and adverse outcomes.

How we birth is a reflection of our values as a society. I want to live in a society that values safety and access to all birthing
people and their babies. St. Peter’s Health Partners and Trinity Health have made their values clear. Physiological birth will
never make healthcare conglomerates rich. It’s time SPHP and Trinity reckon with that fact and do the right thing for our
community.

Resident / Chatham, New York

I started working in the nursing field within the last five years but have always made women’s health the focus of my career.
Pivoting to nursing and labor and delivery was the only option in my opinion and Burdett was the obvious choice. They were
open to working and training a new graduate, they were patient centered and had great statistics, both as an employer
and for patients.

I learned an immense amount from both peers and the providers and was often in awe of the experiences the providers
and nursing staff were able to provide patients. It was very clear very early on that it was a special place to work and deliver
as the providers set the tone of using evidence-based midwifery models to drive their compassionate and comprehensive
care. This has led to great outcomes and very happy patients.

Burdett Birth Center is not only a great option but is an essential one as it is accessible and ingrained in the community
it serves. Losing access to top-tier care limits healthcare options for women at a time when doors should be opening. I
wholeheartedly oppose the closure of Burdett Birth Center and implore the Attorney General and Department of Health to
seriously consider the negative impact it would undoubtedly have. Thank you for your time and consideration.

Resident / East Chatham, New York

The team at Burdett were amazing down to a person. With several unexpected occurrences during my wife’s labor, I can’t
imagine navigating them anywhere else.
We’re Columbia County residents, and fortunate enough we could [have] gone to several places for the birth of our son. So while
I can’t personally speak to the loss of Burdett as a Rensselaer County resident, I am certain it would be an immeasurable
harm for the whole Capital District.

Resident / Melrose, New York

When I heard the news that Burdett Birth Center was slated to close, I immediately became emotional. My first child was
born there at 35 weeks gestation due to my diagnosis of pre-eclampsia in the fall of 2020. It was a scary time due to the
pandemic and my preemie baby, but Burdett Birth Center gave me an amazing birth experience. The second my baby was
placed on my chest, I knew I would do it all again at Burdett with the midwives. They took care of my physical needs, as
well as my emotional needs. I felt cared for and empowered. Everyone from the midwives and nurses to the pediatrician
and young folks who delivered our meals to our hospital room was a welcoming, caring face. Since my daughter was born
unexpectedly early, we didn’t even have the car seat installed yet, but since we were close to home, family was able to find
our car in the lot and install the car seat for us. Our family couldn’t visit during our six-day hospital stay due to the pandemic
policies, but they were able to drop off food because we were close by. The idea of having to drive to Albany to give birth
feels like an extra level of stress that expectant parents don’t need, especially if they emergency care like I did. Rensselaer
County and the Capital District community needs Burdett Birth Center.

Michael Keenan / Cropseyville, New York

First, Trinity closed St. Mary’s & redid Samaritan so that we have less options for especially emergency care. Their $millions
fund raising appeal claimed better service but the opposite has occurred (look at emergency room wait time if that statistic
exists). The birthing center is the next service that they want to cut. If allowed, what will be next?

Christopher Finn / Rensselaer, New York

It is absolutely critical to the health and safety of Rensselaer County residents, and indeed to residents all over the Capital
Region, that Burdett Birth Center remains open.

The facts and data are well established at this point. Burdett provides superior care with better outcomes for both
disadvantaged and more privileged communities than any other maternity facility in the area. It is vital that people in our
community are able to access the model of care that Burdett provides.

It cannot be stated more plainly than this — the closure of Burdett Birth Center will KILL women. The closure of Burdett Birth
Center will KILL babies. The closure of Burdett Birth Center will have a DIRECT and NEGATIVE impact on the quality of life for
thousands of people, especially poor women and women of color. All of the publicly available data supports this.

I implore the [Attorney General's] office to do everything in its power to prevent the closure of Burdett Birth Center, and to help the most
vulnerable communities in our region live better, healthier lives.

Resident / New York

I write this testimonial today as a birth worker of the capital region for 13 years. I have held several different roles in this time
and have had the privilege of caring for birthing women at Burdett Birth Center as well as St Peter’s Hospital. I absolutely
love the career I have chosen and am deeply passionate about providing safe, evidenced-based and consent-informed
care to women.

When I think about the importance of the BBC to the community of Troy, the only way to understand it is to know it. Before
coming here, I didn’t understand it. I viewed the BBC likely the same as many others; a small community hospital where
births occur, likely low-risk patient populations only. Then, I came here. I’ve cared for the women of this community. I’ve
built relationships with the nurses, and was blown away by their assessment skills and ability to support and trust low-risk
protocols for labor and birth as well as stabilize and assist in the delivery and transfer of a 26-week-old fetus from a mother
who had severe preeclampsia delivered by emergency cesarean. I was surprised by that acuity. Burdett is not just a low-risk
birth center. Similarly to any inpatient obstetric unit, it too can be an obstetric ER, but without the capabilities of a level III
hospital, as there is no NICU. There is no higher level of care/service in-hospital. It is up to the nurses, the midwifery practice
that covers arrival to the unit, and two wonderful doctors to assess, stabilize, and potentially determine need for transfer in
acute situations — or in unstable situations, determine if birth needs to be imminent, even when unfavorable outcomes may
come from that decision. Burdett is rooted in Troy, they are intertwined. A place where an entire family has brought their
children into the world... a mother, a grandmother, even great-grandmothers have been at the bedside all at once, proudly
exclaiming “this is where we have our babies, there’s no place better.”

In my humble opinion, the BBC is the Capital Region's best-kept secret. There is no equivalence to an alternate birthing
site like it, arguably anywhere in the eastern part of NYS. As evident by the testimonials today, its uniqueness derives from
the midwifery model of care, and the model thrives here. It’s the best place locally to support physiologic labor and birth
because those that work there are not just trained but they are passionate and comfortable supporting the midwifery
model of low intervention birth. Birth is not feared here. That is the culture which makes birth outcomes here what they
are. And it is not something that can be replicated. Other labor and delivery units in the Capital Region may be a lot of
wonderful things, but they are not Burdett and never will be.

Getting acute obstetric care from a Samaritan ER in lieu of the BBC is also not of any equivalence. There are many
occasions that we anticipate a visit from an obstetric patient with concerns at some point in pregnancy from a local office,
but there are also many occasions that we don’t expect visits. There are women of the community that will come to Burdett
for reassurance, acute assessment, or intrapartum (during her pregnancy) care if they’ve been unable to get to scheduled/
routine visits at their ob/gyn office. There is a large number of women who come to Burdett and give birth <1 hour after
admission. In Rensselaer County, According to Data USA — from the 2020 census report, “The largest demographic living
in poverty are females 18-24, followed by females 25-34, and then males 18-24. This estimation was 10.2% (those 18-24) and
9.66% (those 25-34). One of the values of St Peter’s Hospital, a part of their mission statement is to “stand with and serve
those who are experiencing poverty, especially those most vulnerable." I would have to strongly say the closing of the
BBC is a direct hit to the 19.8% of women in Rensselaer County who are impoverished and of childbearing ages…and this
provides us with a complete contraindication to the mission statement from this organization.

What Trinity Health should be doing instead of focusing on closing the BBC for financial concerns is looking at the statistics
here for birthing women and asking themselves how it can be done better at their other birthing sites. St. Peter’s
Hospital does not have the ability to “absorb 3/4 of the patients” from the BBC closure. There are days the L&D unit there is
bursting at the seams with women birthing in triage rooms and laboring in the anesthesia recovery area outside of the on-unit
operating room. The Albany Medical Center L&D nurses have expressed concerns over bed availability at their birthing
unit as well. Why not advertise and market the BBC further and have it be known as the premier birthing location in the
Capital Region for women seeking low-intervention birth? Why not share the birth statistics which show vaginal delivery
rates far above the national average? Why not support the staff to be able to accommodate larger numbers of women
birthing at BBC annually? There are seven labor rooms and seven postpartum rooms. That’s far more space than St. Peter’s will be
allotting if this closure takes place. Maternal morbidity and mortality in the U.S. is no longer a silent secret in this country. I
plead to you today, let’s make the BBC potential closure the catalyst for change for this county, the state of New York, and
for the nation in a bold step to preserve the safety of mothers and babies in this country.

To all listening here today, thank you for your efforts and continued support in this coalition. And to Letitia James, our local
politicians and leaders, please hear these stories and concerns today and protect the 800+ women who choose the BBC to
welcome their babies into the world each year.

Zanetta Gary / Slingerlands, New York

As a black woman with a public health background and active in maternal health work I was very conscious about where
I was giving birth. Burdett was a clear standout, and I am so glad I had my daughter there. I would be devastated if they
closed.

Resident / Green Island, New York

I had my first baby while Covid still had things strict in medical settings, I was allowed my fiancé and my doula (mom) in
the room. I was absolutely terrified at the thought of having a baby in this time, knowing I would have my own room and
many options for pain relief and a relaxing environment made me so much more comfortable. After arriving and meeting
my nurses and midwife in Burdett I literally could not have had a better birthing experience. I am hoping and excited to have
the same experience with my second baby due in March 2024 in the same place! I will be terrified again, if I have to drive to
Albany while in labor risk hitting traffic and not having the same opportunities for comfort, peace, care, and safety with my
second birth. If this facility closes I am positive there will be many mothers to be affected and worried about having not only
a place to have their child but also the care they will receive in other facilities

Laken Rae Turner / Valatie, New York

I would like to speak about being a woman from a rural area who chose and would again like to choose Burdett for another
beautiful and natural birthing experience. The closing of Burdett would devastate me. It is the only birthing center in our
area that can offer exactly the birth I want while also having the resources to keep me and my baby safe.

Elizabeth Gray / Troy, New York

When I had my first baby, I found out I was pregnant in April 2020. I had just left my job to finish my doctorate, the world was
locked down with covid, and I had new insurance that wasn’t accepted by the midwife I had been planning a home birth
with.

I was encountering all of these changes personally, living in the confusion and chaos that we all were dealing with at that
time, and meanwhile trying to figure out who I am going to turn to for care and medical support for one of the highest
stakes experiences of my life.

And that’s when the midwives at Capital Region Midwifery came into the picture. From my very first appointment, through
all of my prenatal care, and then finally leading up to delivery they were unbelievably helpful, patient, and knowledgeable —
letting me know that giving birth at Burdett Birth Center would give me just what I needed at that time.
My baby was born in December 2020, so Covid was obviously still a major concern, and the week he was due there were
back-to-back snow storms dumping feet of snow.

I cannot tell you the comfort I felt knowing the hospital was close by — literally my family and I talked about the fact that I
could be dragged there in a sled if necessary!

And knowing that I would be in a birth center, in my own room, which kept me apart from the rest of the hospital, gave me
such a sense of relief.

In addition to proximity of care, Burdett provides a precious environment for birthing people and their families.
The comfort of being in one space from labor through delivery and recovery.

The power of the voices and views of the midwives dominating in that space.

Knowing that emergency care is available if it is needed, but that if it is not that interventions will be used sparingly and
respectfully.

Giving birth is one of the scariest, most physically taxing, and also most monumental treasured moments of a birthing
person’s life — and Burdett respects all sides of that experience.

Ultimately my first baby was late, the snow had melted, and I had to be induced, and so I was in the hospital for several
days before giving birth and a few days following.

And I cannot overstate this — to be in one space for the preparation, labor, delivery, and recovery was such a gift. At
Burdett, with the nurses, staff, and midwives there, I felt comfortable, safe, supported, calm, and respected.

In addition to my midwife, I am forever grateful to the rest of the staff at Burdett. I want to express the specific points of
gratitude I carry in my heart to this day, two and a half years later as I plan to have my second baby at Burdett.

Thanks to Mandy for regulating the labor arc and for the double hip squeeze which made unbearable pain turn bearable.
Thanks to Mary for patiently and clearly communicating information from when we arrived, throughout the whole process,
and preparing us to leave the hospital. Thanks to Helen for support with lactation and for helping me to trust my own
process of discovery with the baby. Thanks to Cathy and Cate for good strong nighttime swaddles and much-needed
emotional support, and for encouraging me to trust myself. Thanks to Angie for taking pictures during and after delivery.
Thanks to Bonnie for direct, calm, and supportive coaching through pushing the baby out — her voice in my head made it
feel so possible and clear what I had to do. And thanks to countless other nurses, techs, servers, and others who made our
stay a pleasant, comfortable, and well-supported one. They are an amazing team, who communicate well with each other
and with patients, and I would strongly the Burdett Birth Center for any expecting mother.

I am due with my second child in October and I planned without a second thought to deliver at Burdett and so the
announcement of it closing came as unsettling news.

For myself personally of course, but also for the many birthing people who benefit from the environment it provides.
The fact that we live in a city and would have to travel 20-30 minutes — in labor, by the way — to have a baby is crazy to me.
Thankfully I have transportation and support to make that journey, but plenty of others do not, and many of those without
transportation are people who already have statistically poor medical outcomes. This decision will concretely harm
women already underserved by the system at large.

I have heard that this is motivated by financial concerns, but this is not just a business decision. Real people in our
community will be harmed and may even lose their lives. Babies may not survive or may have lifelong problems because of
this. This is not hyperbole — this is what can happen when birthing people cannot get to care in time, or don’t receive the
kind of care they need.

I am so grateful to have had this experience — and this space must be preserved. We need to protect this resource,
protect the experience, health, and lives of birthing people, and protect the babies that are born into the loving, talented,
professional hands of these midwives.

Ashley Saupp / Troy, New York

Good afternoon, Thank you to the Attorney General’s office for holding this public hearing. My name is Ashley Saupp and
I’m the administrative director at The Albany Social Justice Center and one of the organizers with the Save Burdett Birth
Center Coalition. I live in Troy and gave birth to my son Ben at Burdett Birth Center just six months ago. I was nearly two weeks
past my due date, something that often happens in first pregnancies and my team of midwives at Capital Region Midwifery
just across the street from Burdett were in unanimous support in my decision to let nature take its course — something
that’s considered best practice. Because deliveries have turned into an expediency model over a care-first one, other area
hospitals would likely have pressured me to induce at 40 weeks, before my baby was ready. Burdett respected my birth
plan and we waited.

When it became medically recommended that I be induced, it was the nursing staff at Burdett who were waiting for me and
my husband, ready and welcoming to two nervous first-time parents. While I had a trying labor, lasting 36 hours, it was the
nurses like Lade who held me close; Pam, our midwife who encouraged me to push “just a few more pushes;" Dr. Clements,
who helped Ben arrive safely; and Danielle, a nurse who treated me so tenderly. There were many others but these are the
collection of birth professionals who had a critical role in helping me safely deliver my son and for that I will forever be in
their debt.

My connection to Burdett is a personal one but I am motivated to be here today because I know Burdett is an essential
resource to so many in our community, including medically underserved families. It would be unconscionable to deny them
this incredible maternity care, right in our own city of Troy.
Our coalition knew early on that the closure of Burdett would have a devastating impact and we were not confident that
the health equity impact assessment commissioned by St. Peter’s would adequately reflect that. So, we set out to prove
the real impact by doing a first-ever community-led health equity impact assessment that we will be submitting to the NYS
Department of Health later this week.

Through an online survey, interviews with people who have given birth at Burdett and key stakeholders, outreach at the
Troy farmer’s market, along with other community events and hosting our own community forum attended by more than
200 people, gathering of demographic data and consultations with public health experts, the coalition carefully assessed
the likely impact on health equity and on medically underserved people in the Burdett service area.

Representatives of multiple medically underserved groups — women, racial and ethnic minorities, LGBTQ+ people, people
with low incomes, Medicaid-insured patients, rural residents, and people with disabilities — all told the coalition that closure
of the Burdett Birth Center would negatively affect their ability to obtain timely, quality obstetric care. The assessment
found that 55 percent of Burdett’s patients are Medicaid insured, as compared to 33 percent at St. Peter’s Hospital, and
these people depend on having labor and delivery within convenient reach in Troy. The travel and timing issues uncovered
by the community-led assessment are significant — longer trips to labor-and-delivery units from Troy, especially for the many
low-income pregnant patients who do not have cars and face either hour-long bus trips to Albany or Uber/Lyft trips of $40
or more that they cannot afford. Medi-cabs must be scheduled and cannot be used for pregnancy emergencies. The Troy
Fire Department’s EMS service only has four ambulances and is already overburdened, as you will hear later in this hearing.
Residents of Rensselaer County’s more rural areas would face car trips of an hour or more if they have private vehicles, and
have no access to buses or to Uber/Lyft pickups. We are especially worried about the risks for people suffering pregnancy
emergencies that require immediate care. And, even if patients suffering a pregnancy “scare” could manage to reach a
hospital in Albany, they might not be able to get back home that same night if they were stabilized and discharged.
Even if the transportation challenges could somehow be solved — and we found no evidence they could — the removal of the
only labor-and-delivery unit in Rensselaer County would also mean the elimination of the only midwife-led, low-intervention
birthing site in the Capital District. Women and LGBTQ+ people from Rensselaer County and other locations across the
Capital District –— especially those who are Black and Latinx — said they were particularly dismayed at the prospect of losing
a labor-and-delivery service that they have experienced as culturally competent, respectful, and patient centered.

Data shared with our coalition show that in 2022, 20.77 precent of Black people giving birth at Burdett had a cesarean delivery,
compared to 41.83 percent at St. Peter’s Hospital, which is one of the two nearest alternative birthing locations for Rensselaer
County residents. The state average for cesarean delivery is 28.9 percent. Since the NYSDOH has prioritized safe reductions in the
rate of cesarean births as a part of improving overall maternal health care in New York, why close the birthing site with the
lowest c-section rate in the Capital District?

In conclusion, our coalition believes that our extensive outreach and assessment of the needs of medically underserved
people in Rensselaer County, as well as the outcry of dismay at the proposed closure, have proven without a doubt that this
closure would have life-threatening consequences for the birthing community of Rensselaer County and the surrounding
Capital Region. Based on our research, the closure of the Burdett Birth Center will not improve access to services and health
care, will only harm health equity, and will further the health-disparity gap for the medically underserved communities of
Rensselaer County.

Sophinnian Rich / Albany, New York

Rensselaer has only one birth center. Closing it will reduce access to resources for birthing people in a county already
lacking support for its most vulnerable populations.

Kathryn Cooke / Troy, New York

Thank you to the Attorney General James for holding the public hearing to hear about the proposed closure of the Burdett
Birth Center. My name is Kathryn Cooke, and I am a resident of Troy, mother of three and most importantly, a public health
professional and a member of the Save Burdett Birth Center Coalition.

I have dedicated my career to improving the health outcomes of New Yorkers, especially our most vulnerable populations
like our mothers and babies. Being called to public health is much like any calling except we see health concerns on a
community and population level. We see the bigger picture of complex problems like maternal and infant health outcomes
and acknowledge it takes bigger and better fixes to impact change. It takes innovation, patience, and a lot of courage to
fight institutional knowledge and the status quo. But we can make differences.

New York is amid a maternal health crisis. We rank 23rd among the U.S. states for maternal mortality. Based upon 2018
data, Black, non-Hispanic people who give birth were five times more likely to die of a pregnancy-related cause than were
White, non-Hispanic people. Among pregnancy-related deaths in 2018, discrimination contributed to 46.3% of deaths. We
do not have to imagine a world where almost 50% of maternal deaths in this state are caused by racism, discrimination,
and implicit bias. This is why public health professionals have a moral obligation to care for our mothers and babies,
especially those facing an ever-uphill battle to receive quality of care due to structural racism and implicit bias in our
health care system. Closing the Burdett Birth Center would have a negative health impact on health equity for medically
underserved women in Rensselaer County and surrounding areas. It is estimated that almost 900 babies are born each
year at BBC. Not only would these families need to obtain maternity care outside of Rensselaer County these are the same
families that would access to vital care at a time when obstetrical emergencies can be the difference between life and
death.

We live in a state that values reproductive justice and improving maternal health outcomes. The New York State
Department of Health supports the New York State Perinatal Quality Collaborative, the New York State Birth Equity
Improvement Project, and the New York State Maternal Mortality Review Initiative. All these initiatives in theory promote
maternal health. But what weight do these initiatives hold when we allow the closure of a birthing hospital that embodies
these programs? It tells our mothers their prenatal, delivery and postpartum care is not important. It is a fundamental
human right that all women, regardless of their race, ethnicity, income, or insurance status have healthy pregnancies,
birth their babies with high-quality, trauma-informed providers and watch those babies grow. It is on us, the public health
professionals, to ensure our state focus on reducing maternal morbidity and mortality but also assuring our hospital
systems are available and open to provide quality care. Without birthing hospitals, initiatives are worthless.

I firmly believe the Save Burdett Birthing Center’s Health Equity Impact Assessment will demonstrate that by closing the
Burdett Birth Center, mothers and babies will not have improved access to services and health care, will not have improved
health equity and that health disparities will continue to persist. I strongly encourage the New York State Department of
Health to reject this closure and work with Trinity Health and St. Peter’s Health Partners to maintain the Burdett Birth Center
and uphold our mission to protect, improve, and promote the health, productivity, and well-being of all New Yorkers. Thank
you.

Good afternoon, Attorney General James, elected officials, and community members. Thank you to the Attorney General’s
office for holding this public hearing. My name is Kathryn Cooke, and I am a resident of Troy, mother of three, public health
professional, and a member of the Save Burdett Birth Center Coalition. I will be presenting on why and how the Coalition
conducted its own Health Equity Impact Assessment.

St. Peter’s Health Partners (SPHP) announced their intentions to close the Burdett Birth Center (BBC) on June 13th and began
the Certificate of Need (CON) process with the New York State Department of Health on June 20th. This was two days
before the brand-new, New York State Health Equity Impact Assessment (HEIA) law went into effect.

By July 9th, SPHP agrees under mounting pressure from the community and elected officials to voluntarily conduct a
health equity impact assessment and, by mid-August, selected the Chartis Center for Health Equity & Belonging as
their independent assessor. While Chartis maintains an office in New York City, they are not a local consulting firm that
understands the complex dynamics of upstate New York living such as our rural communities, transportation barriers, and
health care systems.

As part of the health equity impact assessment, Chartis was required to conduct “meaningful engagement” with
stakeholders and most affected community members. Chartis launched their QR code survey for stakeholders right before
the coalition’s public forum on August 23rd. Immediately, the coalition identified multiple concerns with the Chartis survey:

• The survey itself was not widely distributed among community groups and had a short time frame for completion.
• The survey was not available in any language besides English and relied upon individuals having access to
  technology to submit their comments.
• Originally, the survey did not ask which medically underserved population the respondent belongs to.
• It suddenly closed before the deadline, leaving individuals unable to submit comments.
• [It] Used character limits in all the boxes except question #10. Question #10 must be submitted to the New York State
  Department of Health. This question has a 250-character limit and the coalition expressed concerns that eliminating
  the characters from this question would exclude individual’s comments if they accidentally went over the character limit.

While Chartis eventually reopened the survey, it caused confusion among community members and only increased the
coalition’s mistrust in their capabilities to conduct this assessment.

In response to a lack of confidence with SPHP and Chartis, the coalition decided to conduct their own independent health
equity impact assessment. Utilizing the New York State Department of Health instructions, the coalition identified the
following medically underserved groups they would focus their efforts: low-income people, racial and ethnic minorities,
immigrants, women (birthing people), lesbian, gay, bisexual, transgender persons, people with disabilities, persons living in
rural areas, and people who are eligible for or receive public health benefits.

The first step in the assessment was to meaningfully engage with birthing mothers in Burdett’s service area, which is
primarily Rensselaer County. The coalition members, through their own social networks and the Save Burdett Birthing
Center website, put out a call for individuals to share their contact information. The survey sought out individuals who live
in Troy and/or Rensselaer County, gave birth at Burdett or planned to give birth at Burdett, and which medical underserved
group they represented. The survey also asked the impact of the proposed closure and if they would consent to an
interview with a member of the coalition.

In addition, the coalition created a QR code that was distributed across multiple social media platforms, which led to the
coalition website and survey. To generate more awareness, the coalition tabled weekly at the Troy Farmers Market. This
provided an opportunity for the public to engage with coalition members and learn more about the proposed closure, sign the coalition petition and purchase Midwives Save Lives swag. While we cannot quantitate the number of individuals
spoken to at the Farmers Market, it certainly helped with publicity and education of the public.

As of early September, the survey has generated more than 139 responses from individuals who have given birth at Burdett
and 16 interviews have been conducted. As a coalition, we were able to interview women from each medically underserved
community. These interviews will be included in the final health equity impact assessment that will be submitted to the New
York State Department of Health.

Every single interview reflected the same common thread: The Burdett Birth Center provides high-quality, patient-centered,
trauma-informed care. The interviews emphasized that, without the Burdett Birth Center, women would be forced to birth
at hospitals they do not want and do not like and where they do not trust those medical providers. Lastly, many interviews
included stories of women facing obstetrical emergencies that may have led to loss of life for the mother or baby if they had
to travel farther to another birthing hospital. I will end with the question, at what point do hospital profits become more
valuable than the lives of our mothers?

Resident / Troy, New York

I have worked in the emergency department at Samaritan for many years. We see many pregnant people on a daily basis
and having Burdett upstairs in an invaluable resource. We see premature babies who are delivered in either the field or in
the department and Burdett staff is bedside with just a call. I am not saying that my fellow coworkers in the emergency
department are not capable, but there are specialists for a reason. If Burdett closes, I cannot stress this enough, there will
be PREVENTABLE deaths that will occur. Corporations should not be deciding anything that will affect the public health of
New Yorkers. Trinity Health only has one thing in mind and that is profit.

Lily Mercogliano Easton / Albany, New York

Dear Attorney General James,

It is with a lot [of] emotions that I share this testimony. I have been fortunate to experience three seamless and well-supported
live births and am happily raising my three children, now ages 10, seven, and three in Albany — where I myself grew up. All of my kids
were born with the support of midwives and the midwifery model was a transformative experience for our entire family.

As a South End resident in Albany, I am reminded every season, and sometimes more often, how difficult the birthing
process is for people in my community — especially Black and brown women, and those who are poor. Midwives save lives
and this model of care must be a recognized and valued part of our birth choices in this region. Closing Burdett goes
completely counter to the urgent need to drastically improve the dismal rates of mother and infant mortality in the South
End.

Having a strong midwifery-led birth center in our region not only provides a viable birth option for those that can choose
Burdett, but it also provides a professional model and case study for this entire area when it comes to the basic levels of
care all women and birthing people should have access to.

Lastly, as an Albany mother and the daughter of a practicing midwife with over 40 years of experience, I know first hand
the strain that this region is already under when it comes to providing adequate pregnancy and birth health care. People
are laboring in triage rooms. Nurses are completely overworked. How can we possibly handle the closure of a setting that is
currently seeing over 800 babies be born? The results of closing Burdett are sure to hit the most marginalized in the Capital
Region the hardest.

Closing Burdett would be a massive step backwards and is unconscionable. St. Peter’s Health Partners must determine
another option and keep the center open.

Resident / Averill Park, New York

It is an outrage that closure of Burdett is even being considered, especially since it will deeply affect a vulnerable and
already under served population. Often people from Rensselaer County do not own a vehicle. So many citizens live in a
rural area which does not have public transportation. In addition, this closure would affect everyone in our county with
emergency rooms being even more overcrowded than they already are now. In addition, emergency vehicles and first
responders (already in short supply in some cases) would be deployed more frequently and thus less available to all of us.
A family member received care at Burdett following a miscarriage and feels strongly that the birth center should not be
closed. We agree, for so many reasons!

Kathleen Keenan / Cropseyville, New York

This is an important facility to those in Rensselaer County. With St. Mary’s already closed, one needs to have something
close by when giving birth. Also, hospitals are already crowded and if this facility closes other hospitals will be taking on
more responsibilities, which can affect the care a patient is given.

Resident / Troy, New York

I strongly oppose the closure of Burdett. Burdett offers a midwife-led, patient-centered model of care that is not available
at any other area hospital. It is also the only labor ward in Rensselaer County. Its closure would deprive area residents of a
vital service — a supportive place to bring new life into the world!

Resident / Delmar, New York

The maternal health issue in the United States can be solved. It takes valuing people over bottom lines. It takes a willingness
to innovate instead of shuttering a facility. It takes people putting women and birthing people first and allowing them to
have the kind of birth they need and deserve so that it’s safe and driven by their desire. Midwifery care needs to be woven
into the ecosystem of U.S. healthcare. Parents must have the right to choose where, how, and from whom to receive
maternity care. This fundamental principle of reproductive justice requires directed attention, investment, and strategic
reform. This will not be a lone incident but another step in a series of limited health care choices and removing accessible
reproductive healthcare. There is more than ample state and federal data to show that the people affected are Black and
brown birthing people, with a mortality rate of three to four times that of their white counterparts.

Burdett Birth Center offers physiologic, midwifery-led birth and obstetrics care by physicians and surgeons. This
collaborative care model is unique to Burdett Center in the Capital Region. Closing the facility means families receive less
care, and choice is removed from the available options. Closure of collaborative models of care will pose severe risks to
pregnant people and their children and contribute to a cycle of unacceptable health disparities. The United States is the
only industrialized nation that does not have midwifery care integrated into women’s health care, and we have the worst
outcomes. We’re asking doctors to do a job they’re not trained to do. Midwives and physicians have complementary skills.
Physicians are superb at dealing with surgery and medical complications and medically complicated people, and midwives
specialize in physiologic birth and relationship-based care.

Midwifery care is associated with a lower risk of cesarean birth and other interventions versus care provided by
obstetricians. It is likely to lower costs, which could save the United States $340 million per year. When was the last time you
heard a pediatric unit close? A cancer unit close? A gastric surgery unit close? An orthopedic unit close?

Why is maternity care lesser than any other health care need? The struggles of maternity care in the U.S. always come
back to money. Saint Peter’s has claimed that they are closing due to not making enough money. They are mourning their
smaller bonuses and paychecks instead of celebrating having a facility with the best maternal health outcomes in the
region. Midwifery care is associated with a lower risk of cesarean birth and other interventions versus care provided by
obstetricians and is therefore cost-saving for the public, and means profit margins shrink for hospitals.

The CDC recently reported that four out of five pregnancy-related deaths are preventable and that 80% of pregnancy-related
deaths, which can occur up to one year after delivery, are preventable. Improving maternal health requires an approach that
starts with the health care system, improves access to quality care, and makes resources more responsive to their needs.
Causes of death vary widely, with death from hemorrhage most likely during pregnancy and at the time of birth and
deaths from heart conditions and mental health–related conditions (including substance use and suicide) most common in
the postpartum period. More than half of recorded maternal deaths occur after the day of birth. How will closing the only
facility with trained obstetric staff in the county help these horrific outcomes? I do not understand how making a pregnant [person]
drive 30 minutes to an hour will help these outcomes. How does ending prepared childbirth education classes in Rensselaer
County help families have a better birth with informed consent? How does closing lactation services at Burdett Birth
Center help achieve the positive breastfeeding rates set forth by NYS DOH, the CDC’s Healthy People 2030 goal? How will
the neighboring community hospitals prioritize emergency services (with qualified staff ready to respond to an obstetric
emergency that WILL drop in) over any other need?

Residents of Rensselaer County and supporters of Burdett Centers are outraged and sad. We are using our voice not about
Troy and Rensselaer County becoming a maternity desert — deserts are natural occurrences. This is deliberate, and its
outcomes will harm and destroy families, contributing to maternity apartheid. Please intervene and help us create a system
of care where families not only survive but thrive.

Resident / East Chatham, New York

Burdett Birthing Center needs to remain open to give expectant parents the optimal experience and care options for their
families. Please do not close this facility

Statement from Bishop Edward B. Scharfenberger, Roman Catholic Diocese of Albany

I do have serious concerns about the impact the closure of the Burdett Birth Center in Troy could have on the community.
Nothing is more central to the Catholic healthcare mission than supporting life and all of those who bring it into the world.
Since sharing my concerns in July, I have been asked if I would be interested in “joining the fight” to save Burdett. I would
rather suggest a coming together of all parties, to do what is best for the people in need.

If money can be found to keep Burdett operating, great. If not, let’s work together to find solutions. The Catholic Church has
a program called Walking with Moms in need. I’ve asked the head of our Taconic Vicariate, which includes our Rensselaer
County parishes, to work with parish leaders to identify services that are available, needs that exist and to brainstorm steps
we, as a church, can take to help.

This hearing will hopefully shed light on specific needs. Let’s take that information and, instead of fighting each other for
what we want, let’s also listen to each other, and work together to find solutions that can work for all.

Ruth Pelham / Albany, New York

My name is Ruth Pelham. I have lived in the Capital Region for 50 years and for 45 of those precious years I have
been privileged to come to know thousands of low-income women, children, and families through my work as the founder
and artistic and executive director of the not-for-profit organization, Music Mobile.

Through Music Mobile, I have had the privilege of gathering people together at public housing sites; in parks and
playgrounds; on street corners; in vacant lots; and in schools, libraries, and community centers, to sing; [to] do cooperative
activities that build bonds of friendship and trust; and to learn about dignity and self-respect, about standing up for others
and for oneself, and to do what we each can to assure that everyone has equal access to the necessities of what is needed
to be alive and flourish in these very challenging times.

Of the thousands of people who have attended Music Mobile programs and who are part of the extensive Music Mobile
family, I’m sure that many dozens of women in Rensselaer County and surrounding areas have given birth and received
outstanding and exemplary maternity and medical services at the Burdett Birth Center, which I’m here to say, must remain
open. I’m also sure that many dozens of children who are part of the Music Mobile family were safely born and received
outstanding and loving care at the Burdett Birth Center, which I’m here to again say, must remain open.

In my capacity as what people often refer to me as, “The Music Mobile Lady,” I have nurtured and loved and taught and
raised up tens of thousands of children, many of whom, and many of whose parents, assuredly, did not grow up with
privilege.

What does privilege get you? Privilege gets you choices. Abundant choices. Choices of what food your parents can buy
to make sure you’re healthy and thriving, what school you’ll go to make sure you are well educated and prepared to live
well and work using the best of what you have to offer, what kind of housing you live in to make sure that you’re safe and
protected, and what doctor’s you’ll go to and what ease is involved in getting to those doctors, to make sure you are
healthy in body, mind, and spirit.

How dare it to be so that the Burdett Birth Center is now absurdly and immorally targeted to close because it allegedly
doesn’t earn the money that the powers that be say is needed to justify its existence. I have read that the services at the
Burdett Birth Center are so effective and successful that the “need” for high-priced, profit-making, and often intrusive and
risky procedures are lower at the Burdett Birth Center than at other hospitals in the area. How cruelly ironic it is that its
success, whose profits show up in high numbers of healthy human lives perhaps rather than in dollars, is part of why the
Burdett Birth Center is now under the fire of closure.

If I was a 27-year-old woman living in Troy, pregnant with twins, already the single mother of a two-year-old child with
congenital heart and mobility limitations, and I was working two jobs and was also working on a two-year degree at
Hudson Valley Community College to be a lab technician, I can’t imagine the mental and financial pressure that would
pound on me if I had to travel to Albany or Schenectady for maternal services, and not even to get the unique kind of midwifery-based services that I would have wanted to have, and could have had, from the Burdett Birth Center, if it were open.

The Burdett Birth Center must, must, must remain open, and the powers that be, who I’m sure are in fact made up of
individuals with caring and compassionate hearts and who are wise enough to know apart from their business pressures,
that closing the center is wrong, cruel, and immoral. The decision makers must not let money and profit be the determining
factor of the future of the urgently needed, proven highly successful, and much beloved Burdett Birth Center. Of that, I and
thousands of us, are sure and that’s why we are speaking here today.

As Pete Seeger’s wonderful song “Where Have All the Flowers Gone” says, “When will we ever learn? When will we ever
learn?”

Yes, when we will ever learn? It must be now because we are out of time and decisions must be made now for the greater
good upon which our individual and collective futures depend. Keep the Burdett Birth Center open. It is imperative and right
to do so. Thank you very much.

Resident / Averill Park, New York

Our daughter-in-law recently suffered a miscarriage and chose Burdett and its excellent staff and care. She hopes — as do
many prospective Rensselaer County moms — to give birth at Burdett. In addition, we are personal friends with former
staff at Burdett who can attest to the professionalism and quality of care there. Moreover, as residents of central Rensselaer
County, which is only served by volunteer EMS, travel times to St. Peter’s Hospital in Albany for emergency care is 50% longer
than to Samaritan (Burdett) and we fear that the closure of Burdett is just the beginning of St. Peter’s Health Partners (SPHP)
financially driven consolidation efforts. Unless Trinity Health and SPHP are planning to build a new hospital in Albany, the
loss of services at Samaritan and Burdett can only result in reduced services and quality of care for all Rensselaer County
residents. Even if emergency services at Samaritan/Burdett and Memorial Hospital (also part of the SPHP system) remain
at current operating levels, the loss of the Burdett Birthing Center at Samaritan will unquestionably place additional stress
and workload on these services — again, unless SPHP and Trinity plan to make major new investments in these areas to
make up the difference. Please consider this as well: The Burdett Birthing Center is the SAFEST place for a woman to have
a baby in the Capital District and yet SPHP (and its parent Michigan-based Trinity Health) want to close it. How does that
make sense? By definition, the planned closure of Burdett will result in greater risks to the health — and lives — of women and
babies. In the past year, SPHP/Trinity has engaged in a billing and reimbursement dispute with CDPHP jeopardizing the
health (and lives) of 400,000 Capital District residents and last June SPHP/Trinity Health closed several on-call (Well Now)
clinics they just opened in 2019 — for which they blamed the loss of pandemic-related business. These clinics presumably
made financial sense to SPHP before the pandemic but not after?. SPHP and Michigan-based Trinity Health have lost their
way and have abandoned their health care mission. Burdett Birthing Center, which has a significantly lower “intervention
rate” than St Peter’s Hospital maternity services and serves a higher proportion of low-income women, and is therefore less
“profitable.” Health care should be about health: Burdett must remain open.

Liz Addeo / Albany, New York

At a midwife-led birth center as unique as Burdett, families have all the choices available in birth, from catching your own
baby at your unmediated water birth to having a scheduled or emergency C-section, and everything in between.

The staff of Burdett respects all birth choices.

The midwives give expert evidence-based medical advice while also trusting birth and trusting their patients.

They understand that birth is best when it’s left undisturbed and only should be actively managed when there is true
medical indication.

They collaborate with excellent OBs who align with these values. The nurses that support these midwives and OBs truly
understand this collaborative model of care, which lends to the low intervention culture at the hospital.

And that is the biggest reason why the overall C-section rate at Burdett is so much lower than the state averages and those
of local area hospitals. The 2022 C-section rate for first-time moms having one, head-down baby for all of Burdett Birth
Center was 15%. For Capital Region Midwifery specifically, the rate for was 8.8%.

To compare, the 2022 rate for St. Peter’s was 36% and for Albany Med it was 33.2%. For all of New York State, it was 28.9%
To say it more simply, midwives save lives.

Closing the birth center has wider implications for our health care system. It sends a message that personalized, family-centered
care is not a priority to St Peter’s, and it perpetuates a one-size-fits-all approach that fails to acknowledge the
unique needs and desires of families.

Burdett is an integral part of our community, providing essential services that empower families, improving maternal and
infant health outcomes, and contributing to the overall well-being of our citizens.

We need to think about the families who rely on our birth center, the people who deserve a choice in their birthing
experience, and the community that thrives when such vital resources are preserved.

Starletta Renee Washington / Troy, New York

The proposed closure of Burdett Birth Center is an outrage. It’s despicable and will literally threaten the lives of women and
babies. St. Peter’s Health Partners and Trinity Health’s decision to put profits over people is an assault on women’s rights. It’s
a direct example of capitalist greed LITERALLY KILLING US.

As a Black woman in America I am sickened daily by the endless stripping away of rights. The anniversary of the Dobbs
decision, the overturning of Affirmative Action, anti-LGBTQ legislation – who is our country for? As a Black mother, and a
Black leader of YWCA of the Greater Capital Region, an organization dedicated to eliminating racism and empowering
women – I cannot bear to see the loss of this critical community resource. We should be eliminating barriers to care and
increasing access to it.

YWCA of the Greater Capital Region stands with the families that need care and the nurses, doulas, midwives, and staff
who provide it. Black, non-Hispanic women were five times more likely to die of pregnancy-related causes than White, non-
Hispanic women. Rensselaer County mother’s deserve access to a maternity unit that offers choice, is culturally competent,
and ACCESSIBLE.

Future residents of our city deserve to say they were born in Troy. But beyond that – keeping this resource in our community
will SAVE LIVES.

In June a spokesperson for St. Peter’s Health Partners, was asked which community stakeholders the hospital had consulted
about the proposed closure. Among the questionable list of organizations, they stated that they had talked to YWCA. This
was unequivocally false. They did not consult us.

We urge the New York State Department of Health, Governor Hochul, and Attorney General Letitia James to take all of these
points into consideration and please KEEP BURDETT OPEN.

Assemblymember John T. McDonald III, RPh / Albany, New York

I would like to express my sincerest appreciation to NYS Attorney General Letitia James for providing the public the
opportunity to be heard on the proposal by Trinity Health System to eliminate birth services at the Burdett Birth Center
(BBC) located at Samaritan Hospital in Troy, Rensselaer County. As many observers in the Capital Region have noted, this
is unprecedented and to me speaks to the gravity of the situation at hand. In my 23 plus years in public office, I have never
seen an issue that has alienated individuals from one end of the spectrum to the other and many in between. No matter the
political party status or socioeconomic status, the opposition has been widespread throughout the community.

The BBC is currently run by St Peters Health Partners (SPHP) which is affiliated with Trinity Health System which is in Livonia,
Michigan and operates St Joseph’s Hospital in Syracuse, St Peter’s Hospital in Albany, and many other health centers
throughout the country. I may add here at this time that neither SPHP nor Trinity nor Chartis, the consultant hired by Trinity,
has held any type of forum such as this one to receive public input. In fact, the survey issued by Chartis and Trinity was
fraught with so many issues that Mayor Patrick Madden and I sent a letter to the New York State Department of Health
(NYSDOH) Commissioner to express our concerns.

There is much to be said about this abrupt decision by Trinity Health and like many, I have voiced these concerns publicly
just like the many others who will today. I am choosing for this hearing to focus on two main concerns – finding a partner
for future birth services in Rensselaer County if closure cannot be avoided and ensuring that the community can trust that
birth services will be provided in Rensselaer County with a partner who is fully committed to providing those services. SPHP
is an organization that I have been affiliated with and have personally and professionally supported for my entire 33-year
professional career in health care and public service. As I have often said, I never would have thought that we would be
debating a decision to terminate maternity services in our region with SPHP. This decision by SPHP and the process thus far
has eroded the long-standing goodwill, trust, and relationship that SPHP has had with our residents, the hard-working staff,
and many visitors and supporters of SPHP.

It is critical to know that this is not just a Troy issue or a Rensselaer County issue but a Washington, Columbia, and Albany
County issue as well. This is also an issue that especially impacts those in underserved areas including rural and urban
areas and particularly those in the Black and brown communities – communities that are experiencing high-risk outcomes
overall in health care and are communities that have above-average maternal mortality rates. It is well known that over
50% of the births at the BBC were midwife-delivered catches from 2019-2022 of which there was a slight increase followed
by a decrease in births according to data provided by BBC. I state this because BBC is well known for its focus on midwife
services and as many know this is a trusted service. As migration patterns continue to evolve, this service demand will only
increase as midwife-led births are the preferred option in other countries due to the long-standing trusting relationship
between midwife and patient.

Additionally, midwife-led births also lead to fewer surgeries and caesarean births. Avoiding a surgery when there is a
delivery without complication is safer in most instances for the mom and leads to better short and long-term health
outcomes as well. It is well known that not all births can be midwife-assisted; however, I think we all can agree that the
route that is less invasive and less costly than surgery is in the best interest of the mother and child. Based on these facts,
there is unfortunately a perception in the community that this decision is based on a lack of profit margin for midwife-led
deliveries, rather than being based on financial sustainability. I am not here to argue one way or another on that point, but
it is one that has been raised to me. I contend that the healthy birth of a child and the health of a mother are not meant to
generate profits, but the focus should be on financial sustainability and quite honestly if an entity must have a loss leader, I
cannot think of a better purpose for a Catholic institution than the birth of a child.

The lack of consultation by SPHP with the BBC midwives before making this decision to close has given the appearance
that the overall approach by SPHP is to decrease emphasis on midwife services in the future even though national data has
shown this will lead to more surgical delivered births and increased risks. Additionally, it is well documented that surgical
deliveries are reimbursed at a higher rate. As a longtime business owner, I certainly understand the importance of making
sound financial decisions but firmly believe that some things are more important than profit, and if financial barriers exist
to providing these services, we need to consider other solutions. Finally, it is important to note that as this process plays
out, New YorkSDOH has been receiving public comments as NYS is embarking on establishing regulations for midwife-led birth
centers in NYS to bring the state in line with 40 other states in the country. As NYS is moving to provide a preferred, safe,
and proven method of delivery for mother and child, SPHP is diminishing that service in the Capital Region. This should be
evaluated closely by the NYS AG and NYS DOH before any decisions are made on the Certificate of Need under review.
Understanding that we do need to consider long-term financial viability, and not looking at this issue from profitability, we
need to be solution-oriented as how to we can preserve these important services.

I will agree with SPHP leadership that the past few years have been challenging financially and the staffing issues are
significant. Because I understand these issues, my legislative colleagues and I fought for and secured an across-the-board
7% increase in Medicaid reimbursement for all hospitals as it was clearly stated by SPHP that they had a high (>50%)
Medicaid payer mix. Additionally, it is public knowledge that our federal partners were able to reverse a decades-long
trend of underpayment for Medicare payments (a major thrust of work in the hospitals) to a much more sustainable
system that is a 37-point swing in reimbursement rates for all hospitals which in the words of leadership at SPHP “will lead
to $100 million increase in revenue to the overall system and allow us to make our margins.” I am glad that revenue and
reimbursement are improving and believe this should help keep BBC’s doors open.

There is a difference between a decision being made for financial reasons and a decision that is made based on a lack of
profit. I am a for-profit provider who has worked in health care for over 40 years, but I understand that we do not let profit
stand in the way of providing care for the greatest in need. Unfortunately for SPHP, whose publicly stated mission is “to
serve together in the spirit of the gospel as a compassionate and transforming healing presence within our communities,”
this closure decision does not align with that mission and is eroding the relationship that SPHP has had in the Capital
Region.

As a health care professional, elected official, father, and Catholic, I believe we absolutely must retain birthing services
in Rensselaer County, and if we do not it will have a detrimental impact on our residents and a cascade of negative
consequences. SPHP’s actions related to proposing to close BBC are not consistent with the mission stated and as is often
the case, actions speak louder than words.

As NYS AG, your role in oversight of nonprofits and hospitals is critical to the well-being of all residents of New York. In as
much as these entities have valid complaints regarding reimbursement, like any other provider, they are supported with
public funds not only related to operations but also with large capital grants from NYS. Additionally, the organizations are
afforded tax-exempt status because of their mission to provide care. However, when entities stray from that mission then it
is critical for the NYS AG to closely scrutinize and verify that the public benefit is being served.

My hope is that SPHP will rethink this decision and show the community that “partner” is not just a part of their name but a
promise to the community to be fulfilled. I remain committed to finding a long-term partner to retain birth services in the
community.

Once again, to NYS AG Tish James – Thank You for your interest and leadership. It is comforting to know that the residents
are being heard.

Anne Weaver / Troy, New York

As a life long member of Rensselaer County and City of Troy it would be an injustice for the Birthing Center to close.
The members of this community need health services they can depend upon for consistency and follow through with
reproductive issues. Without the Center people in Rensselaer County will have difficulties finding and getting to other
hospitals in this area. There has always been maternity wards, birthing centers or other reproductive services available to
people in this County. Please consider other solutions to this issue before rendering your decision.

Sara Couch / Albany, New York

Testimony for AGs Public Hearing:

Good afternoon, my name is Sara Couch and I am a Regional Healthcare Advocate for the Healthcare Education Project
and I have been a community organizer for almost 20 years.
Concerned that the assessment commissioned by St. Peter’s Health Partners might not be robust and thorough in its
engagement with the affected community, Save Burdett Birthing Center Coalition (Coalition) members decided to conduct
their own community-led independent Health Equity Impact Assessment (HEIA). The Coalition knew they had to engage
with individuals in Burdett’s service area, which is primarily Rensselaer County and Albany County communities just across
the Hudson River. Based upon the criteria provided by the New York State Department of Health (NYSDOH), Instructions
for Health Equity Impact Assessment Template, the Coalition prioritized engaging individuals who utilized Burdett to birth
their babies and who represent one of the medically underserved groups spelled out in the Health Equity law. These are
low-income people, racial and ethnic minorities, immigrants, women (birthing people), lesbian, gay, bisexual, transgender
persons, queer people, people with disabilities, persons living in rural areas and people who are eligible for or receive public
health benefits such as Medicaid.

Coalition members developed and circulated an on-line survey seeking the experiences and views of medically-underserved
people who have utilized Burdett and the organizations that serve these groups or people and/or refer people
to Burdett. The survey asked the impact of the proposed closure and if they would consent to an interview with a member
of the Coalition. The Coalition created a QR code that was distributed across multiple social media platforms which led
to the Coalition website and survey. To generate more awareness, the Coalition tabled weekly at the Troy Farmers Market
in downtown Troy. This provided an opportunity for the public to engage with Coalition members and learn more about
the proposed closure. As of early September, the survey has generated more than 151 responses from individuals who have
given birth at Burdett and from stakeholder organizations. In-depth interviews have been conducted with two dozen of the
survey respondents so far, providing detailed accounts of the importance of Burdett to medically-underserved people.

We found, for example, that the LGBTQAI+ community, and organizations that work with these communities use Burdett
because it is the safest and most gender affirming place to give birth.

In an interview with Meagon Nolasco, Outreach and Advocacy coordinator for the Pride Center of the Capital Region
stated, “LGBTQ+ folks run into many barriers when accessing healthcare. Accessing birthing care is no different, and
LGBTQ+ folks can’t walk in to any healthcare setting knowing they will receive affirming, safe, and competent care that
meets their needs while respecting their gender identity and expression. BCC provides this environment to LGBTQ+ folks,
and without this resource in Rensselaer county, I am unsure where to refer individuals to for birthing care that we know will
treat them with as much dignity as Burdett does and has. “

Rural residents told us they face serious distance barriers in accessing health care that would be severely exacerbated
by the closure of Burdett Birth Center, leaving no maternity centers in Columbia, Greene and Rensselaer counties. As an
illustration, the rural birthing people who were interviewed consistently spoke about the burdens they faced accessing
care. Burdett is the closest place in many of these cases, besides going out of state.

As an illustration, one rural mother said,“ I am happy I chose Burdett because I ended up having complications and a very
short labor…If I had chosen a homebirth, or even another hospital, who knows what would have happened.”
“Dad drove me because I was in so much pain, I couldn’t even speak. I barely made it to the hospital, and the ride took over
30 minutes. Burdett is my closest place to give birth. I am so grateful for the care, the compassion, and kindness of the
staff at Burdett, they saved our lives.”
Black pregnant people often are already traumatized by negative previous experiences with health providers and by
worries about the high rate of maternal mortality and morbidity among Black women, compared to white women. Giving
birth at a place where their concerns are listened to, feel safe and have agency in making decisions about birthing is both
empowering and relieving to Black pregnant people.

This quote from Jordyn Smith of Troy, one of the people interviewed by coalition members, aptly summed up the
importance of the Burdett Birth Center to Black pregnant people in Rensselaer County:

“As an African American woman I have been failed countless times by the health care system. I have anxiety and fear when
it comes to hospitals. My number one goal was to be heard and to bring my baby safely into the world. I had an amazing
natural water birth at the Burdett Center in 2020. This community needs this center and its health care workers. Birthing
safely shouldn’t be a middle or rich class privilege. It should be for all.”

We have found that the birthing people from ALL medically underserved categories we reached all had one theme….

Burdett is not just a place to give birth. It is a place for pregnant people to have power, body autonomy, gender affirming
care and choice over their birthing process. Burdett’s model of care is one of compassion, dignity and a kindness that is
becoming more rare in overcrowded, metrics-driven hospital labor and delivery rooms. The people who spoke out through
our surveys and interviews pleaded that they not be abandoned by Samaritan Hospital, St. Peter’s and the giant Trinity
Health System that all want to close the Burdett Birth Center. I am here on their behalf to urge you, as Attorney General of
our state, to step in, protect these individuals and prevent the closure of Burdett Birth Center.

Sue Rosa / Troy, New York

I strongly oppose the proposed closing of the Burdett Birth Center. As a former resident and current service provider to
the low income residents of Rensselaer County, this determination would be a travesty. The impact to the most vulnerable
members of the community would include lack of transportation, lack of birthing choice causing a greater concern to an
already federally designated medically underserved community. The additional strain to other emergency services within
the City of Troy and surrounding areas such as EMT/EMS will have a broader impact.

Resident / Kinderhook, New York

Closure of the only midwife-led birth center in the area will lead to declining outcomes for everyone, but especially the poor,
marginalized, and vulnerable.

Resident / Nassau, New York

I selected Burdett Birth Center for my daughter’s birth this past August because of their standard practices. They had 4
labor rooms with tubs, had water-birth pools available for any room, had several other birthing props, practiced delayed
cord clamping, extended skin on skin (longer than 1 hour), had snacks available for patients after kitchen hours, among so
many other reasons. I toured Burdett and I immediately felt at home, safe, and respected at Burdett. Burdett felt like home,
rather than a hospital, but with the safety and expertise of a hospital. I felt like I had many options at Burdett, and lots of
freedom to have the birth experience that I wanted to have.

I had such an amazing experience at Burdett. Every nurse that attended to me was very respectful and knowledgeable,
especially my night nurses. I could not have given birth so quickly and smoothly without the nurse that attended to me
during my labor, and I could not have gotten through the first night without the nurse that attended to me the first night. I
am forever grateful for the nurses and my doctor for my birthing and recovery experience, and I honestly cannot imagine
going anywhere else. If I were to have another child, I would immediately elect to go back to Burdett, which is why I hope
that the birth center can stay open.

Even though birth is not a pleasurable experience, and is quite painful, when I look back at my experience at Burdett, I only
feel good feelings, and I am so extremely thankful for my experience and so thankful that I was able to give birth at Burdett.
I am forever grateful to the nurses there, and for the experience that they and the Birth Center was able to facilitate for me.
The room was very clean, home-y, large, and comfortable. If I needed anything (more towels, more diapers for the baby,
more recovery items), they would bring it to me without question. Every nurse readily answered questions I had, helped me
as I adjusted to this new life, and supported me throughout my stay. My doctor was available throughout the night during
my labor, and made my induction (which I had been nervous about) feel much less scary, and I was able to receive an
epidural within a very reasonable time once I decided to get one. I can say so many more good things about Burdett - I had
an amazing birthing experience there and I hope that they are able to stay open so that I can have my second child there.

Julie Van Ullen / East Chatham, New York

My birth at Burdett was exactly how I hoped it would be. Surrounded by caring midwives, my doula and husband. I had the
ability to go in a shower and labor a pool in my room. I ended up having to have an emergency c-section and was prepped
and in surgery in a matter of minutes, still with my midwives by my side. The attention to patients, the professionalism,
the quality and the commitment to an empowered birthing experience is simply unparalleled at Burdett and doesn’t exist
elsewhere in the area. It would be a tremendous loss to mothers like me, who would be forced to give birth in a setting
against our desires should Burdett close. The greater community and attractiveness of the Albany area for folks like myself
who moved here from NYC would be weakened dramatically and seen as as assault on families in the interest of bottom
line profits and religious motives.

Marion Altieri / Pelham Manor, New York

I oppose, STRONGLY, the closing of the Burdett Birth Center, for many reasons. I have a long history with that building, and
the medical professionals who work there, and serve the public in one of New York State’s poorest Counties:

• In 1956, I was born on the second floor of the “old” Samaritan Hospital. (The front of which is on Peoples Avenue.)
• In 1959, my tonsils were removed there
• In 1964, my treasured Great-Uncle Milo died in the old wing.
• In 1993-’94, my Mother had chemo and radiation in the cancer center in the old wing. Obviously, Samaritan has
  deep emotional roots for me.
• Fast-forward, to the “new” part of the building that wraps around Peoples and Burdett:
• In 1979, my Grandma died on the third floor of the new wing, and --
• In 1994, my beloved Uncle Ed died in the ICU in that new wing, of Samaritan Hospital.

Sitting vigil for two days, we took breaks by walking directly across the hallway, to the Nursery -- where newborn babies
warmly greeted many battle-weary relatives of ICU patients.

I asked an ICU Nurse if that was intentional. She confirmed that yes, Death and New Life are connected -- and people who
were ushering their loved ones to the Next Life needed to see that Life continues on, and it’s beautiful.

I’ve had friends over the years -- CNMs, Ob/Gyns and Nurses -- professionals at Samaritan, who have greeted newborns
and mourned stillborns. They’ve held hands and hugged patients and their families, in times both joyous and sad. Their
work and passion are not forgotten by the Mothers and Fathers with whom they’ve rejoiced or grieved; to those people, the
professionals at Samaritan (Burdett) are beloved.

To abolish Rensselaer County’s only birthing and Womyn’s health center is nothing more than Misogyny, disguised as
“pragmatism.” Uncaring, the only concern of SPHP’s Board is The Bottom Line. They seek to punish Womyn for their sin of
being female. (By birth or choice.)

SPHP’s administration doesn’t give a damn about the patients -- ALL the patients, regardless of financial means -- and THAT
is the crux of the sin: to put filthy mammon over Human health and life is a sin, for which the shareholders and SPHP/Trinity
surely will pay. If not in this Life -- surely, in the next.

Nina Nichols / Troy, New York

As a Rensselaer County Legislator and a member of the Health Committee, I am opposed to the proposed closure of the
Burdett Birth Center and deeply concerned about the dire consequences the elimination of access to maternity services will
have on all residents of Rensselaer County—particularly in rural areas and for low income individuals with limited access to
transportation.

Resident

Closing Burdett Birth Center at Samaritan Hospital would be an absolute travesty. BBC is the only birth center in capital
region that offers a unique and safe birthing environment that gives birthing people of the capital region different options
from the traditional hospital environment. The collaborative care model that is midwifery led cannot be replicated at any
other local facility. I have been a health care professional/birth worker for 20 years locally. I am particularly familiar with St.
Peter’s Hospital, Burdett Birth Center and Bellevue Women’s Center, and the differences that each facility offers. The closure
of Burdett Birth Center would force the providers there to take their patient’s to St. Peter’s Hospital in Albany and already
overcrowded unit. I personally have seen patient’s deliver in PACU bays, postpartum rooms, and triage rooms due to all
labor and delivery rooms there being full. Trinity health will tell you they are making renovations and adding extra rooms
when in fact this renovation plan was already underway prior to Trinity announcing without notice their plans to closure

BBC. In this renovation plan they are adding a new triage area, and one additional labor room. They are planning to have
3 “swing rooms” on a different unit to help accommodate the increased number of deliveries, however these rooms are not
set up for this now, and used for overflow most times, the location of them is not convenient to the main unit, providers,
and in my opinion would make for a cumbersome transport if there was an emergency and the patient would need to be
moved to the OR.

The midwifery model of care is unique to BBC. Birthing people have a well established relationship with their providers.
They are given options, and a voice in their birthing experience. They are not just a number, or a patient; the experience is
personal. Their birth plans are welcomed and followed. The data speaks for itself SPH has >30% C/S rate, at BBC it is <15%,
primary C/S rate of under 10%. Patients are allowed time. Time to labor and allow the physiological process to occur even
while undergoing a medical induction. They are not tied to monitors and IV’s continuously, they can eat in labor, they are
free to discuss their plans of care, have options for pain management such as movement, hydrotherapy, pain medication,
nitrous oxide, and an epidural if desired. Then nurses are highly specialized and trained to help birth people achieve a
vaginal birth, and they will literally try any and every position to help patient’s achieve this goal. At SPH very often, there is
continuous monitoring, a domino effect of interventions, and lack of respect for those who desire a less interventional birth.

It would not just effect Rensselaer County residents but, those who travel up to 2-3 hours to have CHOICE, to be heard and
supported in in labor, and who seek out the distinct care model provided at Burdett Birth Center.

Trinity health is claiming financial loss as the reason, and Covid and staffing. Well all of the same issues are at SPH as well.
Having a birthing center where the midwifery model of care is honored and welcomed actually reduces the cost of health
care, but no one from Trinity is talking about that. All while there is room to create more administrative positions which pay
over 6 figures a year, announcing the closure conveniently before the NYS laws changed and Medicaid reimbursement was
raised, as well as grants they received.

Closing BBC would create unsafe birthing conditions for the residents of Rensselaer County and beyond. There are large
numbers of residents that walk to their PNC visits, or in labor for that matter. Trinity states the Emergency Department will
be equipped to handle a laboring person, and any emergency that may arrive. This is just not true. In any hospital locally,
if a patient is pregnant they are almost immediately turfed to the labor and delivery unit. If there are no obstetrically
trained providers in house at Samaritan how quick and safely do you think an emergent Cesarean Section would happen?

Who would be qualified to know if something was wrong? All obstetrical nurses and providers go through tedious
certification processes in this specialty to read electronic fetal monitoring, and be proficient at resuscitation of newborn
or a premature baby. The people of this community deserve better, they deserve access to the appropriate health care not
the added burden of being in labor and trying to decide if they feed their children or pay for an Uber to get to Albany.
Everyone is always talking about decreasing the maternal morbidity and mortality rate, particularly those in high risk area
like Rensselaer county. Closing BBC would increase these rates exponentially.

Birth is a monumental event, and those who experience it deserve the option to do so at Burdett Birth Center where they are
given choice, support and bodily autonomy.

Emily G. Mabb / Schaghticoke, New York

I am not just a patient. I am a person, a first time mother, a wife, and a woman.

Never in the time I spent at the Burdett Birth Center did I feel like “just a patient”.

I came into the Birth Center a scared first time mother who’s labor had come on quick. I hadn’t planned for that, I wasn’t
mentally prepared for that. I had pain management techniques, I had done the research. Not for this. I woke up with a
contraction and three hours later held my daughter in my arms. The experience was terrifying and thrilling all in the same
breath. And I couldn’t have done it without the staff at the Burdett Birth Center. They cared for me, my husband and our
newborn daughter like we were family. From the moment we walked in the doors, they made us feel safe and heard.

My labor was fast, furious, and complicated. Our daughter was face up and had the cord wrapped around her neck, the
staff took impeccable care to help give me the support and strength to deliver her quickly and safely. I couldn’t be more
grateful for that. They listened to what I needed and helped me do what felt like an impossible task. When our daughter
had to be transferred to the NICU at Albany Med I wanted to jump out of bed and go with her. Our nurses did everything
they could to help me take care of me so I could be well enough to go to our daughter.
Never, ever, was I treated like just a patient. I was treated like a person, a scared mom who needed reassurance, and a
strong woman.

The Burdett Birth Center is crucial to the community in more ways than I have time to write about, so I’ll just touch on my
experiences. As an individual who lives in a rural community, access to a hospital, mind you not a birth center strictly a
hospital, would take a minimum of 45 minutes. If I had to travel to the closest hospital I may not have been able to make
it in time. With the complications we had our daughter may not have survived a birth in the car. Unfortunately, calling for
an ambulance isn’t an option as they’re understaffed and wait times in our area are typically a minimum of an hour. Not
having access to a birthing center puts individuals like myself at a disadvantage medically. Think about those who don’t
have access to a vehicle and need to travel further to a hospital. As the ads so beautifully state, a bus stop is not a delivery
room.

The Burdett Birth Center is an important part of our community for proper access to healthcare and for the opportunity to
be treated like more than just a patient.

Resident / Troy, New York

I chose Burdett to deliver our two children, because I’m a resident in Troy, New York. The primary issue was proximity. I chose
to take birthing classes in Albany, but I knew that getting somewhere for my labor and delivery could be a challenge,
especially in the middle of winter with our second, so I wanted to deliver as close to home as possible. My father is a
firefighter and has literally delivered hundreds of babies over his career. I didn’t want to have a baby in our vehicle or the
lobby somewhere.

I also was high risk due to high blood pressure and needed extra monitoring with medical concerns for my health. Proximity
felt like a life and death decision.

The final reason I chose Burdett was because it was the best place to deliver in the Capital District. We did our homework
and it was hands down the only facility that felt like we’d have space, support, and professionals to help during such an
important and challenging moment of our lives. One of my best friends lost her baby due to negligence and medical
malpractice at a hospital almost two decades ago. I didn’t want to risk injury or loss and I knew other hospitals and birthing
centers had worse track records. I’d already gone through difficulties with the OBGYN group I belonged to, I needed to feel
seen and safe.

Burdett was the right choice for both of our births. One occurred in February 2016 and the other in May 2013. I had a
midwife and a doula present for both as well as my partner. The first labor lasted 32 hours. They let me birth naturally
and in one place for as long as possible. I needed intervention and caught an infection during the labor that required IV
antibiotics and extra monitoring. I also needed to use the vacuum and almost had to go to c section, but the doctor and
nurses who came in were outstanding and patient. They communicated throughout and encouraged me. I was getting
sick and couldn’t bear down during four hours of pushing. The nurses tried four different anti nausea medications over 24
hours and eventually found the right treatment to give me relief. The tub in the room allowed me to labor in the water and
clean myself after delivery. The humanity of that relief felt like the only thing that kept me sane, awake, and capable of
continuing.

Giving birth is the most terrifying and difficult thing I’ve ever done. I wouldn’t wish it on my worst enemy. The risks are
enormous. The stakes are the highest someone can experience. The impact to your own body and psychology is
immeasurable. Had I not been supported the way I was, I know my post partum would’ve been terrible.

Our son had a high bilirubin count causing jaundice. I had to stay at Burdett immediately after the birth for five days to
monitor him (and me). They got his numbers down to a safe level and my fever from the infection managed and we were
discharged, but his numbers increased once we were home. Unbeknownst to me at the time, the infection I had was
spreading to my kidneys, but I was in so much pain from the birth that I didn’t recognize the symptoms as something
different.

My son went into the NICU at Albany Med a week after birth and while their care was great, the accommodations for
parents were horrible at the time. I was in so much pain and there were hard, wooden chairs. Sitting hurt. I was still
bleeding, bruised, stitched together, swollen, and aching from such a difficult delivery. Going to Albany Med was the right
escalation for advanced care for my son. He spent three days. I traveled to and from his room and home, because there
was nowhere to sleep. I pumped and tried to make breastfeeding successful even though everyone at Albany Med was
telling me it was okay to do formula.

At Burdett they supported my desire to breastfeed and I had a lactation consultant help us learn to latch and keep
checking in on us. My son struggled and was three weeks early, so it took time to learn, but we eventually got it! He nursed
for years afterwards and was a sickly kid who truly needed the good stuff my body produced. I know Burdett gave us a gift
with their support.

The last part of his birth story is my infection. A week after discharge from Albany Med I had a 104 fever and went to
Samaritan’s ER. They told me I had the flu and sent me home. Twenty four hours later I got a call after my blood work results
came in and they told me to get back immediately, because I had a blood infection and was about to go sepsis. I spent
the next four days on IV antibiotics with a tropical storm flooding everything and no power at home with my mother and
husband caring for my newborn baby fresh out of NICU. It was traumatizing.

My Burdett team visited me in the general population hospital room. My doctor came up and researched antibiotics I could
take that were safe to nurse on. The lactation consultant visited us. My husband brought the baby in so I could see him.
I sobbed at night. I was alone, separated from my son because they wouldn’t let him stay with me in an old, dirty room
with a moaning elderly roommate in pain. At one point I was trying to nurse my son during the day, but he was crying
and a nurse in the hallway said, “can’t somebody shut that baby up.” I cannot emphasize how dehumanizing Samaritan’s
hospital rooms are for new mothers and their infants. I know I experienced medical malpractice during my time at
Samaritan, but I was so relieved to be alive and home when I was eventually discharged and surfacing from three weeks of
absolute hell from delivering my son, that i just wanted to sleep in my bed and hold him.

All of this should be stated with the note that I had an incredibly privileged position. I had a partner, three parents (all drove
to town to help from out of state), access to two vehicles, money, insurance, time off from work, and enough $ that I could
afford birthing doulas. When we went to Albany med, my husband and I were able to have flexible schedules and enough
cash that we could cover the parking fees, gas, food costs, and other expenses that came with living in hospitals. I spent a
total of 12 days in a facility across Burdett, Albany Med and Samaritan.

We labored at Burdett again with my daughter and had the opposite experience — 6 hours of labor and delivery. I showered
and I was discharged the same day and home in our bed that night. She was healthier, but also three weeks early. And,
while I didn’t have medical complications like our first, I did have a traumatic birth injury from pubic symphysis and severe
post partum anxiety and depression. It took two years of PT to help me recover and I’m still not okay after 7 years. Her birth
came so fast that had I had to travel, I would have been in trouble. Burdett was still getting me settled and monitored when
I said I had to push. Everyone said to hang on, but I couldn’t and she was born in a fierce and painful rush. She was ready
and unfortunately, my pelvis was not. There’s nothing Burdett could have done differently. My previous doula was there
as well as the midwife. I was in an alternative position because everyone knew my body had the potential to get harmed
with this condition. Burdett did an amazing job of keeping all of the wires and IV in a place where I could still be mobile and
deliver in the positions that were safest for me. They gave me room with both births to walk around, use a ball, take a bath,
kneel on the bed, rock, etc.

Birth is a process, it’s not a procedure. This is what people don’t understand. You cannot put someone on a bed and deliver
a baby or just cut it out. Women have to have the freedom of mobility. The choice of what to do so their baby will travel
down the birth canal and overcome obstacles and challenges along the way. So much can go wrong. And, with proper and
experienced training and a supportive environment that doesn’t pressure or rush you, so much can go right.

Burdett saves lives. They saved mine. They saved my son’s. Please help us. Our community cannot lose this vital access to
essential healthcare. The laws and insurance aren’t set up to protect us. At least the right environment can help. Please help
New York set a standard for maternal care rather than suffer from the privatization and profit margins of the healthcare
industry.

Protect us. Save lives. I’m begging you. There are so many women with far less than what I had available to me. I know the
privileged position I was in. The closure of Burdett with no other options in Rensselaer County and a population that has so
many folks at or below the poverty line is inhumane, life threatening, and amounts to physical and mental torture. This is
not an exaggeration.

We must have access to a safe environment for babies to be delivered in. Can a child be born in an elevator, a car seat,
or even a building bombed in a war torn area? Yes. That happens, but it shouldn’t and everyone knows it amounts to
traumatizing and cruel treatment of women and children. We are now considering this risk for thousands each year.

There will be deaths, complications, and a cascading effect across so many areas we can’t even begin to process, yet. I’ll
let someone else tackle the overburdening of our already insufficient emergency response infrastructure across multiple
municipalities and agencies.

Imagine if we’d spent the same amount of mobilized effort and energy collaborating on a way to make the birth center
more profitable vs defending its existence. Where could we have been by now? There’s a lack of vision and healthcare
executives are falling short. Our appeals won’t matter because it’s all numbers to them. I know we can help make the
numbers work if they put the community first.

Thank you.

Resident / Troy, New York

I strongly oppose the closure of Burdett Birth Center. It is nothing less than a moral imperative, and an urgent public health
need, that hospital leadership work in good faith with local and state partners to FIND A WAY to keep Burdett’s doors open.
It is the only humane option that I can see.

Resident / Troy, New York

closing the Burdett Birthing center would be a terrible blow to the underserved who need it. The need to find and get to
another hospital further away could endanger the mother and/or child

Carolyn Bardos / Troy, New York

Troy, New York, is home to me. It is also home to 50,000 other human beings, and 23% of them live at or below the poverty
line (U.S. Census Bureau). Troy is also the seat of Rensselaer County.

A small miracle that exists in Troy is Burdett Birth Center, a loved, respected, and high-functioning facility, where midwives
and birthing doulas provide personalized care in an intimate setting.

Burdett Birth Center is under threat of closure, because the powers that run it want to cut costs. I do not exaggerate when I
say that closure of Burdett Birth Center would be a county-wide disaster. The lives of babies and people giving birth would
be at risk.

If Burdett Birth Center closes, people residing in Troy and in all parts of Rensselaer County would need to travel to Albany to
give birth.

If you happen to be a person without access to private transportation, you’d need to take a bus or an uber to Albany.
Imagine having to climb onto a bus, while in labor, possibly alone, to make a 47-minute trip by bus.

The proposed closure of Burdett Birth Center is cruelty under the guise of fiscal responsibility.

Please, please fight like hell to stop this closure.

Sherrie Hunter Kelly / North Blenheim, New York

To Whom It May Concern-

I am a midwife who previously practiced at St. Peter’s in Albany. While the physicians and midwives care deeply about their
patients, the Catholic hospital system, Trinity Health, to which SPH belongs, dictates obstetric practice to its hospitals. The
result is that personalized situation specific care is difficult to deliver. This stands in stark contrast to the care midwives
give, which is high touch low tech personalized care. Capital Region Midwifery is the area’s only midwife led practice, and
Burdett is the place they go for birth. The lack of midwifery care provided by providers from their communities is a travesty
that extends across the Capital Region and the state, and this closure will place another obstacle between families and
midwifery care.

Thank you for your consideration.

Sherrie Hunter Kelly, CNM

Resident / Voorheesville, New York

I work for st Peter’s health partners. Every year I have to do a mandatory training on the mission of St. Peters. Closing the
burdett birth center is inconsistent with what st Peter’s says is their mission. I don’t see any action behind the talk.

Resident / Clifton Park, New York

I chose burdett birth center because I did not want to give birth at a place where they didn’t care about me or my baby,
horror stories have happened to my family in the different areas they’ve delivered.

A birthing floor in a hospital where my siblings where delivered they told my mother to shut up and a separate time, 2 years
later they gave my mother a shot without telling her what it was and the nurse just had a fist of needles and was injecting
people and throwing them out, granted this was during hurricane Katrina but even so, I gave birth in 2022 during a horrible
snow storm and had to drive what should have been 20 minutes, instead was an hour to get there and they were the
kindest nurses and doctors I’ve ever had. No panic. Just kind and patient and caring. Made accomodations for my mother
in law and husband to stay with me when I was induced. And didn’t let me wait when I asked for assistance in any way.
I was in hard labor for 43 hours. Almost 2 days, I saw 6 different shifts of nurses in my time there because there was
complications with my daughter and we had to stay for a few days, every single one of them were so kind and so sweet,
came in and it seemed like I knew them for years.

I want to give birth here again because of how wonderful it was, I don’t want to worry about giving birth at Albany med
where they won’t take my wishes into account and won’t even really consult with me about what we will do.

Burdett is a great place for a mother to give birth to her child especially if it’s their first time delivering. Even 9 months after I
still think about a nurse helping me through a mental block and making it to where I wasn’t traumatized from delivering.

Resident / Williamstown, Massachusetts

Choice!! Closure of the Burdett Birth Center will once again limit choices women have in selecting their care setting. Women
are losing control of their decision making power more and more every day. We are not second or lower class citizens. We
are humans, and entitled to making the best decisions about OUR Healthcare needs. Birthing Centers are the closest in
resemblance to a natural midwife home birth.

Mark Shipley / Troy, New York

Please don’t let this center close. It is clearly a money grab by trinity to increase births at St. Peter’s and given their high
c-section rate, increase the revenue from this far more expensive, overprescribed and often unnecessary procedure. Also,
considering the demographics of burdett’s service area, it is highly unlikely that a majority of the women served by Burdett
will have access to affordable, safe, reliable and timely transportation to any of the other hospitals in the region. For
many, the next closest hospital will require them to cross state lines, which may not be possible depending on their health
insurance coverage.

Resident / Troy, New York

I gave birth to my second child at Burdett Birth Center, after moving to Rensselaer County. I received the best possible care
and support while there. I experience very long labors and long deliveries with my children. At Burdett I was cared for and
supported with my personal birth plan (which was to give birth with as few interventions as possible). I was offered the
support I needed to make that possible. I was never pressured or made to feel uncomfortable or scared for my choices.
I know many women who have given birth in the Albany/Rensselaer area and many of them who did not give birth at
Burdett, have horror stories of doctors pressuring them to have c-sections just for the doctors own convenience, because of
time pressures or because they were intimidated by medical staff to feel like their labors were “too long” and they needed
to have a c-section. This should not happen and does not happen at Burdett, where patients are cared for in a person
centered model and mothers and babies are prioritized over money and convenience.

In addition, as a resident of Rensselaer Country I feel that is completely unethical to close the only labor and delivery facility
in Rensselaer County. There are women coming from all over this county, 45 mins to an hour away, and going to find a
place to give birth somewhere else is not an option and they should not be put in such a position. Some would never make
it to the hospital.

As my testimony mentions above, I do not believe women will receive similar quality care at alternate locations, if they
can even make it. I think you would see c-section increase and women seeking to give birth outside a hospital context,
potentially unsafely, increase.

We need to stop the closing of Burdett Birth Center! We need to prioritize people, babies, mothers and the care that is best
for them over the profits and whims of the owners of St. Peters Health Partners.

Erin Wright / Rensselaer, New York

I appreciate the opportunity to provide testimony to the Attorney General and am heartened to see the attention being
paid to this critical issue in our community. The Burdett Birth Center is the safest place to give birth in the Capital Region
and provides patients with options they cannot easily find in other hospital settings. Based on a midwifery model of care,
the Burdett Birth Center provides patients with comprehensive options through which they have agency to determine the
course of their birth experience. It is a model that empowers the patient to trust in the timing of their own body, while also
offering up all the modern medical options available to them. Patients are guided by the expertise of midwives who are
able to collaborate with obstetricians when more intensive interventions are necessary. It is no surprise that the Burdett
Birth Center has the lowest c section rates of any labor and delivery unit in the region and better health outcomes for
parents and infants.

It is because of this stellar model of care that I chose to work with the midwives who staff the Burdett Birth Center last year
when I was pregnant. Sadly, I experienced a miscarriage several months into my pregnancy, but the care and support I
received from the midwives at Burdett during that time was exceptional. The fact that I may not be able to utilize that care
for the labor and delivery of future pregnancies is nothing short of devastating. I am devastated at the prospect of losing
this option for my personal reproductive care, and I am appalled and outraged at the prospect of what this loss of care
could mean for Rensselaer County as a whole.

In researching the alternative options available to me in the future, I found those options to be startlingly limited. Home
birth, while a safe and effective option in many instances, would not be fully covered by my health insurance and would
cost me upwards of $10,000, a fee which is simply not financially feasible. Giving birth at any of the neighboring hospitals
would mean subjecting myself to an easily over-medicalized model, that does not allow midwives to guide the course of
treatment, if they are even allowed on the unit at all. While obstetric interventions, such as c sections, can be life saving,
those interventions are statistically applied far too often and pose real harm and risk to patients who unnecessarily receive
them. Giving birth at either Albany Med or Saint Peter’s would significantly increase my risk of receiving unnecessary
interventions.

While the dwindling of my own personal options is startling, the erasure of options for many birthing parents throughout
Rensselaer County is downright deadly. The worst effects of the proposed closure will weigh most heavily on people of
color, immigrants, low income families, Medicaid recipients and those uninsured, LGBTQIA+ individuals, and rural residents.
22% of Troy residents do not have personal vehicles and many cannot afford the cost of a Lyft or Uber to St. Peter’s or
Albany Med. Patients in labor are only left with the option of taking CDTA buses, which have no direct route from Troy to
either Albany hospital and do not run at night. Residents of rural Rensselaer County will have to travel even further to deliver
in Albany or Schenectady, and there are no public transportation options available to them. The proposed closure will not
only make it challenging for Rensselaer County residents to get to a hospital for delivery, it will make it nearly impossible for
them to access proper prenatal care during the course of their pregnancies. Removing access to care at the Burdett Birth
Center would only further the harm inflicted on communities who are already medically underserved.

The closure of the Burdett Birth Center would also increase the precarity of emergency services in the region. Neighboring
hospitals and emergency rooms, that are already overburdened, would be forced to absorb patients from Rensselaer
County. Our region already has a shortage of ambulances and first responders are dangerously under-resourced.

Ambulances and fire trucks would be deployed to assist in births and prenatal emergencies, making them less available for
other emergencies throughout the area. It is no exaggeration to say that the closure of the Burdett Birth Center would lead
to the direct harm and death of birthing parents and their babies, as well as to poorer health outcomes for the region as a
whole.

Given all this, it is unconscionable that Trinity Health and Saint Peter’s Health Partners would believe themselves justified in
closing the Burdett Birth Center. For the safety of all residents in Rensselaer County, but most particularly those individuals
who are already underserved by our medical institutions, it is vital that the Burdett Birth Center remain open.

Katherine Lovering / Sand Lake, New York

My name is Kate Lovering. I never wanted to give birth in a hospital because of the way I had been treated during two
surgeries (one as a child) and after being dismissed and demeaned when I had Lyme disease. It was initially my plan to
give birth at home. In the last few weeks of my pregnancy I chose to have a c-section at Burdett because my twins were not
budging from their breech position and I knew the difference between Burdett, St. Peter’s, and Albany Med. In the waiting
room for an MFM appointment I saw Maureen Murphy, whom I had gotten to know before she left HeartSpace midwifery.

Knowing my situation she promised to be at my birth. I only met my OB once because my following visit, as well as an
appointment with my MFM doctor, were cancelled. The pandemic was beginning to shut things down. I began to itch to
the point I could not sleep. My midwife sent me for blood work. I had developed cholestasis and needed an emergency
c-section that day. My OB and Maureen came in on their day off. My doula was not able to be there because of the
pandemic. Maureen sat with my partner and me in the recovery room marveling at our new babies, answering questions,
and honestly being quite motherly. I was treated with such tender care by the staff at Burdett. I expected pushback when

I gave them my birth plan. The only questions I got were for clarification. The team was happy to know my wishes. It was
completely different from the previous surgery experiences I’d had where nurses and especially doctors expected me to be
quiet and pliant so they could do their work. I have heard so many horrific birth stories and I have had the honor for being
present at four home births. I have seen and now experienced what it can be like to be treated humanely during birth. The
idea that our region could lose Burdett is devastating. The fact that Samaritan wants to shut it down because our births
aren’t profitable enough is absolutely appalling. Somewhere around midway through my pregnancy I was having seriously
uncomfortable Braxton Hicks contractions. I went to Albany Med where a teaching doctor showed a student how to check
my cervix, which was painful and unnecessary. They kept me for observation for several hours without any food or drinks.

Anytime we asked what was going on we were treated like we weren’t being patient enough. Everyone was extremely busy
because they were so short staffed. I eventually decided to leave because they had no plan for tests or treatment. I received
no follow-up care. The surrounding hospitals cannot absorb the loss of Burdett. None of us can afford to lose this critical
resource that is the only one around getting it right. I hope the state will not allow the closure of our county’s only birth
center. Thank you for hearing our stories and our pleas.

Kate Smead / Schenectady, New York

I personally had an amazing birthing experience at Burdett. I drove 30 minutes to get there because there are no other
places in the capital district that provide the same type of birthing experience. The midwifery led care is incredible and
vitally needed not only in our local area but throughout our country. Being pregnant and giving birth is not a medical
condition but a normal part of living and the Burdett Center understands this and treats women as they should be; as a
mother and not a way to make money. I work as a Physical Therapist in a hospital setting therefore I am not ignorant to the
fact that healthcare facilities need to make money, however cutting this type of care would be detrimental to our region.
Not only would women all over the region suffer but women in Rensselaer county especially would suffer. Taking away the
only birthing location in the county from a primarily low income area is absurd. Care is being threatened to be taken away
from the people who need it most. How does this demonstrate compassion? How does this care for our fellow women?

KEEP BURDETT OPEN!!!

Keren Carmeli / Albany, New York

Giving birth has been the most empowering experience of my entire life. It is also perhaps one of the most vulnerable
moments of a person’s life and all too often, women leave the birthing experience with trauma: feeling as though their
wishes were disregarded and, in some cases, as though they were physically violated. That is precisely why it is so
important to support birthing centers that promote midwifery-based care. These centers have proved time and time again
to have better outcomes for parents and babies and significantly lower c-section rates.

Birth is a natural, unpredictable process that, when left to unfold on its own, is difficult to schedule, mechanize and
monetize, which is precisely why Burdett’s Birthing Center is under attack. Why support centers that promote natural birth
when conglomerates like Trinity Health can push patients toward hospitals with significantly higher intervention and
c-section rates that generate more money for these so called nonprofit institutions?

Sadly Burdett is not a unique case: birth centers are being closed across the country because they aren’t yielding enough
profit to their parent companies.
What does it say about us as a society when we withdraw support from women at this pivotal moment? When we seek to
“McDonaldize” birth: create a one-size-fits-all model designed to maximize profit, we are giving away part of our humanity.

We will continue the fight to keep Burdett open and support women and babies,
Keren Carmeli

Jennifer F. Baumstein / Troy, New York

Frankly, this is an impossibly difficult task - mostly because most of the people who are submitting testimony are parents.
People who give hours of their days to the lives of others. Who aren’t able to sleep if their child is sick, who always put
others first, whose “free” time (at least speaking for myself) is trying to regain energy from the hours you spent on providing
the best for their children. A birth center, one that is led by the midwifery model Impact on patients / community. It is one
decision that you know you dont have to fight on behalf of your family for. The midwifery model at Burdett has the patients
at the steering wheel and, godforbid, something were to happen, Samaritan is right there. This is unparalleled care.
In a medical world wherein BIPOC people, women, queer folks, trans men, have to actively SEARCH for practices that are
culturally competent, Samaritan stands out. I would not say the same about any other place in the capital region, and
frankly wouldn’t say that about Samaritan as a whole. The expertise of the staff at Burdett is unparalleled. Their training,
and laser focus on doing one thing *VERY WELL* is why people feel safe, and *are* safe, in that bubble. I dont think there is
much that I can contribute to testimony that wont be echoed by many others and that speaks to the community need for
this place. People of all ethnic, religious (which is important - as a Jewish person I do NOT feel the same at St Peters. I frankly
would avoid a place that is called St. Anything and both it Albany Med already has the reputation of being impossible to
get in to at the ER), and economic backgrounds from the WHOLE county rely on this place and these providers. Midwives
(and L&D nurses) Save Lives.

https://www.timesunion.com/health/article/albany-area-hospitals-longest-er-wait-times-n-y-18336129.php

Resident / Troy, New York

I had an excellent experience with the midwives and nurses at BBC. They were patient and helpful, and made the right
medical choices for me and my baby. It did not feel like I was being rushed through a “baby factory”. My care level was
tailored to me and my family’s needs.

Resident / Troy, New York

Burdett Birth Center is the only place to give birth in Rensselaer County. Closing it puts the lives of mothers and their unborn
children at risk. This is especially true for underserved and poor communities. These are people who rely on bus routes,
public transportation and availability of a friend with a car to take them to their medical appointments. A bus from the city
of Troy to Albany Medical Center or St. Peter’s hospital can take 45+ minutes from the time you get in the bus and requires
at least one bus change. A taxi or Uber is between $40-60 which is an exorbitant fee for women who need that money for
food. And either of these transport options may not be available in the middle of the night if a woman is in labor.

Women will be forced to call 911 when in labor which puts an EMT and a fire engine out of commission for hours if they
have to transport someone to Albany. Trinity Health closing Burdett Birth Center will cost the City of Troy thousands of
dollars and limited emergency services for its residents if our EMT’s are in Albany. The burden on the community will be
overwhelming.

Trinity Health is putting dollars first before the health of patients, especially those who have limited income and means. As
a Catholic organization this is an offense to their mission and a disservice to all the women of Rensselaer County.

Nicole Kelton / Clifton Park, New York

Burdett Birth Center has meant so much to me and my family. I have been fortunate to have 2 children there in the last 5
years. The location and facilities are why I chose to have my babies there. It is close to my home, and it is the only Birth
Center in the area. A Birth Center like Burdett is what I needed as a low risk pregnancy, who still wanted to be near an
OR in an emergency. It fulfills a niche. It would be unfortunate to only have hospitals or home births as the only option
available to families.

For my first child, I made the mistake many first-time moms in labor make. I went to the hospital too early. The nurses
spent hours with me, assessing my situation and monitoring me. Ultimately, when they sent me home, I was thankful to
be so close. I may not have been ready for birth, but I was not comfortable, and very anxious. Having access to a nearby
hospital meant a lot to me, since I had to make the journey twice. My son was born after many hours in labor. 90% of that
time I spent in the jet tub. I completely credit that experience with allowing me to make it through hours and hours of labor
in the birth center unmedicated. It was my plan to give birth without the use of the epidural, and I found the rooms and the
nurses so accommodating to the experience I wanted. I felt supported and cared for.

With my second, I had the opposite issue. When my husband brought me to the hospital, I thought we were hours away
from welcoming baby number 2. The nurses brought me into the triage area and began checking me in and getting a tub
ready. After such a positive experience the first time, I intended to follow the same plan. About 20 minutes after I walked
into the birth center, I gave birth to a baby girl to everyone’s surprise, including my own. I felt so thankful that we were so
close to the birth center so I gave birth in triage and not in the car or in the elevator.

Part of my 2 positive experiences were because of the wonderful labor and delivery nurses and the fantastic midwifes.
But a big part was also that the facility enabled them to provide the care I wanted and needed. There are no other birth
centers like that in the Albany area.

Carly Stockwell / Troy, New York

Closing Burdett birth center would leave a huge gap in the care of women and children. The inconvenience of traveling
long distances to Albany or Schenectady will mean more unsafe deliveries for people who can’t receive appropriate and
timely care. This move will hurt the poor and disenfranchised the most as they are less likely to be able to travel long
distances.

Sylva Menard / Troy, New York

Closing Burdett doesn’t actually eliminate the costs and liabilities of the birthing center, it just transfers those costs
and liabilities elsewhere - namely onto the community, the city and county services, and stripping resources from Troy,
Rensselaer County, and individuals who reside here. Where births go, families follow. The loss of a labor and delivery facility
in Troy will result in those families tending to go to Albany for other emergency services, with the future result likely the
ultimate closure of Samaritan Hospital in general. And AMC and SPHP-Albany have the HIGHEST ED WAIT TIMES IN THE
STATE. It’s not acceptable to lose safe and respectful health care choices.

In addition, SPHP-Albany cesarean section rates are sky high compared to Burdett. The collective increased cost in dollars
and abdominal surgery recovery pain and time are astronomical for individual families and their larger community, again,
placing the burden on families and communities, while claiming to “save money” - for the medical facility. At what costs?
This doesn’t address that Burdett serves the LGBTQIA+ and Black families with greater respect than any other local facility.
There is no alternative.

It’s not acceptable to claim these community costs can be mitigated by SPHP when they’re explicitly caused by a closure
sought by SPHP. Burdett should not be closed.

Burdett’s culture of safety, respect, & maternal-infant care is irreplaceable and cannot relocate into another facility and
remain intact. There is no alternative. If births are absorbed into SPHP-Albany/AMC, the culture will comply. Increased CSs
and removal of centralized services results in direct impacts to families – less access or eliminated care, increased cost,
lack of connection to family/friends during/after birth. Community costs will be a HIGH $$/resource burden for Troy/Rensco.
Limited EMS/fire resources will be stolen unnecessarily transporting people in labor to Albany vs traveling quickly on a Troy
busline. AMC/SPHP-Albany don’t have beds/staff to absorb nearly 1000 additional births/year, sapping limited resources to
provide care for low-risk families from Rensco. Due to high rates of maternal-infant morbidity-mortality, March of Dimes,

NYS DOH, and Federal initiatives ALL advocate for low CS rates and better local access to maternity care services inside
of communities. Closure of Burdett would violate all these initiatives, transferring the cost and burdens of care, stealing
resources from our community to protect the profits of an organization whose top director’s 2021 total compensation
was higher than the entire Burdett fiscal loss in 2022. The community costs can’t be mitigated if Burdett closes. We all lose.
Chartis didn’t participate in the 8/23/23 Community Forum (they were invited to hear directly from the community). 250
words/6 days isn’t meaningful engagement.

A meaningful assessment of SPHP/Trinity Health’s financial status is essential. Others can espouse more clearly how absurd
it is that every unit of every health care facility be a source of profit. If that were the standard, we’d all be dying. As it is, few
women and families are choosing to have many children - the burden is too high, the risks are too high.

The maternal-infant health crisis has been known and spoken about for years. Now, something must be done. It’s time to
plug the hole in the dike and fix things.

Ryan Kelton

My wife and I chose BBC because of it’s location and proximity to our home. We also wanted our children to be born here
as we found it to be a one of a kind location for the greater capital region. There are simply no other birthing centers like
it. The jet tubs were critical to my wife and my first child’s birth. The midwives and nurses, their patience and attentiveness
were unlike the experiences of our friends at other hospitals.

My wife and I had two very different experiences for the two children we had at BBC. Based on what I’ve heard from several
friends and family in the capital region I believe that for both BBC provided a unique location for this area. My son came
after more than 36 hours of labor. If it weren’t for the midwives and nurses of BBC I don’t know that my wife would’ve felt
comfortable fulfilling her dream of a natural, no medication, birth. My daughter was different, coming within minutes of
my wife’s arrival to the BBC. While I missed the actual birth due to the speed, the midwives and nurses made it feel “special”
ushering me into triage and allowing me to announce her gender unbeknownst to my wife. Without a place like BBC
I’m not sure that our birthing experience would be the same. Further, due to it’s location, I don’t know that my daughter
would’ve been born outside of a car.

Ellen Irons / Troy, New York

It is essential for the local Troy community and well beyond into the wider Capital District that the closure of Burdett Birth
Center is prevented. Personally, I chose Burdett for the birth of my first child in 2019 because it is local, convenient, came
highly recommended by friends, acquaintances, and the midwife & birthing community I was surrounded by as I prepared
for the birth of my first child. All my expectations were met and exceeded during the fours days I spent at Burdett in 2019.
I felt so lucky to have such a high quality birthing option that centered the experience of birthing parents right in my
community. I remain confident Burdett is the right choice for the birth of my second child, who I’m expecting at the end
of October. Since the birth of my first child, I’ve learned a lot about why Burdett is such a great place to give birth, which
goes well beyond my personal experience and into trends and patterns in birth outcomes nationwide. Burdett Birth Center
provides essential Maternity Care to the community through a Midwife-led, OB collaborative model of care. This model
of care has is statistically proven to produce the best outcomes for moms and babies. I am deeply concerned about the
negative effects this potential closure would have on the birthing people of Rensselaer County and beyond. If this egregious
closure is allowed, it will leave the already-drastically-underserved city of Troy and the hundreds of thousands of rural
residents in the surrounding area without an acute maternity care facility. This will be a disaster for public health and is yet
another glaring example of how profit-driven healthcare is destroying communities. This is not a Rensselaer County issue
– it is a Capital Region and, truly, statewide, and nationwide issue of corporatization of health care at the cost of evidence-based,
intervention-reducing and cesarean-reducing maternity care. BBC’s Cesarean Section rate is 15% entirely and 8.9%
Midwife Group (Capital Region Midwifery).Punishing Burdett Birth Center because they are practicing OB collaborative,
midwifery-led care, which happens to not produce the money from surgeries and procedures, is in direct opposition to New

York State’s initiative to improve care for underserved communities, of which Rensselaer, Albany and Troy are all included
statistically. While Burdett Birth Center is available to all members of the community, 51% of its patients are receiving
Medicaid and this closure will absolutely affect BIPOC and working class families negatively and disproportionately. We
must do everything in our power to stop the closure of this vital birth center and protect the people in our community. I
hope to deliver my daughter there in the next 2 months, and I hope many others will get to do so well after me!

Resident / Troy, New York

My first baby was born at Burdette, and I loved it. I labored, delivered, and stayed in the same cozy room for my entire time
there. I felt cared for and relaxed. Surrounded by a strong, all female group of women who knew that my body knew what
to do. The birth was calm and smooth. The stay was restorative.

My second baby was supposed to be born at burdette but was moved to St Peters last minute. I labored in a room barely
big enough for my husband and mom to stand in, while I was stuck in bed. I was then taken to deliver in a large, sterile
room. The staff was so busy that no one was in the room for most of my final laboring. My mom had to go find a nurse
because I was starting to push. After I delivered I was moved to yet another room, shared with someone else. And I would
be moved once more before leaving at the day 2 mark. I felt like a widget, not a human who just delivered a new life. And
the location was so far from Troy that i was alone most of the first day because my partner had to travel back to troy to
take care of our other child and couldn’t make the trip all the way back to Albany until much later at night.
The difference was so stark that, in fear I might be moved to St Peters again, I had my 3rd baby at home with a midwife.

Resident / Castleton, New York

I am very concerned that the closure of Burdett would have very real negative outcomes for the people of Rensselaer
County and the surrounding areas.

It’s so crucial to have easy access to care during pregnancy and for safe delivery of babies, in addition to post-natal care.
Closing Burdett would limit access to midwife care, and would force people in Rensselaer county to travel significant
distances.

I’m sincerely concerned that closing Burdett will cause babies to be born in unsafe settings, and will push more pregnant
individuals towards high-intervention care because they simply lack choices.

Please keep Burdett open for the well-being of our community.

Amanda Wild / Troy, New York

The Burdett Birth Center has provided needed emergency and planned birth services and closing it would cause a
significant negative impact on the wellbeing and care of patients in Rensselaer County and beyond.

Resident / Ballston Spa, New York

I recently switched practices in my pregnancy to Capital Region Midwifery and Burdett Birth Center because I wanted the
midwife model of care and philosophy, and a birthing place where I felt safer. I heard many positive experiences of the
center from friends, and I felt I trusted Burdett more than the other hospital where my previous practice delivers. I felt that
at Burdett my natural process of labor would be respected and supported. I travel farther to get to Burdett than if I had
stayed with my previous practice/hospital, but I feel that that trust in your providers during labor is crucial.

My impression of Burdett is that it is a unique place, with a distinct midwife culture, where women can feel safe to labor and
birth without having artificial timelines imposed or interventions pushed. This safety and support allow labor to progress.
Women need this; we need more places like Burdett. To close this unique space would be tragic. The women and families
of Rensselaer County need a birth center, especially one so supportive of them—it is crazy to close the only birth center/
maternity ward in the county.

I feel as a culture we are becoming more disconnected from the natural physiologic process of birth, so having a birth
center that honors that process, while being readily available to the general public and located in the center of Troy, is
wonderful, and should be a model to other facilities.

So many other friends that I know have had birth “horror stories” elsewhere, with cascading interventions often resulting in
C-sections, where they felt unsupported and unempowered—a stark contrast to what I have heard of people’s experiences
at Burdett.

There isn’t as much money made in lower-intervention births, but we need to support the health of women and families in
this way. Burdett Birth Center is needed and integral to the health of the local community.

Resident / Troy, New York

Having received life changing care at the BBC, I strongly oppose its closure.

Resident / East Greenbush, New York

Burdett Birth Center is where I gave birth to my first child during the pandemic. Burdett is the closest birthing center to
me and provided me with the medical assistance I needed to have my daughter safely. Due to complications I had an
emergency cesarean. The staff welcomed me, made me feel safe, and helped me through this transition into motherhood
with a birth plan that I hadn’t planned. Burdett is needed here in this community because of stories like mine.

Resident / East Greenbush, New York

As an RN in labor and delivery who has worked in a number of settings and hospitals in the Capital Region, I can confidently
say Burdett offers an experience unlike any other in the area that needs to maintained as an option in the region.

Additionally, as a small community hospital, maternity services at Samaritan have been maintained without question
since 1963 and was predated by maternity services at St. Mary’s and Leonard Hospitals of Rensselaer county. Why then,
since it’s takeover by Trinity in 2019, is it suddenly such a burden to continue to maintain by a large non-profit entity? It
seems as though there were no efforts to change this fate made by trinity itself? Due to Burdett’s inherent success in saving
people and insurance companies money by leading in low intervention and low C-section rates, Trinity quickly evaluated
it’s insurance reimbursements will never financially profit unlike its larger, and higher intervention center at St. Peter’s, in
addition to the fact the over 50% of Burdett’s patient population relies on Medicaid which yields a low reimbursement rate
as well. I’m recent years that I have been here, the lack of financial oversight and high turnover of management has also
contributed to the problem. With a trial of independence in 2011 failing related to those reasons and also due to the lack of
goals, expectations and plans being put in place to create opportunity for it to succeed without future absorption by St.
Peter’s.

Many of our patients have walked here in labor, they rely on friends and family members alike to give them rides which
already has constraints based on their availability to do so, they use ambulances and Troy Fire which is already a precious
resource in Rensselaer county. They come here for care and evaluations multiple times during pregnancy and not just
when labor occurs. Closing this unit would be dangerous to many lives in Troy who don’t have the ability to jump in their
car and cross the river to the other regions options. So when their 32 weeks and cramping and have to go be evaluated at
St. Peter’s, a lot of them will choose to try to wait until the morning when they can go to the office for assessment or maybe
even until the weekend is over, instead of heading in for a timely and essential evaluation that could save a life. I’m very
worried for our residents and how this will affect their lives. I know many birthing families will still show up to Samaritan
regardless of the closure and without maternity care services and specialty trained people, it has a high potential for
disaster.

Finally, the closure does not in any way align with St. Peter’s mission as a non profit and in fact is doing the opposite of what
their mission and values are proposed to be. This large nonprofit should be questioned in its motives to be able to maintain
its nonprofit status serving its community.

As a Rensselaer county maternity care resident and patient, it would be a detriment to lose Burdett and I don’t feel safe
at other area facilities in the region that don’t offer the midwifery model of care within their policies and care. Let alone,
would there even be room at these other hospitals that are already overflowing without adding to their density. How could
they propose Burdetts closure without a contingency plan in place to address all of these questions and problems that
would occur with its doors suddenly closing? I truly hope the Department of Health will see what a detriment to the health
of this community the closure would cause and actively works to prevent it and hopefully aid needs to improve its ability to
function. The closure of yet another maternity care center in a high needs maternity care community is directly against the
Whitehouse Blueprint for Addressing the Maternal Health Crisis and New York State health initiatives. We need to hold these
entities accountable for upholding quality and essential care to our communities and stop these large entities from taking
them away for question of profits.

Resident / Pittstown, New York

Removing Burdett Birthing Center is a form of abuse for this community which has a diverse population made up of many
under-resourced and vulnerable individuals and families. The biggest danger of closing Burdett Birthing Center is that
many birthing people who utilize the hospital are people of color and already in danger of high risk pregnancies, birth, and
post-partum. Taking away this unit has grave dangers.

Additionally, this unit has provided leading care over area hospitals for decades and decades. The unique midwifery
approach brings in birthing individuals well-beyond the county to receive the care and practice they seek. Thinking more
locally, again, our marginalized and vulnerable folx have this vital resource that gives them access to a revered practice
that isn’t available elsewhere.

This community cannot afford losing this resource. Lives will be lost and the impact profound.

Gloria Otoo / Far Rockaway, New York

Burdett Birth Center provides excellent care for a large area of vulnerable populations and should stay open to serve this
community. Mothers and newborns can literally be confronted with life threatening danger if this facility closes.

Resident / Troy, New York

Good Afternoon, my name is [redacted] and I am the Director of Operations at the Hoosic Valley Rescue Squad. We are
located in Schaghticoke NY and our service district is approximately 70 square miles. We provide advanced life support for
over 7500 residents and have one staffed ambulance 24/7. The purposed closing of the Burdett Birth Center at Samaritan
Hospital would be a strain on not only the residents but also the health care providers that serve their community. With
increased wait times at emergency rooms for EMS, this puts surrounding communities at risk. When it comes to pregnancy
related calls, the Burdett Birth center is the closest facility to transport patients from our community, especially if they are
experiencing complications. I would personally trust any of the staff at our agency to treat myself or my family, but when
it comes to a complication related to pregnancy, the patient would benefit from healthcare professionals specializes in
obstetrics. In EMS, pregnancy related calls are for the most part low frequency we don’t get to many of them, but the risk
and the possibility for something to go wrong with the patient and the baby are most defiantly high. Closing this facility
will increase transport times, providers from my community and surrounding will have to make clinical decisions with the
possibility of being the only provider in the back of the ambulance, assisting the mother with child birth, instead of being in
a room full of skilled nurses, doctors, and midwifes where they should be.

Lori Friday / Troy, New York

The Burdett Birth Center provided emergency care for my family in our most urgent hour. Had we not had their services
available to us, we may have lost our baby, which is an unfathomable concept, as she is a bright and healthy 10 year old
girl. The birth center is an indispensable facility for countless Rensselaer County families. To lose it would have unspeakable
consequences.

Resident / Albany, New York

The Burkett birthing center should not be closed and sacrifice the health of mothers and newborn babies to save money for
Trinity health. I know firsthand because I was born at Burdette birthing center and my son who is also born there too. Trinity
health should not have purchased Samaritan Hospital if the economics did not work out for them. They can’t come along
and close things down as they see fit affecting the community like this.

Nando DelCastillo / Athens, New York

Dear Ms.Letitia James attorney general and the Honorable Governor Ms,Hochul,

My wife Sally and I have had 2, children born at Burdett in 2020 and 2022. With the wonderful help of midwife, Pam Platis
and the rest of the midwife crew from right next door! We are expecting our 3rd child in the beginning of October. (This
news of closure was distressing to say the least.) Two of my other grown children birthed a boy and girl in 2016 and 2020.
The staff and hospital were spectacular for all four births! We don’t have a hospital in Greene county. Columbia county
hospital birthing closed right before we were to have our first. This is why we drive over 45 minutes to go to Troy! Don’t close
it!!! It is needed!!! Every one of us were born somewhere and this hospital has proved to be an excellent starting place for
precious children! Put the resources that are needed into what really matters, children’s well being and their MOTHERS!!!
It is shameful that NEW YORK would allow the closure of Burdett especially concerning the mother’s and child’s most
vulnerable time of life. Our family pray that the power of the government, for we the people that you serve will use this
power wisely and remember that you are there to serve us not the other way around. We also pray that our government
isn’t swayed by the power and money of Saint Peter’s hospital.

Sincerely, proud father of 7 children, soon to b 8!

Nando DelCastillo

Madeline Maxkowski / Albany, New York

My experience birthing my son this past July 2023 was empowering and healing After the extremely traumatic induced birth
of my daughter in 2021. I was supported in all my own birthing choices by the Burdett providers and staff and was not only
educated and informed on my options and choices

but also supported and encouraged to make and stick to my decisions regarding MY birth, MY care, and most importantly
MY child. As a result my postpartum experience has been entirely different and more positive than the experience I had
that followed my first birth. I am confident that had I not been supported and empowered in the way I was by my providers
and the burdett staff I would have ended up once again with yet another traumatic birth experience and another life
threatening battle with postpartum depression.

Kelsey Backus / East Greenbush, New York

All of my children were home birth babies but I recognize the vital importance that BBC plays in our community. Fact is
it’s the only L&D unit serving over 160,000 county residents and the only one in the Capital Area which uses the midwifery
model of care which is strongly demonstrated to promote superior health outcomes. This is especially glaring with
consideration to the fact the BBC’s demographic is disproportionately an underserved community

This is a matter of racial, economic, and healthcare justice. The fact that large institutions like SPHP and Trinity think that
they can play games with whole communities is disgusting and this kind of activity should be halted here and everywhere.
Samaritan Hospital has excess revenue every year and it’s parent organizations are highly profitable. The fact that this nonprofit
organization thinks that it’s ok to claims that women’s health doesn’t make enough money is absurd

Angela Beallor / Troy, New York

In 2017, a few months after my child was born, we realized that they had tongue and lip ties. This was after a doctor
determined that we were experiencing “failure to thrive.” Breastfeeding was very important to us and we wanted to try to
overcome the difficulties. We are an LGBTQ+ couple and we wanted someone with competence in LGBTQ experience— we
found this with Carrie Kimble at Burdett birth center. This work was deeply important to helping us navigate the desire to
breastfeed with the complications. My partner was contemplating inducing lactation and Carrie was knowledgeable and
informative on this process. While we didn’t pursue that, it was so deeply helpful and affirming to receive informed care
from Carrie!

Our child was born at a different hospital — at various institutions, we found a lack of competency around LGBTQ+ families.
It was a massive relief to find a space with Carrie Kimble and we will always be grateful for that.

The Birth Center at Burdett is golden because of the caregivers. The midwives, nurses, doulas, postpartum care providers,
etc. They have carved out this space of immense care, driven by listening to the needs of patients, seeking the lowest
interventions and the best practices in patient-centered care.

Where infant mortality and death in childbirth is high for Black women— spaces like Burdett Birth Center are the example of
how to listen and give care that centers Black mothers.

Similarly, to be met by homophobia and lack of knowledge on LGBTQ+ families during the intimate process of childbirth
and postpartum care is damaging, disorienting, and sometimes devastating. Burdett is ahead of the curve on meeting
LGBTQ+ families needs. KEEP IT OPEN!!

Joanne Maher / Troy, New York

Burdette Birth Center is the only facility in Rensselaer county that offers L&D services. It would pose a hardship for many
women if they had to travel to an Albany hospital to give birth. Imagine having to take a bus while in active labor to a
hospital in Albany. The buses don’t run overnight in Troy. There is also a large rural area in Rensselaer County.

The other concern is that midwives are an integral component of the birth center.

Resident / Watervliet, New York

The burdett birth center should stay open, with many more dependable resources there.

Resident / Scotia, New York

DO not CLOSE . I would love to have my future babies here . I wouldn’t want to have to go anywhere else.

Resident / Brunswick, New York

Birthing Centers in close proximity should be available to all expectant mothers.

Kerry Francois / Troy, New York

Everyone who I know that has been to Burdett has had nothing but the highest praise. Their birthing journey was successful
thanks to support of the staff who made them feel safe and supported. They are true heroes and I can’t imagine how one
could think this service can be taken away. The families of the Capital Region deserve to have a safe, local hospital focused
on the women who will raise our future community members.

Danielle Sanzone / Troy, New York

I do not understand why closing this site is being discussed. It seems to come down to money instead of prioritizing what is
best for the patients/babies being born.

This is the only birth center in Rensselaer County. I know Samaritan will still do births in the ER but soon-to-be-mothers won’t
be able to plan their birth at the center that is nearest to where they live.

Many in Troy and Rensselaer County do not have reliable transportation and while CDTA is an option, it will be a very long
trip to the next closest birth centers.

Burdett is providing a service to the public. They should not be allowed to close this needed community resource.

Gary G. Nelson / Troy, New York

Testimony to NY Attorney General
Re: Burdett Birthing Center
Submitted by: Gary G. Nelson
Date: September 11, 2023

My two daughters were born at the Center in 1973 and 1975. Having a facility close to our residence in Troy at the time (128
First St.) was vital to reaching the facility in time.

Also I was working as a planning and management consultant in Troy in the 1970’s. I worked on a project in 1978 for the
regional health services agency on the consolidation of obstetric facilities in the Capital Region. The attention was mostly
on the close-by pair of facilities in Amsterdam and the three facilities in Schenectady. In the latter case time has partly
resolved the issue by closure of St. Clares.

At no time were the facilities in Albany and Troy considered to be an inefficient duplication. That remains the case. The
issue has been further marked by the reproductive policies of the hospitals controlled by Catholic-related agencies.

The center in Samaritan hospital presently provides an important arms-length separation from the Trinity/St. Peters
management. This facility then uniquely serves a large service area to the east, north and northeast of Troy. Closure would
significantly increase access to a large population and so have a negative effect on health outcomes.

The financial performance of the Burdett Center is largely a matter of how the provider allocates its large overhead
accounts. True costs and revenues should be carefully audited. However the existence of the center is a matter of public
health and cannot be left to discretion of the private management.

Submitted/Signed
Gary G. Nelson

Rajani Bhatia, Ph.D. / Albany, New York

Public Hearing on the Proposed Closure of the Burdett Birth Center
Office of the NYS Attorney General Letitia James
Rajani Bhatia, Ph.D.
University at Albany

Good afternoon! I am Dr. Bhatia, associate professor of WGSS at the UAlbany, with expertise in reproductive justice
movements. It’s been nearly 15 years since reproductive justice movements specifically took up the issue of birth, spurring
a national movement led by BIPOC communities to challenge medical violence and coercion during pregnancy and
childbirth, to reclaim midwifery traditions, and to strategize on how to overcome birth inequities^[1]. In the Capital District,
a local manifestation of this movement began in 2017 prompted by the release of statistics by the DOH revealing stark
racial disparities in birth outcomes that made it impossible to ignore how the Black maternal and infant health crisis was
occurring right in our own backyard.

At the local, grassroots and state policy levels, there have been numerous commitments and initiatives put forth in the last
five years to address these entrenched disparities and to ensure access to a full spectrum of reproductive health services.
In this state, thankfully, we are not overwhelmed by ideological positions that would politically intervene to limit access to
sexual and reproductive health care or dedicated public expenditures towards mitigating racial disparities in maternal
mortality, morbidity, and birth outcomes.

And yet, all these efforts have been compromised by the chronic underfunding of clinics and hospitals that serve low-income
communities, disproportionately of color. New York State has seen a 20% reduction in hospital beds since 2000,
creating overcrowding in urban areas and “maternity-care deserts” in rural ones^[2]. Reproductive health resources have
been further strained by local budgetary shortfalls and low Medicaid reimbursement rates. Hospital mergers and similar
structural adjustment, cost-cutting measures lead to constraints not unlike those that appear in states with abortion bans
and high maternal and infant death rates.

Some residents of Rensselaer County, for example, were impacted by Albany Med’s closure of the maternity ward in
Columbia-Green Memorial Hospital in 2019. This was followed by a 2020 structural change made by St. Peter’s that
resulted in the placement of the Burdett Birth Center under the religious directives of the hospital system. The pandemic
then layered onto, and exacerbated, these preexisting dimensions of health inequity. The narrow focus on transmission
risk resulted in policies in which the well-being of low-income Black and brown pregnant and birthing people—groups at
greater risk for negative clinical interactions and/or birthing outcomes—was largely sidelined. A doula I interviewed for
a study on the effect of the pandemic on sexual and reproductive health inequity stated, “Black women are not being
listened to, and now with COVID taking center stage, they sense they’ll be listened to even less.”

It should not come as a surprise that BIPOC communities report mistreatment in hospital settings two to three times more
often than their white counterparts.^[3] “Obstetric violence” signifies multiple forms of mistreatment during childbirth that
range in severity from “less dramatic forms of subtle humiliation to coercion, unconsented clinical care, and more extreme
instances of verbal and physical abuse”^[4]. According to the national Listening to Mothers III survey, 10% of respondents
“reported harsh language and rough handling”^[5] in hospital settings with Black individuals more likely to report such poor
treatment. The rich qualitative studies of Dr. Dána-Ain Davis, who coined the term obstetric racism, depict stories of highly
educated, Black women literally bracing themselves for things to go wrong in the clinical encounter, knowing that they are
at risk of not walking out alive, and therefore taking careful steps to document in detail the experience in real time, just
to be able to hold it into account^[6]. Birth justice movements have put considerable effort, therefore, into advocating for
improved access to doula support, not only to have someone to bring you water or rub your back and otherwise support
you in childbirth, but also to bear witness and provide a form of security against expected disrespect, negligence, and
substandard perinatal care. A number of studies including the Listening to Mothers – California study and the Giving Voice
to Mother study comparing two national cohorts of birthers in hospitals or birth centers demonstrate that Black birthing
people are more likely to report a lack of autonomy in decision-making and the least access to desired community-based
birth center and midwifery options for their care.^[7] A number of national studies, including the Strong Start for Mothers
and Newborns evaluation, consistently demonstrate better maternal and infant outcomes for Medicaid beneficiaries within
community-based birth centers than in hospitals.

The Burdett Birth Center, even if not a free-standing birth center, is rooted in a community and it follows the principles of
respect and relationship building care, indicative of the midwifery model. As such it is an incredibly rare resource difficult
to replicate in hospital settings, even if a patient is lucky enough to have access to midwife attended birth. Midwives in
hospitals face many constraints to actualizing the principles of their care not least due to their insubordination in hospital
hierarchies. Given the ongoing racial disparities in maternal and birth outcomes, our state has an obligation to protect
these extremely limited dignified options that promote compassionate care during childbirth.

REFERENCES

Almanza, Jennifer I., J’Mag Karbeah, Katelyn M. Tessier, Carrie Neerland, Kathrin Stoll, Rachel R. Hardeman, and Saraswathi
Vedam. 2022. The Impact of Culturally-Centered Care on Peripartum Experiences of Autonomy and Respect in Community
Birth Centers: A Comparative Study. Maternal and Child Health Journal 26: 895-904. https://doi.org/10.1007/s10995-021-
03245-w.

Brigance, C., Lucas R., Jones, E., Davis, A., Oinuma, M., Mishkin, K. and Henderson, Z. 2022. Nowhere to Go: Maternity Care
Deserts Across the U.S. Arlington, VA: March of Dimes. https://www.marchofdimes.org/maternity-care-deserts-report.

Davis, Dána-Ain. 2019. Obstetric Racism: The Racial Politics of Pregnancy, Labor, and Birthing. Medical Anthropology 38 (7):
560-573.

Glass, Kelly. 2020. When Maternity Wards in Black Neighborhoods Disappear. The New York Times, May 5.

Kukura, Elizabeth. 2017. Obstetric Violence. Georgetown Law Journal 106: 721-801.

Oparah, Julia Chinyere. 2016. Beyond Coercion and Malign Neglect: Black Women and the Struggle for Birth Justice. In
Birthing Justice: Black Women, Pregnancy, and Childbirth. eds. Julia Chinyere Oparah and Alicia Bonaparte, 1-18. New York and
London: Routledge.

Sakala, Carol, Eugene R. Declercq, Jessica M. Turon, and Maureen P. Corry. 2018. Listening to Mothers in California: a
Population-Based Survey of Women’s Childbearing Experiences, Full Survey Report. Washington, DC: National Partnership
for Women & Families.

Vedam, S. 2018. Person-Centered Decision Making. The BirthPlace Lab https://www.birthplacelab.org/decision-makingtool/.

Vedam S, Stoll K, Taiwo TK, Rubashkin N, Cheyney M, Strauss N, McLemore M, Cadena M, Nethery E, Rushton E, Schummers
L, Declercq E; GVtM-US Steering Council. 2019. The Giving Voice to Mothers Study: Inequity and Mistreatment During
Pregnancy and Childbirth in the United States. Reproductive Health. 16(1):77. doi: 10.1186/s12978-019-0729-2.

^[1] Oparah 2016.

^[2] Brigance, et al. 2022; Glass 2020.

^[3] Sakala, et al. 2018; Vedam, 2018.

^[4] Kukura 2017, p. 728.

^[5] Almanza et al. 2022, p.896.

^[6] Davis 2019.

^[7] Vedam, et al. 2019.

New York State Assemblymember Scott Bendett / 107th Assembly District

Dear Attorney General James,

I am sending this letter to you as my written testimony in opposition to the closure of the Burdett Birth Center. I have resided
in Rensselaer County for two decades. Many residents of not only Rensselaer but also Columbia, Washington, and Albany
counties, which I represent, depend on this center. The Burdett Birth Center is the only birthing center in Rensselaer County.

My own chief of staff and his wife welcomed their baby girl into the world this past summer at the Burdett Birth Center. The
importance of keeping this center open is personal to me. I have had many friends in my community have their children
there over the years. At a time when we are already facing a severe shortage of doctors and nurses, removing this critical
resource from our community would be especially detrimental.

As stated in the letter that my colleagues and I sent to your office on July 10th, the NYS Attorney General has reviewed
hospital consolidations in prior instances, and I believe that once again the office of the Attorney General should carefully
review this proposal. I urge you to oppose the closure of the Burdett Birth Center.

Sincerely,
Scott Bendett
NYS Assemblyman
107th District

James A Slavin, MD / Troy, New York

Comment for Proposed Closure of Burdett Birth Center

I am James A Slavin, MD, I practiced orthopedic surgery in Troy for 32 years. I served on the boards of Northeast Health and
St. Peter’s Health Partners (SPHP) from 2004 until 2018. I am a member of the Unity House Board of Directors, past Chair,
and volunteer. I am a board member of the Justice Center of Rensselear County and member of Save Burdett Birth Center
Coalition.

In 2011, Samaritan Hospital merged with St. Peter’s Health Partners, Burdett Care Center was created as an independent
separately- licensed hospital, offering maternity and reproductive services. In 2020, Burdett Care Center closed and was
incorporated into the SPHP/Trinity system. This action stopped the family planning services that had been available at
Burdett Care Center.

In the St. Peter’s Health Partners News, on June 23, 2023, Dr. Steven Hanks wrote:

In fiscal year 2022, the losses incurred through operation of the maternity services unit at Samaritan Hospital, inclusive of
providers, anesthesia, and fixed costs, totaled $2.3 million. This is a service we’ve been operating with substantive growing
losses annually as birth rates continue to decline. Our not-for-profit status requires that we serve the community, but it is
imperative we maintain financial viability to ensure we can serve the entire community in the long term.

In 2021 (the latest available), St. Peter’s Health Partners Form 990, filing reports that for the Officers, Directors, Trustees,
Key Employees, and Highest Compensated Employees, Bonus & Incentive Compensation alone was over two million
dollars. Benjamin Carter, Director & COO was paid a total of $2,525,463. https://projects.propublica.org/nonprofits/
organizations/453570715/202321359349302902/IRS990ScheduleJ

In 2021 (the latest available), ST PETERS HEALTH PARTNERS MEDICAL ASSOCIATES PC Form 990, Schedule J, the top 5
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees were each paid over one million dollars
in compensation.

https://projects.propublica.org/nonprofits/organizations/461177336/202321329349303747/IRS990ScheduleJ

In addition, the new Medicare Area Wage Index for Upstate New York should significantly increase revenue for the SPHP
system.

The Birth Center model of care is cost-effective and has better outcomes for Medicaid patients according to a study done
by CMS.

“Women who received prenatal care in Strong Start Birth Centers had better birth outcomes and lower costs relative
to similar Medicaid beneficiaries not enrolled in Strong Start. In particular, rates of preterm birth, low birthweight, and
cesarean section were lower among Birth Center participants, and costs were more than $2,000 lower per mother-infant
pair during birth and the following year.”

https://www.cms.gov/priorities/innovation/files/reports/strongstart-prenatal-fg-finalevalrpt.pdf

There is a body of medical literature that indicates that the midwife collaborative model of care is both cost effective, has
improved outcomes and had high patient satisfaction rates.

“The care model’s development and application have resulted in a more team-oriented model that is widely accepted
by providers, nurses, and patients. Over the past 4 years, our practice has experienced consistent improvement in
multiple categories. We have achieved a 42.3% reduction in primary cesarean sections through enhanced compliance
with the ACOG standards before proceeding with a primary cesarean section. This reduction was accomplished through
implementation of a checklist based on ACOG recommendations. We have increased our rate of successful VBAC section
by 12.6%, mostly because of increased recommendation by obstetric providers for a trial of labor after a prior cesarean
section. This approach also resulted in a decreased overall hospital length of stay for our patients. We maintained high
levels of neonatal safety with only 2 cases of hypoxic ischemic encephalopathy compared with the national average of 2 to
4 cases per 1000 live births. Patient satisfaction with the new care model has been reported as very high when measured by
a nationally accepted survey.”

Midwife Laborist Model in a Collaborative Community Practice

Mayo Clin Proc Innov Qual Outcomes. 2020 Feb; 4(1): 3–7.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011006/

Closing Burdett Birth Center will significantly affect the quality of life and disproportionately affect mothers and newborns
living in poverty and others who are marginalized in our community.

The excuse that Burdett Birth Center is a financial burden to St. Peter’s Health Partners/Trinity is an insult to the mothers and
newborns of our community considering the salaries paid to the executives and physicians of St. Peter’s Health Partners/
Trinity.

Instead of closing Burdett Birth Center, I recommend that SPHP/Trinity reinvent Burdett Birth Center as a center of excellence
along the line of the Mayo clinic model or the Oula model in New York City. https://oulahealth.com/

James A Slavin, MD

Emily Marynczak / Capital District, New York

I have been an independent childbirth educator and a doula in the Capital District of NY for nearly 30 years. I teach a
comprehensive 12-week course that has a strong focus on learning ways to best support the natural physiological birth
process and empowering pregnant people to navigate the dysfunction of our US healthcare system. I help people learn
to take responsibility and participate in their healthcare decisions, and to reduce unnecessary risk, which often means
choosing midwifery and doula care. For many years the majority of my clients pick Burdett for their midwifery and doula
supported births, there isn’t another option like it in the area.

The US maternity care system adds a lot of unnecessary risk to birth with its reliance on fee-for-service healthcare, and
obstetrician lead protocols for all birthing people including healthy low risk people. Oppressive systemic inequalities and
biases leave non-Whites, gender non-conforming, and poor people at a marked increase in risk of complication and death,
and the current system isn’t very good for rich cis whites either. The headlines in the media are thankfully finally starting to
see that as the richest country in the world, it is a horrendous shame that our maternal mortality rates have been climbing
over the last 30 years for all birthing people. It is particularly shameful because we know how to stop this flow of blood.
The climbing maternal mortality rate is a fixable problem! We have the science, we understand the process, we know how
to help pregnant people stay as safe as they can be given their biology. And a huge part of the solution is the utilization of
doulas and midwives. Burdett Birth Center is a part of the solution. We need Burdett!

The fear of Burdett closing has been keeping me up at night as I toss and turn perseverating my concerns and the facts:
poor people won’t be able to access care. What are they supposed to do take a bus in labor? Babies like to arrive in the
middle of the night! How long would someone have to wait at 3am on a cold winter night for a bus? What if they are
vomiting or bleeding? Would they call an ambulance? Are there enough ambulances in Troy to cope with what is sure to
be an increase in calls if Burdett closes? Won’t people without cars just skip going to prenatal appointments, or going in
for a check if something feels off? Won’t this lead to an increase in ER visits? Burdett has been handling between 800 and
900 hundred births a year, who can pick up that slack? Albany county? Albany Medical Center and St Peter’s hospital are
already at capacity. The wait times in their ERs are the worst in the state already! I have already had at least one client
who spent many hours laboring in a curtained area in an ER at one of the Albany hospitals as there was “no room at the
inn.” What will happen to maternity care in Albany county when their number of birthing people grows to fill in the gap
that would exist if there were no maternity care centers in Rensselaer County? What about the nursing shortages? Where
will the nursing staff come from to manage all the extra births? These questions and concerns all point to the fact that if
Burdett is closed we will have more dead mothers and more people unhappy with their birth experiences. Please don’t let it
get worse than it is right now in NY. We are not winning at maternity care right now, can we really afford to let it get worse?
Let’s not allow a mega corporation to put profits over people. We need Burdett birth center! NY state is ranked only at 13
out of 50 states for maternal mortality. In such a resource rich state, how can we let that standing sink even lower, as it is
sure to do if we lose this vital resource that is the Burdett Birth Center.

The Burdett Birth Center is unique in the area as a truly doula friendly, midwifery model of care. Their excellent outcomes
and their low cesarean section rates all prove that point. Doulas and midwives improve outcomes and birth satisfaction.
Improved outcomes and satisfaction with the birth experience set up families well for their adjustment to family life. We
must be successful in keeping Burdett open or all pregnant people will see an increase in harms, and those most vulnerable
will clearly be the most harmed.

Chelly Hegan, President and CEO of Upper Hudson Planned Parenthood (UHPP)

Testimony on behalf of Burdett Birth Center in opposition to the attempts by Trinity Health to close this valuable community
asset.

I am Chelly Hegan, President and CEO of Upper Hudson Planned Parenthood (UHPP). At UHPP we serve communities in
Albany, Rensselaer, Columbia, and Greene County with a wide array of services. We provide over 16,000 visits for people
seeking sexual and reproductive health care including contraception, preconception counseling, STI testing and treatment,
cancer screenings and abortion. In addition, our amazing staff of nearly 75 people also focuses on transgender healthcare,
including gender affirming hormone services and assessment to provide letters for our patients opting for surgery. Upper
Hudson also offers behavioral health care with consists of mental health counseling, support for social indicators of health
and a wide referral network to connect people to care. Our patients come to us expecting high quality, compassionate,
non-judgmental care. No matter what.

We are connected to the communities we serve not only because of the health care we offer, but because our education
department provides programming in schools and community centers all year long. I stand here today because this
community we care so much for and the patients who are our reason for being have come to rely on the Burdett Birthing
Center as an equally high quality, compassionate and non-judgmental place for care. Troy in specific, but Rensselaer
County as a whole, has been so fortunate that this center is here. When our patients (and in many cases our staff) decides
to start or grow their families this is the place they go. Not only is the skill and sensitivity of the Doulas and Midwives well
regarded, but their access to private insurance or high incomes is not required, but they are easy to access for birthing
mothers and their families. The Burdett Birthing Center is truly central to this community. We – Burdett and UHPP – serve
similar patients. Patients who have historically poorer health outcomes because they may have lower incomes, or they may
be Black or Hispanic. It is mind boggling to me how such an unmitigated success can be eliminated purely because of profit
motives.

As I mentioned we also serve Columbia County. Our Hudson Health center is in the city of Hudson and much like here
in Troy, it is a fully integrated part of the social fabric. A few years ago Columbia Memorial announced that it would
be discontinuing deliveries at that hospital. On the surface it seems like a similar situation. But there were some major
differences. I spent time talking to hospital leaders who reached out to me and some who I contacted independently.
Collectively we discussed what would happen and why this decision was made. And I can share that to me these decisions
were very different. In specific, what happened at Columbia Memorial was focused on patient safety and the quality of
care they could provide. Columbia Memorial was delivering fewer than 600 babies each year. In addition, staffing for
providers and nurses had become impossible to maintain with the hospital relying on travelling staff to fill many gaps. This
was heartbreaking. Hudson too loved having a place that was easy to access by local people. But with so few births and a
county population that is among the oldest in the State there was no way to continue to provide safe service. Most doctors
would tell you that when you don’t provide a service often enough, the risk of complication grows. This was not a risk they
were willing to take.

Looking at the decision by St. Peter’s and their parent company Trinity Health we do not see any of this concern for what is
best for patients. What I see is a birthing center that is best in class with highly qualified Doulas and Midwives with access
to supportive medicine when needed that have health outcomes anyone would be proud of. The Midwife model is widely
seen as successful and patient centric and lower in cost than a purely medical model. And why we are here today as far as I
can understand it, is not that they are failing, but that they are not making enough money. Let me say that again because I
think it is important. They are making money; they are just not making enough money to satisfy a metric somewhere in the
algorithm at Trinity Health.

At Upper Hudson Planned Parenthood we believe that all people are entitled to make health care decision that are best for
them, supported by health care professionals that bring the skill and compassion to deliver it. From our point of view the
Midwives and Doulas at the Burdett Birthing Center believe the same thing and have been delivering on that promise for
years. To close the center now is to say that these people do not deserve to make healthy positive decisions for themselves
and their growing family. For this reason and all the others mentioned by so many others, Upper Hudson Planned
Parenthood is strongly opposed to the Department of Health approving the closure of the Burdett Birth Center.

Noreen McKee, The Justice Center of Rensselaer County, Vice President / Troy, New York

September 18, 2023

Good afternoon,

My name is Noreen McKee. I am a vice president and board member of the Justice Center of Rensselaer County. I have
been a resident of Troy for the last 11 years and I am happy to say that my 3 grandchildren were born at Burdett Birth Center.
I have been retired since 2007. I spent the last 25 years of my career in the for profit world working in accounting (I’m a CPA)
and operations in the financial services industry in New York City. In my last position I was a partner and the chief operating
officer of an investment management company serving institutional clients. I also have work experience in the non-profit
world. I graduated from college as a social worker and my first job was with Catholic Charities.

The goal of my testimony is to provide you with insight into the management and operations of Trinity Health and St.
Peter’s Health Care Partners, which I believe undermines their argument for closing Burdett. And, furthermore, that in
reality they are run more like for-profit organizations rather than tax-exempt non-profits.

I have examined the last 5 years of tax filings by both Trinity and St. Peter’s. I specifically looked at revenue/expense
statements to determine overall profit or loss, and I compared that to total compensation packages for key employees and
the highest compensated who receive a basic comp package, with bonuses when profits are earned. Trinity execs did not
take bonuses when reporting a loss, but made up for it the following year when revenues exceeded expenses. That’s not
the case however for St. Peter’s. During the 5 year period examined, St. Peter’s showed a loss in the first 3 years and in two
of those years, the execs took bonuses.

For the year ending June 30, 2022, the last year in which a tax filing occurred, the total compensation for the CEO of Trinity
was $4,404,461, which included a bonus of $1,900,000. This represents an 84% increase over the previous year when no
bonuses were dispensed to make up for Trinity’s net loss in 2020. However, the bonus of $1.9 million in 2022 represents
a 15% increase over the combined bonuses of $1.66 million received for the two years prior to the year of loss. There’s a
clear pattern of compensating the chief executives based on “profits”. And, even though bonuses are not taken when
losses occur insofar as Trinity is concerned, they are more than made up for in the following year. It’s not hard to draw a
conclusion that the incentive for management is to produce profits and limit losses.

The pattern of comp for St. Peter’s execs is similar though there seems to have been a change in compensation philosophy
from the earliest years examined to the later years. In years 2018 and 2019 losses occurred but bonuses continued to be
issued. During the COVID epidemic and the same year that Trinity suffered a loss in 2020, St. Peter’s execs did not take
bonuses in 2021 to make up for that loss. Coincidentally, this is the same year that Trinity acquired a new CEO. With a
new CEO at Trinity, the parent to St. Peter’s, one could assume that pressure was put on St. Peter’s to limit losses because
contrary to the past at St. Peter’s, losses equal NO bonuses.

Thus, for the year ended 2022, $35 million in total comp when out to the top execs in Trinity ($25 million) and St. Peter’s ($10
million). We wonder, did any of the line staff--the nurses, the midwives, the maintenance workers—receive bonuses?
Another observation gleaned from Trinity’s audited financial statements is that Trinity possesses an enormous investment
portfolio. At June 30, 2021, its value was $5.7 billion with reported investment income of $508 million, which represents
almost 30% of Trinity’s total program revenue. Investment income substantially contributed to Trinity’s bottom line of over
$167 million profit. In comparison, according to Steven Hanks, current president and CEO of St. Peter’s, “in fiscal 2022 the
losses incurred through the operation of the maternity services unit at Samaritan (Burdett) totaled $2.3 million.”

As stated, Trinity’s mission is to “promote optimal health for people experiencing poverty and other vulnerabilities in the
communities we serve by connecting social and clinical care, dismantling systemic racism and reducing health inequities.”
It goes on, “Trinity Health and its member hospitals are committed to the delivery of people-centered care and serving as
a compassionate and transforming healing presence within the communities they serve. As a not for profit health system,
Trinity Health reinvests its profits back into the communities and is committed to addressing the unique needs of each
community.”

In conclusion, with its enormous resources Trinity has the power and finances to sustain the critical work that is performed
at Burdett Birth Center every day. We implore you to compel Trinity to practice their lofty stated goals to reduce poverty
and health inequities by investing a fraction of their substantial profits into Burdett. At little cost, this would keep the
welcoming doors of Burdett open so that they can continue to provide excellent healthcare to the most vulnerable moms
and babies in Rensselaer County.

Thank you.
Noreen McKee
Current Certified Midwife

Medical Professional

I am a medical Professional. I have worked in this state, in this field, in this department for just months shy of 30 years! It
has not always been easy. The hours are long and not often convenient. The work is hard. The work is messy. The bad
days are REALLY bad. But the ability to do what I do is rewarding, it is an invitation to be a part of a woman’s or family’s
most important day of their lives. And to do so in a manner in which they are empowered, proud of themselves, satisfied,
and recalling their birth with fondness....it is beyond description. How fortunate am I? This belongs to all the women- 30
yo suburban housewives, scared college students, newly single women whose partner could not face pregnancy but she
feels she must. Infertility patients who have finally reached their goal and achieved their dream. These women are from
all backgrounds. Brown women, poor women, well off women, drug addicted women, refugees, women who are brand
new to this country and this culture who do not yet even speak English. They all get this treatment, respect, information,
empowerment. We become a part of their lives. We deliver not just babies, but end up being a part of their whole families’
births. And see them year after year for compassionate women’s health care. They will not travel outside of Troy. They will
not go to the chaotic St Peter’s Hospital. Our care is unique.

I don’t know if I can find the words to describe the number of situations I have seen and been a part of since the
announcement of Trinity’s plan to close Burdett Birth Center. These situations, if Burdett doesn’t exist, will be life threatening
for many of our Moms and babies. We have had numerous preterm labor patients come through the emergency room and
just make it up to Burdett in time to birth. We have neonatal resuscitation skills that the ER personnel do not. We have had
Moms come in with placental abruptions, umbilical cord prolapse, fetal distress, and breech presentation- all Obstetric
emergencies of varying severities, but ones that are not appropriate for a 30 minute drive to Albany. In the future these
babies will die. I shutter to think that this really is “all about the money” as the majority of these situations are the poor,
the underserved, the women of color or women who have limited resources. We cannot allow money to matter more than
women and babies. There will be devastating results for our population.

Then there is the physical space that is proposed for our births to go to. St. Peter’s Hospital Labor & Delivery is not physically
spacious enough for our 800-1000 births per year to have rooms to see them- be that triage an OB problem, or for delivery.
I have the unique perspective of working at SPH as well as my usual job at Burdett/SPHP. The labor rooms are rarely not full.
They will say there are renovations currently going on. That is going to provide 3 more triage rooms. Not adequate.

When St Mary’s Hospital and Samaritan Hospital merged in 2011, there was community outcry then and the DOH gave
Burdett Care Center (the entity at the time) the CON contingent upon certain factors that would insure that our type of
midwifery care- evidence based, culturally sensitive care would continue as the model going forward. Once BCC became
a part of St Peter’s Hospital (DBS Samaritan in Troy and BBC for labor & delivery), it seems they said “well, there goes that”.
We can eradicate the board, the Chief of OB (Margaret Holcomb, CNM at the time) and take away any involvement with
Medical Executive Committee as they will be governed by the St Peter’s Chief going forward. Someone who has no idea
how a community hospital operates, has never caught a baby or labored with a patient outside of a tertiary care center.
That person came to govern our practices. This is beside the point but lends to the beginning of our downfall as from then it
was decided that certain groups of women would have to deliver at St Peter’s. So our numbers started dwindling.

For an organization whose mission statement includes “service to the poor”, this closure of Burdett Birth Center certainly is
a slap in the face, and difficult to fathom.

NAACP, Troy Branch / Troy, New York

NAACP Troy Branch position on the closure of the Burdett Birthing Center and its impact on the Black population of
Rensselaer County, New York

The pending closure of the Burdette Birthing Center (BBC) at Samaritan Hospital in Troy, New York, has raised significant concerns
about its potential effects on the local community, particularly the black population. This position paper aims to outline
the potential impact of the pending closure on maternal healthcare access and outcomes within the context of racial
disparity.
The BBC center plays a crucial role in providing quality maternity care services to all residents in Troy and its surrounding
communities. The pending closure will have far-reaching consequences, especially for communities disproportionately
affected by healthcare disparities.

The pending closure of the BBC center threatens to reduce the accessibility of maternal healthcare services for all residents,
particularly the black population. The lack of access to nearby facilities can result in delayed and inadequate care during
pregnancy and childbirth, leading to potential adverse outcomes for both mothers and newborns.

Racial disparities in maternal health outcomes are well-documented issues in the United States. Black mothers are more
likely to experience complications during pregnancy and childbirth, resulting in higher maternal mortality and morbidity
rates than white mothers. The pending closure of BBC will exacerbate the disparities.

Three vital and significant problems are the coordination of prenatal and maternal care; transportation challenges; and
socioeconomic factors. The pending closure of the BBC can further hinder marginalized communities’ access to alternative
healthcare facilities. Lower-income individuals, including many within the black and brown population, will struggle to
afford transportation to more distant facilities, resulting in delayed or suboptimal care. According to the census-reporter.
org, the median age of a Troy resident is 32 and a half years old, and 30% of that population is black and brown citizens. In
addition, the report shows that 23% of this population lives below the poverty level. This rate is more than double the rate
of Albany and Schenectady, which stands at 10.3%. Based on the data, there are economic challenges for the residents of
Rensselaer County, specifically Troy.

The BBC is known for providing culturally competent care for its patients’ diverse needs. The pending closure will lead to
the loss of such specialized care, potentially leaving black mothers and families without the support they require during
pregnancy, childbirth, and postpartum periods.

The NAACP does not support the recommended closure of the BBC in Troy, New York, which presents a pressing concern for the
black population and all residents who depend on quality maternal health care services. Furthermore, the proposed
closure is not consistent with the objectives of the Prevention Agenda 2019-2024, which aims to reduce maternal mortality
in the state by 22% to 16.0 per 100,000 live births and to improve the racial and ethnic disparities in the state maternal death
rate by 34% by the end of 2024.

Addressing the potential impact requires a concerted effort to engage various stakeholders that are experts and lay
persons knowledgeable in the field of maternal mortality, women’s health, public health, and advocates of the underserved
community to ensure that equitable access and care are maintained to ensure disparities in maternal health outcomes are
not exacerbated.

Respectfully submitted
Renee A. Powell
President, NAACP Troy Branch

Mary S. Applegate, MD MPH / Delmar, New York

Testimony regarding proposed closure of Burdett Birth Center, Troy, New York

Mary Applegate, MD MPH September 18, 2023

Thank you for inviting me to testify at this hearing. I’m Dr. Mary Applegate, a public health physician with special expertise
in maternal and infant health. I am an alumna of the Johns Hopkins School of Medicine and am board certified in public
health and preventive medicine. I worked at the NYSDOH from 1992 to 2006, serving as medical director in the Bureau of
Women’s Health. I led the Department’s programs to protect and promote the health of mothers and infants through
access to quality perinatal care, breastfeeding promotion, and maternal mortality research.

I have many concerns about Trinity Health’s proposal to discontinue maternity services at Samaritan Hospital’s Burdett
Birth Center. I will focus my remarks on two issues:

• The importance of the midwifery model of maternity care, particularly for the patient population served by Burdett
• The danger to mothers’ and infants’ health due to increasing travel time between patients’ homes and their source
  of birth care.

Midwifery care:

All of us (whether we’re involved in birth care or not) know that pregnancy and birth are a normal part of life. We also know
that complications can develop during that time. As a physician I have seen many of those complications. Healthy birth
outcomes for mothers and infants require attention to both the healthy and the complicated aspects of pregnancy and
birth.

[Brief aside: While recognizing that some people who give birth do not identify as women, I am using the words woman/
mother/she, but including all birthing parents in my meaning.]

Midwives and physicians (obstetricians and sometimes family doctors) care for women during the whole perinatal period:
pregnancy, birth, and beyond. They approach that care with different, but overlapping and complementary, perspectives
and skills.

Midwives’ primary focus is on promoting and protecting the normal aspects of childbearing while being alert to
complications that require special care.

Physicians’ unique contribution to pregnancy and birth care is their expertise and skill related to diagnosing and managing
complications that need high level medical or surgical intervention such as cesarean delivery. Appropriately, their focus is
directed more to the physical aspects of a woman’s pregnancy, and somewhat less to the emotional and social aspects.

In keeping with their emphasis on birth as a normal life process, midwives focus on all aspects of their patients’ lives, seeing
the pregnancy in the context of their social, emotional, and physical conditions. For optimal birth outcomes, women need
prenatal care that is both medically and socially appropriate and that is integrated with excellent care at birth.

The mothers’ health throughout pregnancy is key to a healthy birth outcome, minimizing the risk of morbidity and
mortality for mother and infant. Because she only sees her heath care provider intermittently during pregnancy, the mother
herself needs to have the knowledge and support to make healthy life choices every day of her pregnancy. Childbearing
is challenging, even when everything goes smoothly. It requires physical and emotional strength, courage, stamina,
and confidence. The mother needs to have confidence in her healthcare team and confidence in herself. Midwives aim
to prepare and empower the mother to be actively engaged in her own health during pregnancy, encouraging her to
see herself as capable of succeeding in having a healthy birth and being a good mother -- among the most important
challenges she will ever face.

Achieving both types of confidence can be difficult for many people during pregnancy, particularly for those who face
hardships related to race, ethnicity, immigration status, language, or LGBTQ status. Many such women have developed
a distrust of the medical system after encounters with situations that were intimidating, antagonistic, or disrespectful,
sometimes to a harmful degree. They may also have developed a low sense of self-confidence after a lifetime of overt and
subtle messages that they are not as good as they should be.

Midwifery patients at Burdett are low risk from a medical standpoint. Those with prenatal complications or with significant
pre-existing medical problems are transferred to an obstetric provider who can meet their needs. The greatest pregnancy
challenges for Burdett patients are social issues such as family strife, food insecurity, domestic abuse, substandard
housing, and language barriers.

In the words of WHO epidemiologist, Dr. Marsden Wagner, in an article comparing birth outcomes in the US with outcomes
in Europe: “Infant mortality is not a health problem. Infant mortality is a social problem with health consequences.”
The midwifery model of care recognizes the wisdom of Dr. Wagner’s observation and focuses on addressing the mother’s
social problems as well as her medical needs.

Public health statistics bear out the value of midwifery care. It has been shown to be a safe and healthy perinatal option for
women at low medical risk. It can reduce the risk of low birthweight and increase breastfeeding rates, two factors that help
prevent infant deaths.

Health impact of increased travel time

Rapid access to skilled maternity care is essential in pregnancy. Complications can arise at any point in the childbearing
period, sometimes with little warning and requiring immediate care. Life threatening obstetric emergencies are rare, but
because of their gravity, they demand special attention. The most serious obstetric emergencies include:

• hemorrhage (a top cause of maternal mortality)
• umbilical cord compression shutting off the infant’s oxygen supply
• uterine rupture, due for instance to accidental injury in a motor vehicle crash or intentional injury from an assault

Emergency Room physicians and nurses can usually stabilize the mother’s immediate condition, but definitive treatment
poses special challenges unique to pregnancy: changes in anatomy and physiology can lead to hemorrhage that is more
severe and harder to control; some complications are due to conditions like eclampsia that occur only in pregnancy;
and the obstetrician needs to consider the wellbeing of both the mother and the infant. As a result of those factors,
definitive treatment for an obstetric emergency may be delayed while the mother is transferred to a hospital with obstetric
capabilities, increasing the risk of a bad outcome.

If Burdett closes there will be no birthing service in all of Rensselaer County and in a largely rural surrounding region.
Transportation difficulties will pose a major burden and danger, especially for families who live in remote part areas and
for those who rely on public transportation. CDC data indicate that the risk of maternal mortality is highest in rural areas

without rapid access to obstetric care: the rate of maternal deaths per 100,000 births is 26 in rural areas, compared with
only 16 in urban communities.

For all of the reasons outlined above, closure of the Burdett Birth Center should not be allowed. It will risk great harm to the
health of birthing parents and their infants. At the community level, eliminating this vital service puts the public’s health in
jeopardy. It would risk increasing rates of prematurity and low birthweight, reducing rates of breastfeeding, and ultimately
increasing rates of infant and maternal mortality. Families’ health should not be put in such danger.

Lois Uttley / Troy, New York

Testimony of Lois Uttley, MPP
NYS Attorney General’s public hearing on proposed closure of Burdett Birth Center, September 18, 2023,
Troy, New York

Introduction and overview

Good afternoon. I am Lois Uttley, founder of the statewide coalition called Community Voices for Health System
Accountability (CVHSA). I have more than 25 years’ experience tracking hospital consolidation and helping communities
protect access to key services, including comprehensive reproductive and maternity care, when hospitals are merging,
downsizing or closing. I hold a Master’s in Public Affairs and Policy from Rockefeller College, have authored numerous
reports and journal articles on hospital consolidation, and teach in the Master’s in Health Advocacy Program at Sarah
Lawrence College. I am grateful for the opportunity to offer some remarks today urging the state Attorney General’s Office
to hold the St. Peter’s Health Partners accountable for its responsibility to preserve timely access to high quality labor and
delivery services here in Rensselaer County.

The proposed closure of the Burdett Birth Center at Samaritan Hospital by the St. Peter’s Health Partners system would
violate the promises St. Peter’s made to this community when it took over Samaritan Hospital in 2011 and created the
separately-licensed Burdett Care Center to preserve access to comprehensive reproductive health services. It would
also violate promises St. Peter’s made in 2020 that ending the Burdett Center’s independent status and absorbing it into
Samaritan Hospital would preserve access to maternity care in Rensselaer County.

Moreover, the closure would appear to violate the non-profit charitable missions of both St. Peter’s Health Partners and
its parent Trinity Health System. As Catholic health facilities, they are governed by the Ethical and Religious Directives for
Catholic Health Services, which emphasize the importance of “the biblical mandate to care for the poor” and for uninsured,
underinsured and otherwise vulnerable and marginalized people among.¹ Moreover, St. Peter’s declares on its website a
dedication to diversity, equity and inclusion.²

Yet, St. Peter’s is proposing to close a birth center where 55% of the patients are insured by Medicaid, and in a city (Troy)
where more than 25% of the population lives in poverty and 22 % of the households have no cars that could be used to drive
to other hospitals.³ This proposed closure would harm health equity and the medically-underserved people who depend on
the Burdett Care Center.

¹ See Part One, The Social Responsibility of Catholic Health Services, in the Ethical and Religious Directives for Catholic
Healthcare Services, accessed here: https://www.usccb.org/resources/ethical-religious-directives-catholic- health-servicesixth-
edition-2016-06_0.pdf

² For example, the St. Peter’s Health Partner’s website declares: “The issues women, people of color, people with disabilities,
LGBTQ+, religious minorities, and other marginalized groups face are our responsibility to understand and address.
Everyone deserves to have an equal opportunity to be as healthy as possible. One of our primary focuses is to create a plan
that addresses and removes any and all barriers to optimal health for all.” Accessed on September 11, 2023, at https://www.
sphp.com/about-us/diversity-and-inclusion

³ Source: 2021 American Community Survey (5-year estimates).

Decades of hospital consolidation have harmed community hospitals

How did we arrive at a place where the people of Rensselaer County are faced with the imminent prospect of having
not a single labor and delivery service in the entire county? This is, in microcosm, the story of how hospital consolidation
across the U.S. and in New York State has created large regional and multi-state health systems. These systems acquire
community hospitals by promising to improve the quality of care and bring financial viability. But unfortunately, these
systems often turn around and strip communities of key health care services and sometimes, entire hospitals.

More than 40 community hospitals have closed across New York State over the last 25 years, according to a study I led with
support from the New York Health Foundation⁴. The remaining independent hospitals have mostly joined one of the big
regional or national health systems. Our study found that 70 percent of the acute care hospital beds in New York State are
now controlled by these large systems. Unfortunately, however, hospital membership in one of these systems has often
failed to protect community access to care or even served to improve financial viability of local hospitals. Community
hospitals acquired by these large systems have often been forced to shutter emergency departments, inpatient psychiatric
care, dental clinics and -- of particular relevance to this public hearing -- maternity services. Patients who were accustomed
to receiving acute care services in their own communities have been forced to travel to the “hub” or anchor hospitals in
these systems, a so-called “hub and spoke” health system business model that is clearly playing out here in the Capital
District.

St. Peter’s expands into Rensselaer County, making promises and then breaking them

In 2011, St. Peter’s Hospital expanded its reach beyond Albany County by merging with Northeast Health, a non-Catholic
health system, and Seton Health, a Catholic system. The resulting system, St. Peter’s Health Partners, included not only St.
Peter’s, but also Albany Memorial Hospital, Samaritan Hospital and St. Mary’s Hospital in Troy. Maternity care from both
St. Mary’s and Samaritan was consolidated into the Burdett Care Center, a separately-licensed “hospital within a hospital”
on the second floor of Samaritan Hospital. The purpose of the center was to protect reproductive health and maternity
care from prohibitions on those services by the Catholic religious directives, which were imposed on the rest of Samaritan
Hospital as a condition of the new ownership by St. Peter’s. Although abortions could not be allowed, contraception and
post-partum tubal ligations were permitted. I was one of the community partners who worked with then -Northeast Health
CEO Dr. Jim Reed to bring about this solution.

I was, therefore, dismayed to learn in 2020 that the Burdett Care Center would be abolished as separate entity and its
maternity care absorbed into the rest of Samaritan Hospital, thus becoming subject to Catholic religious restrictions
on reproductive health care. Samaritan and St. Peter’s officials argued that the Burdett Care Center was not doing
well financially, and that maternity care in Rensselaer County could only be preserved through this move. This was a
tremendous broken promise to the community.

Now in 2023, St. Peter’s and its parent Trinity Health System are once again breaking their promises to the community. This
time, they want us to believe that Samaritan Hospital can no longer afford to operate the Burdett Birth Center, because it is
losing $2 million a year. Therefore, St. Peter’s asserts, the promise to maintain maternity care in Rensselaer County cannot
be kept.

⁴ Empowering New York Communities in an Era of Hospital Consolidation, New York Health Foundation and the MergerWatch
Project, 2018, accessed at https://nyhealthfoundation.org/resource/empowering-health-consumers- in-an-era-of-hospitalconsolidation/

Can St. Peter’s really not afford to keep maternity care in Rensselaer County?

St. Peter’s Hospital was part of a regional health system called Catholic Health East, which merged with another Catholic
system, Trinity Health, in 2013. Since then, Trinity has grown to become the third largest Catholic health system in the nation
and sixth-large private health system overall. How large is it? A report I co-authored in 2020 found that Trinity controlled 111
hospitals, as well as 106 urgent care centers and 53 physician practices. The system, headquartered in Michigan, has total
assets of $31 billion⁵, according to its most recent financial reports, and pays its President more than $3 million a year in
total compensation, according to its IRS 990 filings.

Think about that for a minute. A system with $31 billion in assets, whose President earns $3 million a year, says it desperately
needs to shut a birth center in Troy which it says is losing $2 million a year!

Perhaps the urgency to close the Burdett Birth Center has been spurred by the current financial woes of both Trinity and
St. Peter’s Health Partners. Just a few months ago, in March of 2023, Trinity reported that for the first nine months of its
current fiscal year, it had an operating loss of $298 million⁶. St. Peter’s Hospital – the hub of the St. Peter’s Health System
that includes Burdett – reported a $43 million loss in operating income for the year ended June 30, 2022, which was offset
somewhat by other revenues but still produced a total net loss of $19.7 million. By contrast, Samaritan Hospital reported
essentially breaking even on operating expenses and revenue during that same period ending June 30, 2022, with a surplus
of $153,074 and, when other revenue is counted, net income of $10.3 million.

Again, we must ask: Why is this system closing a birthing center at a hospital that overall is breaking even, instead of at St.
Peter’s or in the administrative ranks of the Trinity Health System, which are both losing money? Clearly, having joined St.
Peter’s Health Partners and the Trinity Health System has not helped to protect access to services at Samaritan Hospital.

Other Trinity Health System hospitals are also suffering cuts. St. Joseph’s Health in Syracuse, another Trinity Health hospital,
just announced it is closing its in-home health care service, forcing 250 patients to find alternative sources of care.⁷ Trinity
Health’s Chelsea Hospital in Michigan is closing its inpatient behavioral health unit.⁸ Trinity Health New England has closed
a home health and hospice unit in West

⁵ See Trinity Health 2022 financial statement here: https://www.trinity- health.org/assets/documents/financials/trinityhealth-
fy22-financial-statements-long-form-final.pdf

⁶ See Fierce Healthcare magazine’s summary of Trinity financials here: https://www.fiercehealthcare.com/providers/
trinity-health-logs-298m-operating-loss-merger-fueled-revenue- growth-h1- 2023#:~:text=Trinity%20Health%20logs%20
%24298M%20operating%20loss%20along%20with%20merger,revenue %20growth%20in%20H1%202023&text=Trinity%20
Health%20reported%20a%20six,that%20grew%20faster%20tha n%20revenues.

⁷ See article about this closure in Becker’s Health Care: https://www.beckershospitalreview.com/finance/trinity-to- closenew-
york-home-health-agency-lay-off-63.html

⁸ WXYZ Detroit reporting here: https://www.wxyz.com/news/chelsea-hospital-to-close-in-patient-behavioral- health-unit-atthe-
end-of-the-year

Springfield, Mass., and laid off numerous other employees in Massachusetts facilities⁹ The system has been asking the state
of Connecticut for permission to formally close the labor and delivery unit at its Johnson Memorial Hospital, which stopped
deliveries during the pandemic using flexibility granted to Connecticut hospitals during the pandemic emergency, but then
never resumed them when the emergency rules expired, prompting state officials to levy a heavy fine.¹⁰

Burdett’s closure would harm medically underserved people and health equity

The consequences of all this hospital consolidation and downsizing became painfully clear when COVID- 19 hit New
York hard in early 2020. Some communities – particularly those serving Black and brown people, as well as people with
low incomes -- had been left without adequate access to desperately- needed health care, and were crowding into the
remaining hospitals, overwhelming the facilities. I and other New York health advocates recognized that something had to
be done to slow or halt the closing of hospitals and key services, and to protect access to care for New Yorkers who are the
most vulnerable. We approached Senate Health Committee Chair Gustavo Rivera and then-Assembly Health Committee
Chair Richard Gottfried, who worked with us to draft and then introduce the Health Equity Impact Assessment Act.

This new state law, which went into effect on June 22 of this year, requires that when a hospital is proposing to eliminate
or reduce services, there must be an independent assessment of the likely impact on health equity and on specific groups
of medically-underserved people. These groups include women, LGBTQ+ people, racial and ethnic minorities, immigrants,
people with disabilities, people with low incomes, people with Medicaid insurance or no health insurance, rural residents
and older adults. The purpose of the assessment is to flag for state health regulators any negative impacts on medically-underserved
people and recommend whether there are ways to mitigate these impacts. An equity impact assessment
must include “meaningful engagement” of the affected community.

The proposed closing of the Burdett Birth Center is the first health facility transaction to undergo a health equity
assessment. St. Peter’s initially appeared to have avoided the need for such an assessment by submitting its Certificate
of Need application to the state Department of Health just two days before the health equity law took effect. But, after
considerable public criticism, St. Peter’s agreed to commission the assessment on a voluntary basis.

As one of the people who advocated for passage of the new health equity law, I was excited to see it in action and so
have been closely monitoring the progress in Troy. How is it going? Not well, I’m sorry to report. St. Peter’s hired a national
consulting firm, Chartis, to conduct the equity assessment. Chartis staff prepared and circulated an on-line survey for
people to fill out, but initially gave the community only five days to respond. That timeline was extended after I and
Assembly-member McDonald complained to the state Department of Health that this did not constitute meaningful
engagement of the community. The survey was also flawed by its failure, initially, to ask any demographic questions, thus
making it impossible to determine whether the respondents were members of any of the medically- underserved groups for
whom the assessment is supposed to determine the likely impact of the closing.

⁹ https://www.masslive.com/news/2022/07/trinity-health-closing-home-health-and-hospice-care-in-west- springfield-laysof-
60-workers.html

¹⁰ https://ctnewsjunkie.com/2023/07/12/johnson-memorial-hospital-makes-a-case-for-closing-maternity-ward/

Again, after complaints to the Health Department, the survey added a question about whether the respondent is a
member of a medically-underserved group. But the survey did not explain which groups are considered to be medicallyunderserved,
and the drop down menu of choices began with “Not a member of a medically-underserved group.” Finally,
the survey was distributed only in English, not in Spanish or one of the other languages spoken by immigrant Troy residents.
As to required engagement with key organizational stakeholders and public health experts, we are only aware of a single
one-hour meeting with a handful of non-profits serving the community and know that Chartis has not met with the Save
Burdett Birth Center Coalition.

Anticipating that the health equity assessment commissioned by St. Peter’s might be inadequate, the coalition working to
save Burdett Birth Center decided to do its own community-led health equity assessment, which is nearly complete and will
be submitted to the state Department of Health shortly. The community-led effort utilized multiple methods of meaningful
community engagement, including an on-line survey and follow-up interviews with dozens of individuals who responded to
the survey. The community engagement also included weekly outreach at the Troy Farmer’s Market, a speakout at the local
YWCA and, on Aug. 23, a public forum attended by more than 250 people. By the way, staff of the Chartis firm showed up
at the forum, but refused to enter and listen to what people in the community had to say, explaining that their assessment
needed to be “unbiased.” Instead, Chartis staff stood outside the forum room, trying to get people to fill out their flawed
survey. The community-led assessment also included extensive data gathering about the demographics of the people
living in the service area of the Burdett Birth Center and the people who have given birth there.

You will hear from members of the coalition in detail today about the key findings of their health equity impact assessment.
You will also hear from some of the individuals who responded to the survey, or who spoke out at the community forum. I
want to close by giving you an Executive Summary of what the community-led assessment found.

Representatives of multiple medically-underserved groups – women, racial and ethnic minorities, LGBTQ+ people, people
with low incomes, Medicaid-insured patients, rural residents and people with disabilities – all told the coalition that closure
of the Burdett Birth Center would negatively affect their ability to obtain timely, quality obstetric care. The assessment
found that 55 percent of Burdett’s patients are Medicaid-insured and depend on having labor and delivery within
convenient reach in Troy. Moreover, Burdett has a c-section rate far lower than other local hospitals, which gave pregnant
people confidence that they would not be forced into unnecessary interventions.

The community-led assessment found significant challenges to patients in traveling to obtain timely care – longer trips to
labor and delivery units from Troy, especially for the many low-income pregnant patients who do not have cars and face
either hour-long bus trips to Albany or Uber/Lyft trips of $40 or more that they cannot afford. Medi-cabs must be scheduled
and cannot be used for pregnancy emergencies. The Troy Fire Department’s EMS service has only four ambulances and
is already overburdened. Residents of Rensselaer County’s more rural areas would face car trips of an hour or more, if
they have private vehicles, and have no access to buses or to Uber/Lyft pickups. Even if patients suffering a pregnancy
emergency could manage to reach a hospital in Albany, they might not be able to get back home that same night if they
were stabilized and discharged.

But even if the transportation challenges could somehow be solved – and we found no evidence they could – the removal
of the only labor and delivery unit in Rensselaer County would also mean the elimination of the only midwife-led, low
intervention birthing site in the Capital District. Women and LGBTQ+ people from Rensselaer County and other locations
across the Capital District – especially those who are Black and Latinx – said they were particularly dismayed at the
prospect of losing a labor and delivery service that they have experienced as culturally competent, respectful and patient-centered.

The conclusion of the community-led assessment was inescapable: Closure of the Burdett Birth Center will do nothing to
improve health equity and much to harm it. I urge the Attorney General to protect the people of this community from that
harm by preventing the closure of the Burdett Birth Center.

Tisha Graham / Capital Region, New York

Testimony for Attorney General Letitia James — public hearings on the proposed closure of the Burdett Birthing Center
in Troy, New York
September 18, 2023
Respectfully submitted by Tisha Graham
Certified professional midwife, certified doula, certified childbirth educator, certified lactation counselor
Co-founder, board member, BirthNet NY
Member, The Doula Network of the Capital Region
Owner, Rites of Passage – Professional Support for Birth and Beyond

As a person in the Capital Region who wears many hats regarding both birth work and birth advocacy, I thank you for the
opportunity to testify today regarding the proposed closure of the Burdett Birth Center in Troy, New York. I stand before you as
someone who, for the last three and half decades, has been a provider of clinical, physical, educational and emotional
care and support of pregnant people, as well as an activist, fighting for the reproductive rights of families and their babies,
specifically as those rights relate to the access of the Midwifery Model of Care.

Why? In short: Midwives Save Lives – the midwifery model at Burdett centers on individualized, compassionate and
collaborative care with far fewer interventions which result in more favorable outcomes which ultimately decreases
mortality and morbidity of the most vulnerable populations of people living in Rensselaer County. Black and Brown birthing
people, whose birth experiences and clinical outcomes are far worse than those of their white counterparts, have far better
outcomes, with greater health, wellbeing, and satisfaction, as do their babies, when cared for in the collaborative midwife/
OB model that Burdett offers.

The universal reaction of outrage and disbelief in the birth community, in Rensselaer County, and in the greater Capital
Region as word spread of the proposed closure of the Burdett Birth Center took the shape of the Save Burdett Birth Center
Coalition, of which I am a proud member. This broad coalition of individuals and organizations, politicians and labor
leaders, health care providers and families represent just some of the many stakeholders who are committed to keeping
the Burdett Birth Center open.

Why? Because what we have here in the city of Troy is a unique place with stellar statistics and a compassionate staff of
custodial and nutritional service providers, techs, nurses, midwives and doctors, all working together to provide a positive
and respectful experience for all who look to Burdett for care. As a doula who has attended hundreds of births at Burdett
over many years, I can personally attest to the experience of JOY that families experience when they give birth at Burdett. I
want to testify today about joy in birthing.

Joy is the result of an experience that fosters shared decision making, agency, autonomy, choice, voice, freedom from
coercion, being treated with respect, and having a healthy outcome. Joy increases satisfaction with the birthing experience
which results in greater success with breastfeeding and lower incidences of postpartum anxiety and depression. Joy, then,
translates into healthier parents, healthier babies, happier families and stronger communities. Not to mention healthcare
savings for everyone.

We don’t often look at healthcare savings through the lens of low interventions, far fewer surgeries, less operative deliveries,
more vaginal births, and higher VBAC rates - all of which result in greater success with breastfeeding and with happier,
healthier mothers and babies. When a healthcare conglomerate such as Trinity Health determines one of its facilities
should close because they are LOSING money – they are punishing providers and a facility for managing maternity care
correctly – for having better outcomes, for lowering healthcare costs, for saving money!

What generates money in maternity care is more frequent and often medically unnecessary use of common interventions
and higher surgical birth rates – what puts birthing people at risk is more frequent and often medically unnecessary use of
common intervention and higher surgical birth rates. It’s an old story. One that puts profits before people. Shame on Trinity
Health, and shame on St. Peter’s Health Partners. We call upon the Department of Health to recognize that a community
that is exposed to less medical management than with more is a community where healthcare thrives. This is especially
true for a community that has been historically disenfranchised, disrespected and denied access to optimal outcomes.

Burdett Birth Center does birth well, they do birth right. They should be the example of what we want and need more
of, not less of. Burdett must remain open. It is a shining example of optimal health care, and it has a direct and positive
impact on the wellbeing of our communities. To close it would be unconscionable and criminal.

Thank you.
Tisha Graham

Michelle Ostrelich / Schenectady County, New York

Testimony Of Michelle Ostrelich
Troy — Burdett Birthing Center public hearing
September 18, 2023

Good afternoon. I am Michelle Ostrelich, a Schenectady County Legislator and a founding member of the Schenectady
Coalition for Healthcare Access – fighting cuts in services and educating the public about the risks of the proposed merger
between Ellis, our community hospital, and St. Peter’s Health Partners, part of Trinity Health.

Now, why in the world would someone from Schenectady come all the way across the river to talk to you about the closure
of Burdett? First of all, because healthcare in the Capital Region is interconnected and what happens in the eastern part of
the Capital Region will undoubtedly affect the care of residents to the west in Schenectady County.

Historically, there were three independent hospitals in Schenectady County that had all offered labor and delivery – Ellis,
St. Clare’s and Bellevue Woman’s. In 2006 the “Berger Commission”¹ forced the three hospitals to merge, and a choice was
made to eliminate any affiliation with the Catholic church that existed at St. Clare’s. The misspending of St. Clare’s pension
fund is the subject of an investigation by the Attorney General, and we are very grateful for that. But today I’m focusing on
Bellevue which is now part of Ellis Medicine and our only option for labor and delivery in Schenectady County. Bellevue is
still located on its original campus. It is still secular and highly-regarded throughout the Capital Region. And it still offers
comprehensive reproductive care including labor and delivery, a NICU, pre- and postnatal care, all types of birth control
including sterilization as well as abortion care.

Bellevue and Burdett are about 16 miles apart, and in between are Albany Medical Center and St. Peter’s Hospital which
also offer labor and delivery. By eliminating Burdett, 900 births will likely be pushed to Albany Med, St. Peter’s, or Bellevue.
That means there will be a significant pressure on those hospitals to absorb cases, leaving less resources like OR time,
OB/GYN and midwife patient capacity, and office appointment time for pre- and postnatal care. Close Burdett and
Schenectady residents will have less opportunity to obtain the care they need.

The second reason I’ve traveled across the river is because of a frightening pattern – what happens to Burdett happens to
Bellevue. The parallels between the populations of the cities of Troy and Schenectady, which, compounded by the parallel
histories of the hospitals in Rensselaer and Schenectady counties, mean that closure of Burdett sets a very dangerous
precedent for all of us in the Capital Region.

Compared to the surrounding suburban and rural areas in their counties, residents in the cities of Troy and Schenectady
both have significantly higher rates of poverty, people under 65 living with a disability, percentages of Black, Brown, Asian,
Latino & Hispanic residents,² households without access to a car,³ and residents who are publicly insured and uninsured.⁴
The demographic indicators of marginalized and medically underserved residents in the communities served by Burdett
and Bellevue are undeniably similar. My written testimony includes citations and links to the data.

And regarding reproductive care, we’ve noticed a pattern when St. Peter’s/Trinity Health expands and dominates into our
communities – first it becomes limited and then eliminated.

In Troy, through a series of mergers, Samaritan came under the St. Peter’s-Trinity umbrella, and promises were made that
comprehensive reproductive care would continue at Burdett. We watched Burdett exist for five years as an independent
healthcare facility, free from Trinity’s restrictions⁵ on birth control, tubal ligations, vasectomies, abortion care and
now trans care. We watched how, despite promises of Burdett’s continued independence, it was taken over by St.
Peter’s and Trinity Health. We watched as comprehensive reproductive care was eviscerated at Burdett. We watched
knowing that people who needed those services were likely denied care at their community hospital. And because of the
disproportionate number of residents who are poor, disabled, racial and ethnic minorities, without cars, without insurance
or on Medicaid, who already face barriers accessing healthcare, who already face factors that negatively affect their
health, who are the most marginalized and the most vulnerable, many simply won’t get the care they need.

The merger in Schenectady is following a similar path. Without substantial Department of Health review, St. Peter’s and
Trinity have come onto campus to manage Ellis and Bellevue,⁶ and we’ve been promised that comprehensive reproductive
care at Bellevue will continue. And yet, we know it’s just a matter of time. Just like Samaritan, Ellis will also likely come under
the St. Peter’s-Trinity umbrella and with it, Bellevue. Comprehensive reproductive care will be eviscerated and those archaic
non-medical institutionally-imposed prohibitions on birth control, tubal ligations, vasectomies, abortion care and trans
care will be put in place.

And now? Now we are witnessing an attempt to close Burdett altogether. We didn’t even think that Trinity Health might
plan to close Bellevue. But now, watching Burdett’s path, we have every reason to be worried.

With so many similarities between Troy and Schenectady and Burdett and Bellevue, if Burdett can so easily be closed
without regard for the over-represented medically underserved community members, then what hope will Bellevue have?
How will we be able to fight the inequities that come with cuts to reproductive services? How could we fight the closure of
Bellevue? Without Burdett and Bellevue, how will Albany Med absorb all of the patients seeking comprehensive reproductive
care including abortion care? Something as typical as a tubal ligation during C-section will become unattainable.
Trinity Health must be held accountable now to our Capital Region community and stop taking away reproductive
healthcare from our residents. Thank you.

Endnotes

¹ Formally known as the “New York State Commission on Health Care Facilities in the 21st Century.”

² https://www.census.gov/quickfacts/fact/table/schenectadycitynewyork/PST045222;https://www.census.gov/quickfacts/
fact/table/schenectadycountynewyork/PST045222;https://www.census.gov/quickfacts/fact/table/troycitynewyork/
PST045222;https://www.census.gov/quickfacts/fact/table/rensselaercountynewyork/PST045222.

³ In Troy, 21.8% of occupied housing units have no vehicles available. In the City of Schenectady, 20.4% do not have a car.
https://data.census.gov/table?tid=ACSDP5Y2021.DP04&g=040XX00US36_160XX00U S3675484&hidePreview=true; https://
data.census.gov/table?tid=ACSDP5Y2021.DP04&g=160XX00US3665508_040X X00US36&hidePreview=true

In the counties of Rensselaer and Schenectady (which include the suburban and rural areas surrounding the cities of Troy
and Schenectady) only 10% and 12% of occupied housing units have no vehicles available respectively. https://data.census.
gov/table?tid=ACSDP5Y2021.DP04&g=050XX00US36083_040XX0 0US36&hidePreview=true; https://data.census.gov/
table?tid=ACSDP5Y2021.DP04&g=050XX00US36093_040XX0 0US36&hidePreview=true

⁴ In the city of Troy, 4.1% of the population are uninsured and 45.8% are publicly insured, and in the City of Schenectady,
6.3% of the population are uninsured and 50.4% are publicly insured.

https://data.census.gov/table?tid=ACSDP5Y2021.DP03&g=040XX00US36_160XX00U S3675484&hidePreview=true; https://
data.census.gov/table?tid=ACSDP5Y2021.DP03&g=040XX00US36_160XX00U S3675484&hidePreview=true

In Rensselaer County, 3.4% of the population are uninsured and 36.8% are publicly insured, and in Schenectady County,
3.9% of the population are uninsured and 39.9% are publicly insuredhttps://data.census.gov/table?tid=ACSDP5Y2021.
DP03&g=050XX00US36083_040XX0 0US36&hidePreview=true; https://data.census.gov/table?tid=ACSDP5Y2021.
DP03&g=050XX00US36093_040XX0 0US36&hidePreview=true

⁵ https://www.usccb.org/about/doctrine/ethical-and-religious-directives/upload/ethical-reli gious-directives-catholichealth-
service-sixth-edition-2016-06.pdf; andhttps://www.usccb.org/resources/Doctrinal%20Note%202023-03-20.pdf

⁶ In August, 2021, Ellis submitted a proposed Management Services Agreement (MSA) to the New York State Department
of Health (DOH). Although the Coalition for Healthcare Access submitted objections to the MSA, there is no allowance for
public comment under 10 NYCRR 405.3(f), which governs review of management services agreements by the DOH.The MSA
was approved in November, 2021.

United Way of the Greater Capital Region
September 15, 2023

Please accept this testimony submitted to the Office of the New York State Attorney General on the subject of the proposed
closure of Burdett Birth Center, the only labor and delivery facility in Rensselaer County.
Submitted by the United Way of the Greater Capital Region:

Peter Gannon, President & CEO
Claire Reid, Chief Impact Officer
Heather Senecal, Director Learning & Evaluation

Testimony:

A decision to save Burdett is a decision to uphold the right of every person to birth safely. It is a decision to respect birthing
women’s and people’s autonomy. It is a decision to save lives.

St Peter’s Health Partners and its parent Trinity Health Care System’s decision to do otherwise, to close the only birthing
center in Rensselaer County and the only midwife drive care model in the Capital Region, is by contrast a decision to
support profit over people, so-called efficiency over quality care.

I. What will be the impact of the closure? The closure will accelerate an already worsening maternal mortality crisis.

With slightly more than half of its patients eligible for Medicaid, Burdett has been a lifeline for many of the most
underserved members of our community. In a community where access to care is already limited, this would halt years of
progress toward building a more equitable healthcare system in the Capital Region.

This attempted closure comes at a time when we are already facing a worsening maternal mortality crisis. Maternal deaths
have been on the rise across the US. 1 in 6 women report experiencing mistreatment during childbirth and 32% of deliveries
are cesarean section, a major abdominal surgery. While it is a life- saving procedure, its overuse is well documented with
drastic consequences for mom and baby. Black and Brown mothers experience worse outcomes than any other race,
irrespective of income and education levels. Black mothers have higher rates of preterm births. Prematurity is a leading
cause of infant mortality and has been linked to lifelong conditions like behavioral development issues, learning difficulties,
and chronic disease. Black and brown women are more likely to have a baby with a low birth weight and have the highest
rates of cesarean births. All of these facts significantly impact the morbidity of mother and baby. Black women in NYS are
nine times more likely to die from a pregnancy-related death compared to white New Yorkers, and about five times more
likely on average nationally, according to the CDC.

This closure will adversely impact a number of the people in our community who are already identified as underserved as
per the New York State Health Equity Law. Women, expectant mothers and birthing people, and in particular those who are
low-income and who are Black, Brown, Indigenous and Latina are disproportionately impacted by this proposed closure.

II. Closing Burdett does not make financial sense, for the entire community

St. Peter’s Health Partners’ reason for closing the health center is financial. Keeping the birth center open also has strong
financial reasons. Given that almost half of all pregnancies in the United States are unintended, it is frequently difficult
for people to anticipate and build sufficient savings to cover maternal health-related costs. The Federal Reserve noted in
2021 that nearly 40 percent of people in the United States could not cover an unexpected $400 expense (a percentage
that has almost certainly grown as a result of the current economic crisis). (Fields Allsbrook & Ahmed, 2021) There is a
financial burden placed on families when they have to travel farther to access care. These costs continue to compound
when you think about the extra distance, time, and difficulty of accessing care during your pregnancy, birthing your
baby and then follow-up visits for both the mother and child. What does this mean? Maybe you miss a few prenatal visits
because the health center is too far away or overburdened and you can’t get an appointment at a time that works for your
schedule, maybe you don’t have access to a personal vehicle and the taxi cost is too high for you? Maybe all the extra costs
associated with going farther away to birth your baby means that you don’t have enough money for food, diapers, or fall
behind on rent or utilities. That’s if the birth goes smoothly and there are no complications for either the mother or the child.

These aren’t just hypotheticals; we know from our research on dignified living standards (ALICE Research project) that in
Rensselaer County 39% of households (~25,908) do not have sufficient resources to meet their basic needs on a regular
basis, including costs associated with housing, utilities, food, childcare, healthcare, and transportation. Approximately 13%
of these households are in poverty but double that (26%) are above the Federal Poverty Level, unable to access additional
resources (public assistance programs) because they are above the income thresholds.

Not surprisingly, people living in poverty are less likely to have a car to drive to a different hospital. In Troy, for example,
22% of the households have no car. In the more rural communities, this is also a challenge. In Hoosick, for example, 12% of
households have no car.

It can surely not be a reasonable expectation that person in labor take public transit. With no direct route, never mind the
very obvious reasons for why no birthing person would want this, the trip could take 1-2 hours.

That leaves the option of hiring a ride service or taxi. From Downtown Troy to St Peters in Albany or to Belllevue, a one-way
trip would run approximately $40. More if it’s the middle of the night. To Saratoga, the cost would be $72. From Hoosick
Falls to St Peter’s, $100. This cost will be a significant barrier to women accessing pre-natal care, postnatal care, and
birthing safely.

Med Cab Corp is not an option as they clearly state they will NOT drive people in labor.

That leaves ambulances. The President of Firefighters Local 86- which has 4 ambulances- clearly stated at the August
23rd public forum held in support of Burdett: “There is not enough staff or ambulances to take on this additional burden
of adding drive time to Albany or surrounding areas. We have been short-staffed for years. It puts us at risk and the
communities we serve at risk. It creates longer wait times for patients, delay care, longer response times (and wait times in
the ambulance outside the hospital.”

What is the cost to the community if Burdett closes? Besides all the midwives, clinicians and health care workers no longer
being employed or being transferred to locations much farther away, it also means the surrounding community feels
the lack. The American Hospital Association (of which Trinity Health is a member) states that “Hospitals are Economic
Anchors in their Community” and that the goods and services hospitals purchase from other businesses create additional
economic value for the community. With these “ripple effects” included, each hospital job supports about two additional
jobs, and every dollar spent by a hospital supports roughly $2.30 of additional business activity. (Hospitals are Economic
Anchors in their Communities, 2017). We are not suggesting that it is the Attorney General’s job to ensure the economies
of local communities, however, we highlight this attempted closure as part of a trend we are seeing across the country; a
systematic approach to under or dis-invest in low income urban and rural communities where many patients do not have
private insurance.

III. Burdett offers a unique and prized approach

Should Burdett Birth Center close, there will be NO birthing space at all in three counties in the Capital Region- Columbia,
Greene, and Rensselaer. This attempted closure is part of a wider trend that has seen the number of hospitals with labor
and delivery in Columbia, Greene and Rensselaer drop from its high of 5 in the 1980s to possibly none in 2023. That is
unacceptable.

Further, the closure of BBC means that there will be NO access in the entire region to the particular type of labor and
delivery care that evidence attests has the best possible health outcomes for mom, baby and family. In other words, closing
Burdett Birth Center means that there are NO alternative services for labor and delivery that offer comparable quality and access.

In 2022 alone, over 800 babies were born at Burdett Birth Center. Burdett offers a unique collaborative care model between
midwives and OB-GYNs. Women can choose between catching their own baby in a natural water birth or have a c-section
should that be required. Midwife driven care is not just about having a midwife present at birth but provides a whole
continuum of care from prenatal through delivery to post-partum that centers the woman or birthing person’s agency,
celebrates their strengths as whole people, and honors their choices.

In the Capital Region, in NYS, and nation-wide there is great demand for midwifery driven care. It is a model that avoids
unnecessary medical interventions. For example, data illustrates that c-section rates are twice as high at St. Peter’s than at
Burdett for Black patients.

The birthing model offered at Burdett is one that centers a trusting relationship between the birthing mother/person and
their caregivers. This is a key health equity concern, given the kinds of experiences repeatedly reported by Black and Brown
pregnant women. In spring of this year, the NYS Maternal Mortality Review Board and Maternal Mortality and Morbidity
Advisory Council held listening sessions statewide with women and persons who had recently given birth, specifically
persons of color, and people who had negative outcomes. The Medical Director of NYS Health Department’s Family Health
Division, Dr. Marilyn Kacica, shared that “From that, we learned... people don’t feel heard, they don’t feel like they’re part
of their decisions, that they’re not taken seriously.” Midwifery driven care, in contrast, centers a trusting relationship and
the birthing woman/ person’s choices and autonomy in the birthing experience. Likewise, LGBTQIA+ people seek affirming
caregivers at the time of birth. The Pride Center of the Capital Region consistently refers community members to Burdett.

Closing Burdett is a decision to close the only birthing center that offers this kind of care and boasts such outcomes. Its
closure would mean that not a single women/ birthing person in the Capital Region would have access to a safe place to
give birth that offers both midwifery driven care alongside emergency surgical options should the need arise.

IV. This closure is at direct odds with St Peter’s mission to serve the poor and most vulnerable

Rensselaer County is home to many individuals and families who are low-income and living in poverty. 39% overall; 35% of
families with children are not financially secure; 67% of Black households, 45% Latina Households, 29% Asian households
are struggling financially.

More than half the births at Burdett are to Medicaid-insured patients, compared to 33% for St. Peter’s deliveries. These are
the low-income folks specified as medically-underserved in the health equity law. Because of limited resources, they have
the least ability to go to alternative sources of care.

V. Conclusion

We have shared the integral role that Burdett has played in the health, wellbeing and vitality of our community. The solution
cannot be to close Burdett because Trinity Health and St. Peter’s claim that there is no profit in keeping it open. The solution
cannot be that substandard care is given in order to cut costs. The solution cannot be that underserved communities
become even more underserved. The solution cannot be that healthy pregnancies and healthy birth outcomes are a luxury
only few can afford.

All the evidence and data tells us that we need more places like Burdett Birth Center, not less. The United States is
already the worst place to be pregnant in the industrialized world and by closing Burdett we will continue to support this
dismal distinction. If healthcare and health outcomes are strictly decided on a for profit basis by the private sector and
government alike, then we need to re-examine our priorities. Otherwise, more women, pregnant people and babies will
continue to suffer the consequences of our collective greed.

Jessica Hayek / Troy/Brunswick, New York

My name is Jessica Hayek. I have been a birth worker in the Capital Region, for the past 11 years. I’m certified as a Birth
Doula, Childbirth Educator and Lactation Counselor. I am a resident of Troy/Brunswick.

As a birth doula, I support families wherever they choose to give birth. Hospital, home, or Birthing Center. I have
witnessed births in all settings in the Capital Region and I have attended births at every hospital. Doulas have that unique
perspective - we see it all. I know that Burdett Birth Center is a unique place and there literally is nothing else like it. Burdett
provides birthing people, a midwifery-led collaborative model of care. Burdett is on the top of my list when a client needs
a recommendation for providers. In choosing Burdett, families will experience individualized care. Care that looks at
the entire picture of what their specific needs are. At Burdett, I have only witnessed birthing people’s minds and bodies
respected during the childbirth process. They are given space and time for choice and consent. When people feel safe, and
are given this type of care, they are healthier and happier.

The midwifery-led model of care is what sets Burdett apart from other facilities. It minimizes interventions, monitors the
physical, psychological and social well-being of the birthing person throughout the childbearing cycle; provides education
and counseling during the prenatal period; offers hands-on assistance for labor and birth; provides postpartum support
and offers referrals for obstetrical care when necessary. For my clients who fall into that small percentage needing need
surgical intervention to bring their babies into the world, Burdett’s obstetricians provide stellar surgical skill and expertise.
Around the world, midwives attend approximately 70% of all births. The countries with the lowest maternal and infant
mortality and morbidity rates are those in which midwifery is a valued integral part of the maternity care system.

When I talk with my clients, in appointments or in a class setting, we talk a lot about options. Families are encouraged
to explore what is available to them for support during this profound time in their lives. Should they choose an epidural?
Should they choose hydrotherapy? What about a Water birth? Will they choose an Obstetrician? Midwife? The thing about
Burdett is that people have access to whatever they may need to bring their babies safely and joyfully Earthside. At Burdett,
birthing people have access to a full range of options, that is not available at any other medical center in our community.
Back in June, when Saint Peter’s Health Partners made the closure announcement, the birth community was stunned.
Capital Region Birthworkers know the high quality of care people receive at Burdett. We know the Midwifery Model of Care
results in better outcomes for moms and babies. The midwifery model results in lower c section rates, lower intervention
rates and lower maternal and infant morbidity and mortality rates. We were stunned because closing Burdett goes against
all the efforts being put forth to improve maternal health. Why would you close a facility that is meeting and supporting
the goals set by entities like The World Health Organization, Healthy People Initiative, The United Nations, National Institute
of Health, Us Office on Women’s Health and The New York State Department of Health. These initiatives include reducing
maternal mortality and morbidity, reducing infant mortality and morbidity, increase breastfeeding numbers and taken
from NYSDOH Prevention Agenda Action Plan). One of the goals listed is “reduce racial, ethnic, economic and geographic
disparities and promote health equity”. Closing Burdett would make these disparities worse not better.

This is taken from the Surgeon General’s Call To Action

“Every medical appointment or interaction with health care professionals is an opportunity to ensure that standards of
care and the full needs of women are being met. Given the vast diversity in geography, economy, and racial and ethnic
make-up of communities across the U.S., healthcare professionals can ensure that the care they provide is scientificallysound
and culturally appropriate to the individual and their respective community.” This is midwifey-led care. Midwifery
care is Evidence-based, scientifically sound, wholistic, culturally appropriate, gender affirming, family centered, woman
centered, birthing person centered care. The Midwifery-led model values patient consent, informed decision-making,
and individualized care. All birthing people deserve this model. All birthing people deserve to be approached as unique
individuals during the amazing time of life that is pregnancy and birth. As a doula in this community, I know that Families
in the Capital Region deserve to keep Burdett as a safe option for their care. I know that people will be harmed if it closes.
Hospital conglomerates that are based in another part of the country should not be allowed to dictate what choices
families have here, in our part of the country, in NY, in Rensselaer County, in Troy. We know what our community needs,
because we are the community. We know that Burdett Birth Center must not only stay open, but must be preserved,
supported, funded and protected, so it can continue to provide excellent, safe, life-saving maternity care.”

Kathryn Mitchell, National Director of Maternal & Child Health and Collective Impact at March of Dimes / Capital Region, New York

Testimony Kathryn Mitchell, MPH
March of Dimes National Director, Maternal & Child Health and Collective Impact
NYS Attorney General’s public hearing on proposed closure of Burdett Birth Center
September 18, 2023

Introduction and overview — maternity care deserts

Thank you to Attorney General James for convening this important public hearing. My name is Kathryn Mitchell and I am
National Director of Maternal & Child Health and Collective Impact at March of Dimes, but more importantly I am a resident
of the Capital Region. I am testifying today to express my strong opposition with the proposed closing of Burdett Birth
Center and the growing trend of hospital and maternity unit closures and their impact on maternal and child health. Over
the last 5 years, approximately 300 maternity units have closed across the country. Leaving more than 5.6 million women
with no or limited access to maternity care services. We are moving in the wrong the direction. Just a few short years ago,
Columbia Memorial in Hudson ended birthing services at the only birthing facility in Columbia/ Greene, forcing many of
those individuals to travel to the Capital Region and to locations such as Burdett to receive services. Are we on the path to a
state filled with maternity care deserts?

We have all seen the headlines, and we know the statistics. We live in one of the richest nations in the world and one of
the most progressive states in the country, yet birthing individuals are facing staggering rates of maternal mortality and
morbidity with Black and brown women shouldering most of the burden. In fact, in the latest New York Maternal Mortality
Review Report looking at maternal deaths in 2018, Black, non-Hispanic individuals who gave birth were 5 times more
likely to die of a pregnancy-related cause than were their White, non-Hispanic counterparts. We should be looking at
opportunities to bolster our maternity care system instead of dismantling it piece by piece.

What is a maternity care desert?

In March of Dimes’ latest report on maternity care deserts, we found that more than a third of counties in the United States
are considered maternity care deserts. What do we mean by a desert? A maternity care desert is defined as a county
without a hospital or birth center offering obstetric care and without any obstetric providers, including OBGYNs, Nurse
Midwives and family physicians who deliver babies. Since our first report in 2018, 70 additional counties have been classified
as maternity care deserts due to a loss of obstetric providers and obstetric services. Even before the pandemic, hospitals
started closing maternity units across the country, with many indicating they struggled with low birth volume, staff
recruitment and retention, and rising costs.

The impact of closing Burdett

The closure of Burdett will not result in a maternity care desert designation, as there will still be individual providers offering
obstetric services, but we are clearly moving in the wrong direction. The loss of the only birth center in the region will no
doubt create a hole the impact of which will be felt throughout Rensselaer and the broader Capital District.

Residents will see their care suffer: disruptions in continuity of care, issues with transportation and challenges finding or
navigating new services. In addition, providers at the receiving facilities will now have to absorb this patient load adding to
the existing strain in the system.

Additional analysis done by March of Dimes data and evaluation team found that if Burdett were to close, the distance
to the nearest birthing hospital would increase nearly 2 times for women living in Rensselaer County, with those in the
more rural parts of the county being most impacted. The farther a birthing individual travels to receive maternity care, the
greater the risk of maternal morbidity and adverse infant outcomes, such as stillbirth and NICU admission. Furthermore,
longer travel distances to care can cause financial strain on families and increased prenatal stress and anxiety.

As the pandemic came to close, we talked about building back better, building more robust and equitable systems. To
achieve that goal, I envision a state with more birth centers and more perinatal and obstetrics care providers. I envision a
well-integrated system with midwives and obstetric physicians which across the globe continues to be a key to improving
maternal health outcomes. And I envision a state where, where you live does not determine your ability to access quality
care. Families face enough obstacles. Getting the care they need shouldn’t be one of them. This is why March of Dimes
opposes the closing of Burdett Birth Center.

Robert Martiniano, The Justice Center of Rensselaer County, Treasurer / Troy, New York

Testimony to the Attorney General of New York State on the potential closure of the Burdett Birth Center at Samaritan
Hospital

September 18, 2023
By Robert Martiniano, DrPH, MPA,
Treasurer and Board Member, The Justice Center of Rensselaer County

Madam Attorney General, members of the panel, and all those listening in the audience, good afternoon. My name is
Dr. Robert Martiniano, and today I am speaking on behalf of the Justice Center of Rensselaer County. I am a health care
researcher, and I am an adjunct professor at a local college in the health services administration master’s program. Finally,
and most importantly, I am also a proud member of the Save Burdett Birth Center coalition, and I have lived in Troy for the
past 34 years.

The Justice Center of Rensselaer County is dedicated to achieving equality and promoting and welcoming a diverse
community in Rensselaer County by addressing persistent and structural prejudice in our political, economic, educational,
and social systems, including health care.

We believe that equitable access to health care is social justice. Health care cannot be about who can afford it or what
hospital can dictate where services are or are not. Equitable access to health care means that all individuals, regardless of
race, ethnicity, gender, sexual preference, or ability to pay, have appropriate and quality health care services determined
by personal choice and by health care needs. Equitable and quality health care services should be a right not a commodity
that is only accessed when a person has the ability to afford it.

What are the statistics? Many speakers today will talk about travel time, the population of Rensselaer County and of Troy,
and the patients at Samaritan Hospital and at the Burdett Birth Center. I am not here today to repeat those statistics.
Rather I want to give context to those statistics. The United States pays substantially more per capita than any other
country for health care, and we have some of the worst health outcomes – mirroring those from third world countries.
Those poor outcomes include life expectancy, maternal mortality, and infant mortality. And those outcomes are even
worse for people of color, especially for women who are Black/African American, non-Hispanic. Recent research has shown
that women who are Black/African American, non-Hispanic have more than twice the maternal mortality than women who
are White, non-Hispanic. Similarly, the rate of infant mortality was more than twice as high for infants who are Black/African
American, non-Hispanic compared to infants who are White, non-Hispanic. We have a two-tiered health care system in the
United States based on race and ethnicity and based on income, with the most vulnerable populations fighting to access
quality and appropriate health care. That needs to change. Let’s start that change in Troy, New York, here, today, and now.

Going beyond the data, what is the primary issue before us? Does a health care facility have an obligation to provide
services to a community? The New York State Department of Health has a certificate of need, or CON, process, that
requires licensed health care facilities to request state approval when opening, closing, or changing services they deliver.
Approvals historically have been to purchase equipment, such as CAT scans or MRIs, add services or beds, and in some
cases, close or reduce services or beds. CONs historically have been used to ensure that services or beds in communities are
not oversubscribed. Too many beds, too many MRIs, can be costly to the health system and ultimately to the patients. But
shouldn’t we go one step further and use the CON process to ensure that services in a community do not close, regardless
of the financial impact to health care institutions? Acute care hospitals in New York are required to be not-for-profit, with
a charitable mission. Shouldn’t that mission include ensuring access to health care, even when that access results in
diminished profits for specific services or for the facility in general?

One question for you and for the New York State Department of Health – were there other options that would have made
more sense? Could beds have been slightly reduced or beds repurposed. Closure of labor and delivery at Samaritan
Hospital should be the last resort and not the first option. When St. Peter’s Health Partners and Trinity Health proposed this
closure in their press release, they identified a number of hospitals that could deliver babies for Rensselaer County mothers,
including one out of state. They recognized that St. Peter’s Hospital could not pick up the deliveries should Samaritan
Hospital labor and delivery close. They recognized the impact but choose not to take responsibility. Then again, Trinity
Health is located in Michigan and does not have to bear the burden of delivering babies in Rensselaer County, especially to
vulnerable populations that do not have a voice at the headquarters in Michigan, run by executives making multi-million
dollar salaries.

We have heard a lot about this CON submission. St. Peter’s Health Partners and Trinity Health submitted their CON two
days before the Health Equity Impact Assessment requirement went into law. They were subsequently shamed into
conducting one, though by a consulting firm outside of the Capital District and outside of New York State. Strike one. More
importantly, we have seen slow reductions in services in Troy, losing endocrinology, dental services, and reducing mental
health services. Strike two. When is this going to stop. If we lose labor and delivery, what other health services will we see
go away? When Samaritan Hospital and St. Mary’s Hospital merged with St. Peter’s Hospital, there was a commitment to
retain women’s health services. How can St. Peter’s Health Partners and Trinity Health justify closing labor and delivery at
Samaritan Hospital after that commitment? How can the New York State Department of Health approve such a closure
after that commitment? Strike three. Let’s make the CON process about what is right for the community and what is right
for the patients, not about how many dollars can be saved.

More importantly, how would this proposed closure affect women’s health services in the Capital District? This cannot
be discussed in a vacuum. Numerous articles recently have outlined delayed wait times at Capital District emergency
departments. Closing Samaritan’s labor and delivery would only add to that burden when expectant mothers experiencing
emergencies have no other place to go. Additionally, our fire departments and ambulance services, already strained, have
outlined the additional burden this would cause. This just isn’t about the closure of beds at one hospital, but how closing
labor and delivery at Samaritan Hospital will impact all health care services throughout the Capital District.

And as you may know, there have been ongoing discussions among Ellis Hospital, Bellevue Women’s Center and St. Peter’s
Health Partners around a merger. If Samaritan Hospital’s labor and delivery unit were to close and Bellevue Women’s Center
were to come under St. Peter’s Health Partners and Trinity Health, women’s health services in the Capital District would be
severely restricted, eliminating many choices for expectant mothers and for women of all ages. This piecemeal approach
to reducing reproductive choices for women in the Capital District by a Catholic hospital in a state that promotes choice is
appalling. The New York State Department of Health needs to review this request with a more holistic lens, not just one CON
request at a time.

I want to end by testimony on a personal note. My two sons and one of my grandchildren were born at Samaritan. After
the birth of my second son, I needed to go back and forth to my home to help my mother-in-law with our first son as well as
attending to household duties preparing for our newest addition. I was lucky enough to have a car and a short drive home.
Not all families have that option. This decision has to be about those who have not rather than those who have. We need
to understand what the community and the most vulnerable of us will lose, instead of considering only what money will be
saved by a distant health system.

I thank you for allowing me to provide testimony today on this important issue.

Madeline Reilly / Albany, New York

Lack of access to vehicles for many Troy residents

My name is Madeline Reilly, I am the Public Affairs Manager at Upper Hudson Planned Parenthood, and a member of the
Save Burdett Birth Center Coalition. The closure of Burdett Birth Center will have negative effects on the community’s ability
to access health care that cannot be mitigated by relying on transportation to alternative birthing sites. 22% of city of
Troy residents do not have access to a personal vehicle. That is more than one in five people who cannot rely on driving
themselves to an alternative birthing site in another county. Since many Troy residents do not have access to a car, they will
have to resort to alternative means of transportation to access maternity care.

Rural residents of Rensselaer County

Getting to alternative birthing sites in Albany County will be burdensome, even for people with access to private vehicles,
especially those living in rural Rensselaer County. In the case of Hoosick Falls and Berlin, the closest hospital in terms of
travel time is Southwestern Vermont Medical Center, and Burdett is the second closest. People should not have to travel
out of state to access maternity care, nor should they have to navigate the logistical and administrative challenges that
come from paying for out-of-state medical care, whether that is with private medical insurance, Medicaid, or paying out-of-
pocket.

Traveling by bus

Traveling by bus from Downtown Troy takes around 15 minutes. This trip length is nearly quadrupled to get to Albany to
receive care at St. Peter’s or Albany Medical Center. These trip time estimates were calculated in mid-August 2023, so it is
reasonable to project that these times will only increase in the winter months due to inclement weather, road closures, etc.
All CDTA bus routes from Downtown Troy to Albany require transferring buses, and these bus routes also do not run during
the middle of the night. Traveling by bus to an alternative birthing site from Downtown Troy can be unpredictable, and a
significant logistical barrier to expecting parents in the final stages of their pregnancy, which is already a time that is often
fraught with logistical challenges.

Uber/Rideshare

Traveling from Troy to an alternative birthing site via Uber/other rideshare apps is expensive. Rush hour pricing for a one-way
trip from Downtown Troy to St. Peter’s/Albany Med is around 41 dollars, and this price can fluctuate greatly depending
on the time of day one is trying to get an Uber. Setting aside the prohibitively expensive cost of one Uber ride that may be
out of the question for low-income folks, Uber is more unpredictable and unreliable than buses or having access to a
personal vehicle. The availability of an Uber is dependent on the availability of drivers, among other factors out of control
of the birthing person who is attempting to get access to vital medical care.

Emergency services

Emergency services are already overwhelmed. Troy Firefighters Local 86 covers Rensselaer County, but also encompasses
13 other counties. They only operate four ambulances. Eric Wisher, President of Local 86, has shared publicly that they
have been short-staffed for years, and that taking on transporting folks to alternative birthing sites will “put [them] at risk
and [put] the communities [they] serve at risk”. If Burdett is closed and emergency services have to transport people to
alternative birthing sites, he says that it will create longer wait times for patients, delay care, lengthen response times, and
lengthen wait times in the ambulance outside the hospitals.

The next-closest hospitals that expectant parents from Troy will be expected to go to, Albany Medical Center and St.
Peter’s Hospital, have the second and third highest emergency room wait times in New York State, respectively. Patients
in Albany Medical Center’s emergency room spend an average of 5 hours and 45 minutes in the waiting room before
being seen, and patients in St. Peter’s emergency room spend an average of 5 hours and 35 minutes in the waiting room
before being seen.

The logistical challenges that will undoubtedly be associated with transporting Rensselaer County residents to alternative
birthing sites in neighboring counties should Burdett Birth Center be closed cannot be mitigated. Whether it’s taking a
long bus ride, paying for an expensive Uber, traveling from rural Rensselaer County to receive maternity care, waiting long
periods before getting picked up by an ambulance, waiting in the emergency room at a hospital in Albany County, or some
combination of all of these challenges, the research is clear: the closure of Burdett Birth Center will mean worse health
outcomes for birthing parents and newborns alike.

Mayor Patrick Madden / Troy, New York

Public Hearing on Status of Burdett Birth Center in the Capital Region
Prepared Testimony of:
WM. Patrick Madden
Mayor
The City of Troy, New York

September 18, 2023
WM. Patrick Madden
Mayor The City of Troy, New York
Mayor WM. Patrick Madden Monday, September 18, 2023

Attorney General Letitia James,

Thank you for offering the City of Troy the opportunity to provide testimony on the status of the Burdett Birth Center.
Let me start by telling you a little about the City you are in today. The City of Troy is home to roughly 51,000 people. In fact,
the City is a bright spot in Upstate New York with growth of two and a half percent since the 2010 Census. We are a diverse
and growing city boasting a vibrant arts scene, a growing small-business economy, world-renowned universities, and so
much more. Most importantly though, we are a City of neighbors and neighborhoods. It is on their behalf that I write to
you. As it has been a true honor to serve my hometown as mayor for nearly eight years.

The City of Troy was previously home to three hospitals, but as we have seen across the country there have been a series of
consolidations in health care over the years. This has left the City of Troy with one remaining hospital, Samaritan, and the
accompanying facilities such as the Burdett Birth Center.

This brings us to today, the Burdett Birth Center is the only birth center in the City of Troy; indeed, it is the only Birth Center
within a contiguous stretch of three counties (Rensselaer, Columbia and Greene). In addition to providing maternal
appointment and delivery care for these urban, suburban and rural Upstate families, the center provides these services for
families in neighboring Massachusetts and Vermont, as well.

A news release from the Oce of State Senator Samra G. Brouk (SD55) puts the problem succinctly: “Maternal mortality,
which is the death of a woman during pregnancy, at delivery, or soon after delivery has decreased by more than 30%
worldwide over the last twenty years. However, this progress is not seen in the United States, where maternal mortality has
continued to increase—rising by nearly ten percent from 2020 to 2021 alone. New York State is one of the more dangerous
states to give birth, ranking 23rd overall in maternal mortality when compared to other states.”

The City of Troy and surrounding communities will be grievously harmed by this closure. While we understand that
prenatal care would continue to be available, the loss of the Burdett Birth Center would mean that the only options for
delivery within our community are local emergency rooms. It does not make sense, in this moment of need, for our state
government to allow a move that would reduce the availability of and access to services. It does not make sense, as we see
greater demands on our emergency rooms, for us to expect they also serve as delivery rooms.

Another challenge created by this closure is transportation. A significant number of lower income families in our City do
not own a car. Transport to Albany by rideshare is expensive and not always available. Transportation by ambulance is
enormously expensive for the community and ties up important public safety assets.

Albany Medical Center and St. Peter’s Hospital, two hospitals in Albany who provide delivery care, are over half an hour
away from many Troy addresses, and even further for families in neighboring communities. Such a long commute during
labor would certainly increase the number of prehospital deliveries. No mother’s birth plan should have to include such
a painful, unpredictable and stressfully long commute to the hospital. To their credit, St. Peter’s Health Partners (SPHP)
recognizes this challenge. To our dismay they have offered no solutions. This is another aspect of the proposed closure that
disproportionately impacts lower income families and minorities.

This latter delivery option is doubly untenable for our community since our emergency medical service infrastructure is
already operating beyond its capacity to serve our City’s increasing needs. The increase in diversions caused by the closure
of the Burdett Birth Center would tie up ambulance services as they more frequently would need to commute to and from
hospitals in faraway communities, jeopardizing response availability within our own neighborhoods.

We do not know whether SPHP knew that the Department of Health (DOH) was implementing recently passed legislation
requiring a health equity impact assessment (CHAP.766 of 2021) on June 22, 2023, nor whether the timing of their submission
of a certificate of need was influenced by this date, but the timing meant that SPHP would not have to conduct such an
assessment for their closure plan.

Calls from the Madden Administration, our partners in government and the community resulted in SPHP agreeing
to conduct such an assessment voluntarily, but this assessment is not bound by the law and has already proved
underwhelming. In fact, Assembly-member John McDonald and I recently called on the Department of Health to provide
more opportunities for public input when we saw that SPHP’s community survey was poorly designed and executed, and
seemingly was not sufficiently advertised by their vendor, let alone targeted toward high-risk families.

For the reasons noted, we are highly concerned about what this closure would mean for our families, but we are even
more deeply troubled about the implications for Black women; Latina women; low-income families; transgender, gender-non-conforming and sexual minorities; and other neighbors who are already underserved by the current healthcare system
and already assume elevated risks with pregnancy.

According to DOH’s New York State Expert Panel on Postpartum Care, Black women in our state experience a maternal
mortality rate of 51.6 per 100,000 births; non-Hispanic white women experience a maternal mortality rate of 15.9 per
100,000 births. According to the Maternal Mental Health Leadership Alliance, “almost 40% of Black mothers and birthing people experience MMH [maternal mental health] conditions... Compared to white women, Black women are twice as likely to experience MMH conditions but half as likely to receive treatment.”

We know that these racial disparities persist when you control for income and other factors. Beyoncé Knowles-Carter and
Serena Williams have both come forward with stories of life-threatening complications during their pregnancies. If they are
struggling with the resources at their disposal, what does that mean for say, a Black woman in our community who walks
to her OB/GYN appointments for lack of a care For Troy’s Black women especially, this proposal may very well be a matter
of life and death.

More broadly, we know that the type of care administered at the Burdett Birth Center was unique in meeting the needs
of patients. The center offered a range of doula and midwifery services. An NIH study suggests that doula care can
significantly reduce the need for cesarean sections while reducing the time women spend in labor. These are exactly the
sorts of resources we should be investing in for our families—not wrenching away from them—as we struggle with shocking
rates of maternal and infant mortality.

One of the key reasons that SPHP and Trinity Health have provided for the proposed closure of the Burdett Birth Center is
that they cannot afford the losses incurred by the Center. While no institution can be expected to operate under a sustained
deficit, we believe that the financial concerns presented by SPHP have not been enough to justify the proposed curtailing of
services.

In early August, Senator Chuck Schumer announced a significant increase in the Medicare Wage Index in Upstate regions. It
is estimated to have a nearly $1 billion impact for Upstate New York hospitals annually. Dr. Steven Hanks, President and CEO
of St. Peter’s Health Partners, has acknowledged that this change will represent an increase of $100 million for SPHP on an
annual basis. There are no restrictions upon hospitals as to how to use this funding.

In addition, New York State has passed measures to support beleaguered hospitals during and after the worst days of
COVID-19. The most significant change was the seven percent increase in Medicaid reimbursement rates passed in the
SFY 2023-24 Budget. Assembly Speaker Carl E. Heastie and Assemblymember John T. McDonald III, RPh have been stalwart
supporters of our hospitals.

The Burdett Birth Center was created as a compromise when Trinity acquired Samaritan Hospital and SPHP. It was
understood that the Catholic healthcare providers would not provide our families with services that violated their beliefs,
including but not limited to, abortions, tubal ligations and vasectomies, which is why the Burdett Birth Center was selected
to remain an independent entity. A few years ago, SPHP quietly reabsorbed the Burdett Birth Center and today, these
legal but non-sanctioned services are no longer available. This quiet reabsorption went back on a promise made to our
community to continue to provide quality reproductive health services, and this proposed closure is further insulting to our
families.

Had we known that the birth center was struggling, we also could have worked with SPHP to explore options before they
reached the point of acute crisis. Our first indication from SPHP that the birth center was under fiscal distress was a Times
Union story about their plan to close the birth center, published less than a week before the filing of the certificate of need.

We continue to engage in dialogue with our partners in government at all levels and across party lines to keep the Burdett
Birth Center serving our families. Our City has a regionally celebrated restaurant scene, an active housing market, historic
communities and infrastructure that are repeatedly used as locations for film and television productions, but most
importantly, it has all of us. It is my sincerest hope that generations of families to come will be able to say they were born in
Troy.

Thank you.

New York Civil Liberties Union (NYCLU)

Testimony of the New York Civil Liberties Union to
the Office of the New York State Attorney General regarding
the proposed closure of Burdett Birth Center

September 18, 2023

The New York Civil Liberties Union (NYCLU) respectfully submits the following testimony to the Office of the New York State
Attorney General, regarding the proposed closure of Burdett Birth Center and its anticipated impact on the reproductive
rights and health of the Capital Region community.

I. Introduction

The NYCLU, the New York State affiliate of the American Civil Liberties Union (ACLU), is a not-for-profit, non-partisan
organization with eight offices throughout New York State and more than 95,000 members and supporters. The NYCLU’s
mission is to promote and protect the fundamental rights, principles, and values embodied in the constitutions of New
York and the United States. As an organization that focuses on legal and policy work in service of civil rights and social
justice, the NYCLU strives to ensure that New York is a leader in the effort to secure the full range of rights and supports that
underpin people’s decision making around reproduction and family, from access to abortion care to birth justice.

The proposed closure of Burdett Birth Center would further distance New York from this goal. Equitable access to
comprehensive, patient-centered, birth-related care is essential to people’s ability to meaningfully determine their
reproductive futures and exercise their bodily autonomy. This is especially critical amidst a maternal mortality crisis that
is even more acute for Black and low-income pregnant people. As the state works to reduce these racial disparities and
improve maternal health outcomes across the board, it must not allow hospital closures and consolidations to undermine
its progress by further eroding access to reproductive health care, least of all for communities already bearing the brunt of
longstanding structural inequities in the health care system. With above-average patient outcomes, Burdett Birth Center
is an essential resource for pregnant people throughout the Capital Region, and we welcome the opportunity to testify
against its closure today.

II. Burdett Birth Center plays an essential role in the Capital Region health care ecosystem as the sole provider of
dedicated, midwife-led prenatal and birth care.

For over a decade, Burdett Birth Center has provided comprehensive birth-related health care to the Capital Region
community. Burdett Birth Center has been the only birth unit in Rensselaer County since 2011 and its closure will create a
dangerous care desert for county residents. Burdett is also important for patients in Columbia and Washington counties,
who have few birthing resources following the 2020 closure of the birth ward at Columbia Memorial Hospital, an affiliate of
Albany Medical Center.¹ Burdett oversees roughly 900 births each year, and many of its patients are Black and low-income,
with 51% of Burdett patients receiving Medicaid.²

Beyond its geographic significance as the sole birth ward in the county, and one of the few remaining in the region,
Burdett is also uniquely important as one of the only providers of low-intervention, midwife-led birth care in a hospital
setting.³ Burdett’s collaborative midwifery model allows it to provide more attentive, patient-centered care and to offer
a variety of care options, such as hydrotherapy.⁴ It also welcomes doula involvement. This not only supports Burdett
patients’ more empowering and satisfying birthing experiences, but also results in better maternal health outcomes—
Burdett is the only maternity ward in the Capital Region that exceeds the federal government’s Healthy People 2020
Initiative recommendations.⁵ It also boasts a lower primary cesarean rate than the statewide average—only 12.7 percent at
Samaritan as opposed to 28.9 percent statewide.⁶

Moreover, until 2020 Burdett played a crucial role as a provider of certain reproductive health services, such as tubal
ligations and vasectomies, which are prohibited under the ethical and religious directives binding St. Peter’s religiously-affiliated
network of facilities.⁷ In 2020, St. Peter’s dissolved Burdett’s independent nonprofit status in order to merge it
with Samaritan Hospital, citing this as necessary to preserve maternity services in Troy, and effectively ending sterilization
procedures at Samaritan.⁸ At the time, St. Peter’s made statements assuring the public and regulators that it had no
intention of closing Burdett—a testament to the vital role the facility plays in the community.⁹

Notwithstanding this prior commitment, St. Peter’s now claims that financial considerations spur it to close Burdett Birth
Center entirely.¹⁰ It filed its application for closure to the New York State Department of Health two days before a law went
into effect that would have subjected it to community engagement and an independent health equity impact assessment.¹¹

III. Closing Burdett Birth Center would further degrade an already hollowed-out reproductive health care landscape for
Capital Region residents, with the impacts falling hardest on low-income patients of color.

After a series of hospital consolidations and closures that have eroded regional reproductive health care access, the loss
of Burdett Birth Center would cement Rensselaer County as a birth-related care desert. Closing Burdett would require
people to travel long distances to access care, which is simply not feasible for many patients. It would also severely reduce
patients’ ability to choose a care setting and philosophy that meets their needs.

In 2019, Albany Med Health System closed its eight-bed maternity unit about 30 miles south of Albany at Columbia
Memorial Hospital, leaving Burdett as one of the only remaining dedicated birth centers in the area. Since then, pregnant
patients have already been made to travel longer distances to access care, a challenge that Burdett’s closure would further
exacerbate.¹² The lack of nearby maternal health facilities especially burdens low-income patients—the majority of Burdett’s
patient-base—who may lack their own vehicle and rely on slow and unpredictable public transit or expensive taxis and ride
shares in order to access medical care.

Recognizing these obstacles, Albany Med now claims to make efforts to provide transportation support for its pregnant
patients—an approach St. Peter’s CEO Dr. Steve Hanks has said he views as a model.¹³ But assistance arranging
transportation is no substitute for geographically proximate care, especially when patients experience emergency
complications that require urgent treatment. Moreover, such transportation assistance would only benefit patients who
coordinate with the hospital in advance, which not all patients can or will do.¹⁴

Closing Burdett would also deprive the community of access to the Center’s unique collaborative midwifery model of care,
which is associated with better maternal health outcomes—especially important given Burdett’s large base of Black and
low-income patients, who experience disproportionately high rates of maternal mortality.¹⁵ Integrated access to midwifery
is associated with improved maternal and infant health outcomes, including lower rates of cesarean section, higher
rates of breastfeeding, lower rates of preterm births, lower rates of neonatal deaths, and fewer obstetric interventions;
conversely, having less midwife integration and access to midwives and community birth has been correlated with higher
rates of neonatal mortality.¹⁶ Burdett lives up to the promise of this integrated model, boasting a below-average cesarean
rate and exceeding the Healthy People 2020 recommendations. Accordingly, many patients intentionally seek care from
Burdett in order to take advantage of its low-intervention, midwife-led approach to birth. Closing the Center would not only
eliminate access to this potentially life-saving care model, but it would also jeopardize the quality of care at other nearby
facilities, which will have to absorb the roughly 900 births that occur at Burdett annually, testing their already limited
capacity.¹⁷

Amidst a maternal mortality crisis,¹⁸ closing Burdett Birth Center would have the doubly damaging effect of eliminating
an overperforming facility while exacerbating the challenges and dangers patients must face when forced to seek care
elsewhere.

IV. As New York combats a maternal mortality crisis, it must ensure hospital consolidations and closures do not
undermine progress to improve health equity and birth justice.

Ranking 23rd among states in one of the only countries to have seen a rise in maternal mortality since 2000, New York
recognizes that it faces a maternal mortality crisis.¹⁹ In 2018, the Governor convened a Task Force on Maternal Mortality
and Disparate Racial Outcomes to develop recommendations for decreasing maternal mortality, morbidity and racial
disparities; in 2019 the Department of Health established the Maternal Mortality Review Board (MMRB) to examine
pregnancy-associated deaths and issue recommendations; and the state has invested millions of dollars initiatives meant
to improve maternal health outcomes and equity.²⁰ Much of the state’s work in this area has sought to increase access
to midwives and doulas. The most recent MMRB Report explicitly recommends access to the midwifery model of care,
as it is “associated with less intervention in labor and birth and a very patient centered approach throughout prenatal
care...”²¹ The Report also highlights ongoing efforts by the state to expand access to midwifery-led birth centers by further
integrating them into regional health systems.²² Burdett Birth Center embodies precisely the model of care that New York
is affirmatively working to expand; allowing it to close would be antithetical to the state’s longstanding goal of reducing
maternal mortality and racial disparities.

Moreover, by passing the Health Equity Impact Assessment Act, the state committed to ensuring transparency with respect
to how hospital closures impact community members, especially communities who are already medically underserved.
Members of the legislature recognized that “disparities in access to care result in unequal health outcomes. The distribution
of health care providers and to whom they provide what services inevitably contributes to these inequalities.”²³

St. Peter’s sought to circumvent this much-needed state oversight by filing an application to close Burdett two days before
the health equity impact assessment law went into effect. Although St. Peter’s agreed to independently hire a firm to
evaluate the potential consequences of the closure after significant community pushback, this effort— consisting of a
poorly worded survey that did not even collect demographic information and was open for only a few days—was woefully
insufficient to solicit meaningful community feedback and did not amount to earnest cooperation with the intent and
requirements of the law.²⁴

V. St. Peter’s plan to shutter Burdett is part of a striking pattern of secrecy and rejection of community involvement in
hospital consolidation decisions and reductions in health care services in the Capital Region.

The state should be especially wary of St. Peter’s attempt to evade Department of Health oversight considering the greater
context of hospital consolidations and mergers in the region and their impact on access to reproductive health care.
In 2020, St. Peter’s announced its intent to merge with Ellis Medicine in Schenectady, New York, which includes Bellevue
Woman’s Center—at the time, the Capital Region’s only inpatient hospital providing dedicated care to pregnant people and
infants. The proposed merger faces significant opposition from community members who fear the loss of comprehensive
reproductive care, infertility care, LGBTQ-inclusive care, gender affirming care, and end-of- life care within their local
community. Instead of submitting a Certificate of Need to the state and allowing for public review, St. Peters pursued
a similarly secretive process in 2021 that failed to account for community engagement.²⁵ As it originally claimed with
respect to Burdett, St. Peter’s again promised to maintain reproductive health care at Bellevue unimpeded by the ethical
and religious directives of the larger hospital system. But history shows that absent meaningful state involvement and
enforcement of such assurances, St. Peters—like any other hospital system—can make and break promises with grievous
impacts on regional systems of health care. Allowing St. Peter’s to close Burdett would deal yet another destabilizing blow
to the already precarious reproductive health care landscape in the Capital Region.

VI. Conclusion

Hospital closures and consolidations—particularly by hospitals that limit available care based on ethical and religious
directives—can significantly impact health outcomes for New Yorkers, especially those who already face deeply embedded
race-, gender-, and class-based structural inequities throughout the health care delivery system.²⁶ New York State leaders
must scrutinize proposed hospital closures such as Burdett’s through this lens to ensure that corporate motives do not
prevail over the needs of New York patients. These concerns are even more pressing as the state grapples with high
maternal mortality rates and strives to reduce racial inequities and improve health care outcomes for all pregnant people.
Burdett Birth Center represents a uniquely bright example of the kind of collaborative, patient-centered facility that can
bring the ideal of birth justice closer to reality, especially for low-income patients of color. It is a model of care that the entire New York health care system should be working to emulate, not allowing to close.

¹ Rachel Silberstein, Attorney General to hold hearing on Burdett Birth Center closure, Times Union (Sept. 7, 2023), http://bit.
ly/3RoMLdr.

² Save Burdett Birth Center, About, https://www.saveburdettbirthcenter.com/who-we-are.

³ Rachel Silberstein, supra, note 1.

⁴ St. Peter’s Health Partners, Our Midwifery Model of Care, Maternity Care (2023), https://www.sphp.com/find-a-service-orspecialty/
maternity/midwifery-model.

⁵ Jesse King, Midwives, parents rally against proposed closure of Burdett Birth Center in Troy, WAMC Northeast Public Radio (Jun.
21, 2023), https://www.wamc.org/news/2023-06-21/midwives- parents-rally-against-proposed-closure-of-burdett-birthcenter-
in-troy. Burdett was also named a “Best Hospital for Maternity Care” by U.S. News & World Report; holds a “Baby-
Friendly” designation, considered the gold standard in maternity care; and is a Blue Distinction Center for Maternity Care,
a national designation for hospitals that show expertise in delivering improved patient safety and better health outcomes
based on objective measures developed with input from the medical community. St. Peter’s Health Partners, National
Recognition, Maternity Care (2023), https://www.sphp.com/find-a-service-or-specialty/maternity/national-recognition.

⁶ Jesse King, supra, note 5.

⁷ Rachel Silberstein, supra, note 1.

⁸ Id.

⁹ Id.

¹⁰ Robert Webster Jr., A Message from Dr. Steven Hanks on the Proposed Closure of Burdett Birth Center, St. Peter’s Health Partners
(Jun. 30, 2023), https://news.sphp.com/news/a-message-from-dr- steven-hanks-on-the-proposed-closure-of-burdett-birthcenter/.

¹¹ See 2021 Sess. Law of N.Y., Health Equity Impact Assessment Act (S.1451-A), https://www.nysenate.gov/legislation/bills/2021/
A191.

¹² Some experts predict that the current closure plan may even force pregnant patients to travel out of state for care when
they are in labor. Jesse King, supra, note 5.

¹³ Rachel Silberstein, St. Peter’s agrees to conduct impact study for birth center closure, Times Union (Jul. 11, 2023), https://bit.
ly/3PnTp1a.

¹⁴ While St. Peter’s leadership appears to minimize this concern—Dr. Hanks has publicly dismissed “the ones who show
up without ever having seen somebody” as “pretty rare”—it is foreseeable that not all pregnant people will choose to
involve St. Peter’s in their pregnancy and birth planning, especially considering the high rates of patient distrust of medical
providers. Rachel Silberstein, supra, note 13; see Harvard School of Public Health, Marginalized communities likely to distrust
healthcare system, polling finds (Feb. 7, 2023), https://www.hsph.harvard.edu/news/hsph-in-the- news/marginalizedcommunities-
likely-to-distrust-healthcare-system-polling-finds/.

¹⁵ Rachel Silberstein, Officials: Burdett Birth Center survey falls short, Times Union (Sept. 4, 2023), https://www.timesunion.
com/health/article/officials-burdett-birth-center-survey-falls-18340856.php. According to New York’s most recent Maternal
Mortality Review Report, the maternal mortality rate for Black women was over four times that for white women, and the
majority of pregnancy- associated deaths occurred to individuals with Medicaid as their insurance. New York’s pregnancyrelated
mortality rate was also 1.7 times higher for cesarean delivery than for vaginal births. New York State Department of
Health, New York State Report on Pregnancy-Associated Deaths in 2018, at 1-2, https://www.health.ny.gov/community/adults/
women/docs/maternal_mortality_review_2018.pdf.

¹⁶ A study mapping midwifery integration into the health care system across the United States found that increased
access to midwives and a higher density of midwives in a state were associated with improved maternal and infant health
outcomes. These include higher rates of vaginal delivery and vaginal delivery after C-section; higher rates of breastfeeding;
lower rates of C-sections; low rates of preterm births, low birth weight infants, and neonatal deaths; and fewer obstetric
interventions. The study also found that states with the least integration of midwives and least access to midwives and
community birth saw the highest rates of neonatal mortality. Nora Ellman, Community-Based Doulas and Midwives Key to
Addressing the U.S. Maternal Health Crisis, Center for American Progress (Apr. 14, 2020) https://www.americanprogress.
org/article/community-based-doulas- midwives/ (citing Saraswathi Vedam and others, Mapping integration of midwives
across the United States: Impact on access, equity, and outcomes, PLOS One 13 (2) (2018), at https://journals.plos.org/plosone/
article?id=10.1371/journal.pone.0192523.

¹⁷ Jesse King, supra, note 5; Anne McCloy, Columbia Memorial Hospital to stop delivering babies due to doctor shortage, WRGB
Albany (Sept. 12, 2019), https://cbs6albany.com/news/local/columbia- memorial-hospital-to-stop-delivering-babies-due-todoctor-
shortage.

¹⁸ See supra, note 15.

¹⁹ See, New York State Department of Health, Maternal Mortality, https://www.health.ny.gov/community/adults/women/
maternal_mortality/.

²⁰ See, New York State Taskforce on Maternal Mortality and Disparate Racial Outcomes, Recommendations to the Governor
to Reduce Maternal Mortality and Racial Disparities (March 2019), https://www.health.ny.gov/community/adults/women/
task_force_maternal_mortality/docs/maternal_ mortality_report.pdf; Anna Kheyfets, Assessing New York State’s Progress on
Maternal Mortality and Racial Disparities, Mount Sinai (Jun. 30, 2022), https://www.health.ny.gov/community/adults/women/
maternal_mortality/; New York State Department of Health, supra, note 18.

21 New York State Report on Pregnancy-Associated Deaths in 2018, supra, note 15 at 75.

²² Id. at 76-77.

²³ 2021 Sess. Law of N.Y., Sponsor’s Memo, Health Equity Impact Assessment Act (S.1451-A), https://www.nysenate.gov/
legislation/bills/2021/A191.

²⁴ Patrick Madden and John T. McDonald III, Letter to New York State Department of Health Commissioner McDonald (Aug. 29,
2023), https://troyny.gov/DocumentCenter/View/1629/83023--- Joint-Letter-for-Increased-Burdett-Input.

²⁵ Rachel Silberstein, supra, note 1.

²⁶ See, Allie Bohm, Pushing past the pandemic means going beyond vaccine mandates and constantly improving on the progress
New York has made., New York Civil Liberties Union (Feb. 8, 2022), https://www.nyclu.org/en/news/ny-cant-just-rely-vaccinemandates.

Maryfran Wachunas / Rensselaer County, New York

Good afternoon. My name is Mary Fran Wachunas, and I proudly served as Public Health Director for Rensselaer County. I
make these comments on behalf of the county Health Department, our County Executive Steve McLaughlin and the people
of Rensselaer County.

Rensselaer County is a great and growing county, with many new residents coming to our county to live, invest, work and
contribute to our rich heritage of innovation and industry. We believe our greatest days as a county are ahead, and we are
optimistic and resolute about creating a better future for all in Rensselaer County.

The proposal to close the Burdett Birthing Center is wrong for Rensselaer County, and wrong for those living in surrounding
communities. As a county, we oppose the proposal, and note that County Executive McLaughlin and myself were among
the first in the region to oppose the Burdett shutdown proposal. We again call on the State Health Commissioner, an
appointee of the Governor, to reject this proposal and help ensure our county continues to have needed access to
maternity services.

This proposal was made with no prior notice to the public, no advance consultation with representatives of the public or
stakeholders in the fields of health and public safety, and is done with an apparent disregard for the obvious needs of the
people served in the county and surrounding areas.

The proposal to close the county’s only maternity ward will negatively affect the health and safety of those living in
Rensselaer County and communities including but not limited to Cohoes, Watervliet, Green Island, Waterford, Mechanicville
and others, reduce access to needed medical services and present new difficulties to those facing economic or logistical
challenges, and extend travel time for all seeking this needed medical service. The closure of the county’s only maternity
ward will also injure the reputation and standing of the county as a growing county and the work done by surrounding
communities to renew and revitalize their areas.

Just a few decades ago, Rensselaer County was served by three hospitals located in the county, along with at least five
hospitals in surrounding areas and states. The majority of our residents would be forced to travel to two hospitals in
Albany, or hospitals located in other states if the Burdett closure plan is approved.

Rensselaer County residents and residents of counties surrounding our county helped build this country, working in
industry, agriculture, commerce and related fields. They have risen up time and again to contribute to our nation and,
when needed, defend our community. Our residents and neighbors in nearby counties, deserve to be born with dignity and
care foremost in their treatment, and not be forced to shuttle considerable distances as the miracle of birth is engaged.

In closing, we hope that forums like this one will draw the attention of those that can make the decision to stop the process
of closing our only birth center in Rensselaer County. It is a wrong decision and it must be stopped. Thank you.

Patricia Fahy, New York State Assemblymember, 109th District / 109th Assembly District

Testimony of Assemblymember Patricia Fahy Regarding the Proposed Closure of the Burdett Birth Center in Troy, New York

September 18, 2023

Attorney General James,

Good afternoon. I’m Assemblymember Patricia Fahy, representing the 109th Assembly District, which includes the City of
Albany, Town of New Scotland, and part of the Town of Guilderland. I’d like to thank Attorney General Letitia James for
hosting this hearing to allow myself and others to express concern over the closure of the Burdett Birth Center.

I oppose the proposed closure of the Burdett Birth Center, which is the only birth center located in Rensselaer County.
Burdett serves patients not only in Rensselaer County but also Columbia, Washington, and Albany County. It is because
of these regional concerns that I am here today to join my colleagues on this side of the river in expressing our collective
concern.

In 2022, 881 babies were born at Samaritan Hospital. This year, as of May, 320 babies have been born at the hospital,
underscoring the importance of this facility in advancing positive public health outcomes regionally, especially for women
of color and those from disadvantaged backgrounds at increased risk for complications during pregnancy. For example,
56% of patients served by Burdett Birthing Center are Medicaid recipients. There are serious concerns about the capacity of
other birthing centers in the region to absorb the patient population served by Burdett Birthing Center. Given this fact, there
are serious concerns about the ability of Medicaid patients to access quality care at other providers in the region.

• Maternal mortality rates: According to the Centers for Disease Control and Prevention (CDC), the United States has
  seen a disturbing increase in maternal mortality rates in recent years. In New York State, while we have made strides
  in reducing these rates, we still face challenges, especially in underserved communities; black women are nearly three
  times as likely to die during pregnancy from related complications than white women. The Burdett Birth Center has
  played a pivotal role in helping to mitigate these disparities and has consistently maintained lower maternal mortality
  rates compared to the state average.
• Access to prenatal care: The closure of the Burdett Birth Center would limit access to prenatal care for expectant
  mothers in Troy and the surrounding Capital Region. Studies have shown that early and consistent prenatal care
  significantly improves birth outcomes and reduces the risk of complications. Denying this access could lead to higher
  rates of low birth weight and preterm births, which are associated with long-term health and developmental issues for
  children, especially among women of color.
• Economic impact: Beyond the field of healthcare, the closure of the Burdett Birth Center would have a detrimental
  impact on our community and prospects for future economic development. The center employs a dedicated team
  of healthcare professionals, many of whom live in our district. Their livelihoods would be jeopardized, resulting in job
  losses and a subsequent hit to our local and regional economy.
• Longterm cost implications: While the proposed closure is being framed as a cost-saving measure, we must
  consider the long-term financial implications. Insufficient prenatal and maternity care often leads to costly medical
  interventions down the road, including neonatal intensive care, developmental therapy, and special education
  services. The immediate savings may pale in comparison to the future financial burdens on our healthcare system
  and taxpayers.

Considering these impacts, it is clear that closing the Burdett Birth Center would disproportionately impact the health and
well-being of our constituents, but especially those who are women of color and/or economically disadvantaged. I implore
us to explore alternative solutions that ensures quality maternity care remains accessible to all residents of our broader
Capital Region.

I urge the rejection of the proposed closure of the Burdett Birth Center and that we work collaboratively to find innovative
solutions that preserve this essential healthcare resource. Our community’s health, economic vitality, and future
generations depend on the choices we make today. Considering the troubling trend of closures of small and midsized
regional hospitals and healthcare providers, it’s even more key that we play our part in reversing this trend when
considering the impact these closures have on local public health outcomes and access to quality care in our communities.

Thank you for your time and consideration.

Amy LaFountain, Executive Director, Joseph's House & Shelter

For over 40 years Joseph’s House & Shelter has provided nonjudgmental services to the homeless. We believe housing,
health care and basic human needs should be readily available to all. The reduction and/or elimination of any necessary
medical services would further burden the most vulnerable in the community.

Resident

Burdett Birth Center (BBC) is a unique maternity care unit featuring a collaborative model of care with midwives and
obstetricians working together to provide safe, respectful, evidence based care. Patients seek out the Midwives Model of
Care at BBC because it minimizes interventions, monitors not only the physical but psychological and social well-being of
the parent throughout the childbearing cycle, provides education, counseling, prenatal care, hands-on assistance during
labor and delivery, postpartum support, and collaborates or refers for obstetrical care when necessary.

The model of care at BBC is an interprofessional collaboration between obstetricians and midwives that demonstrates
dynamic, equitable, accountable and respectful care for birthing people and improves obstetric health outcomes. Safety,
savings, and satisfaction. BBC’s collaborative care model achieves the Triple Aim of healthcare in the US by improving the
experience of care, improving the health of populations, and reducing per capita costs of health care. The staff nurses have
extensive knowledge of normal labor and how to support birthing people with low-intervention birth. The intimacy of the
community setting supports mentoring of novice staff by the expert nurses helping to grow a capable staff prepared to
support birth at BBC.

It has taken years to create and cultivate the culture and care model at BBC- to think it can be undone in a matter of
months is disheartening. Maternity care never makes money unless we do interventions and interventions in OB are known
to increase risk of morbidities and mortality. Midwives save billions of dollars by protecting physiologic birth. Also midwives
support women and families which increases the likelihood that those women’s families then utilize the other services in the
hospital and that’s where the hospital can make money. A little marketing could go a long way to appeal to a “better payor
base” to offset Medicaid losses but big healthcare organizations don’t see our value so don’t allow it- as demonstrated by
SPH’s continued reluctance to market BBC. The healthcare system needs an overhaul because mothers and babies deserve
better- no wonder maternal mortality is getting worse and we are the only developing country that is not improving these
statistics. Incidentally we are the country with the smallest number of midwives.
St. Peter’s proposed plan to close BBC is in direct conflict with the health care organization’s core mission and values. Infact,
SPH’s actions smack of a penalty for being poor. Burdett Birth Center embodies St. Peter’s mission. By “living our values”
BBC has historically stood with and served those who are poor, especially the most vulnerable.

Dr. Joshua Drake / Troy, New York

Attorney General James,

My name is Dr. Joshua Drake. I am an Emergency Medicine physician practicing at Samaritan Hospital in Troy, New York and I am
writing to you in adamant opposition to the closure of the Burdett Birth Center.

As the sole birth center in Rensselaer County, the Burdett Birth Center provides an essential service to the people of Troy.
The closure would have a disproportionate effect on the most vulnerable in the city. Many parents have limited access to
transportation or rely entirely on public transit and may not be able to reach Albany in the event of emergency labor. A 2018
study cites a 108% higher maternal death rate among women of lower socioeconomic status. ¹Lower socioeconomic status
has also been correlated to higher rates of miscarriage, preeclampsia, and preterm delivery. ²Access to critical resources
such as a local birth center can play a role in mitigating these effects.

The Samaritan emergency department is dedicated to providing ongoing care for laboring patients and we Emergency Physicians strive to provide safe and equitable care to all. Unfortunately, like the rest of the healthcare system, the emergency department is limited in its resources and staff. While we in the Emergency Department are committed to providing the very best care for our patients, we cannot replace the comprehensive care received by patients at a birth center.

The decision to close the Burdett Birth Center is financial in nature. I urge you to seek a collaborative solution which would
allow these essential services to continue. I appreciate your attention and consideration in such an important matter.

The views which I express in this statement are my own and do not necessarily reflect the views of US Acute Care Solutions,
Samaritan Hospital, St Peter’s Health Partners, or Trinity Health.

Sincerely,
Joshua Drake, MD
Emergency Medicine Physician

¹ Singh GK. Trends and Social Inequalities in Maternal Mortality in the United States, 1969-2018. Int J MCH AIDS. 2021;10(1):29-
42. doi: 10.21106/ijma.444. Epub 2020 Dec 30. PMID: 33442490; PMCID: PMC7792749.

² Kim, M. K., Lee, S. M., Bae, S. H., Kim, H. J., Lim, N. G., Yoon, S. J., ... & Jo, M. W. (2018). Socioeconomic status can affect
pregnancy outcomes and complications, even with a universal healthcare system. International journal for equity in health,
17(1), 1-8.

Kelly Duheme / Malta, New York

Dear Madame Attorney General,

I am writing to you today in hopes of shedding some light on the need to keep Burdett Birth Center open.

• Not only does Burdett provide needed maternity services to Rennselaer County, which as you are full aware is an
  underserved community with a high ratio of women of color. Statistics demonstrate a higher maternal mortality
  within the African American population. Moving these services out of the county could easily jeopardize the needed
  close proximity to care/services.
• I currently work at Burdett Birth Center in the capacity of a per diem IBCLC. The number of women of color initiating
  breastfeeding is far below to that of Caucasian women. It is without question that breastfeeding/breast milk
  feedings are best for babies. The opportunity to improve these statistics starts at home, in the community. Moving
  the opportunity to have local lactation support and education will greatly diminish the opportunity to improve
  breastfeeding initiation rates. All infants deserve the opportunity to begin life with the optimal nutrition.
• Burdett also offers the birthing women of the Capital District and beyond a full scope of options to birth with choice!
  The acceptance of doulas, options of water birth, and respect of an individual birth plan clearly set Burdett apart from
  other birthing facilities in the area. The cesarean rates are without compare when looking at neighboring facilities.

Thank you for taking your time to read my thoughts on this matter.

Sincerely,
Kelly Duheme

Jill Parillo Lewis / Niskayuna, New York

High cesarean rates lead to high maternal deaths, and St Peters’ cesarean rate is over twice that of the Burdett Birth
Center’s, so it would be unethical to close the Birth Center and expand St. Peters in its place.

According to the 2019 New York State Taskforce on Maternal Mortality and Disparate Racial Outcomes, which Governor
Hochul convened, in 2012-2014, 66% of prenatal deaths in New York State involved a cesarean section.[1] I quote, “compared
to vaginal deliveries, cesarean deliveries carry overall higher rates of mortality and morbidity.”[2] This task force was
established to make recommendations to the governor of NY on ways to curb racial disparities in maternal mortality and
decrease maternal mortality in NYS. Per 100,000 births, 51.6 black women are dying birthing in NYS compared to 16 white
women.

In 2022, the Burdett Birth Center saw 900 births with a cesarean rate of only 15%, meanwhile, St. Peter’s had a rate of 36%.
There are no public records of how many mothers or infants have died at St Peters in the past five years, but knowing that
New York State’s (NYS’s) cesarean rate is lower than St. Peters, at 34%, and 20 women per 100,000 die in childbirth here in
NY. We can assume that St Peter’s maternal mortality rate is the same or higher than that of NYS’s, and that the Burdett
Birth Center’s is lower (due to far lower cesarean rate).

Again, St. Peters’ cesarean rate is 36%, and NYS’s is 34%, so we can assume that the death rate of black women at St Peters
giving birth per 100,000 is approximately equal to NYS’s rate or greater (that is, 51.6 or greater deaths per 100,000 births).

Why would we close the Burdett Birth Center that is saving lives, especially those of minority women in Albany? New York’s
brightest professionals came together on this task force and concluded that NYS hospitals are disproportionately killing
black women, that high caesarean rates correlate with high mortality, and yet, we are considering expanding the work of a
hospital with double the cesarean rate of the Burdett Birth Center it would close.

Thank you,
Jill Parillo Lewis
[redacted]

Additional information and background

The United States has the worst record of any industrialized nation when it comes to infant and maternal mortality rates.
The United States saw 33 women die per 100,000 live births in 2021, up from 20 per 100,000 in 2019.[3] All other industrialized
nations see 10 and under die per 100,00 births. For example, two and under mothers die per 100,000 in Italy, Poland, and
Norway. Compare that to 70 black women per 100,000 dying in the United States giving birth.[4]

The World Health Organization (WHO) proved there was a 21% cesarean rate globally, and that these [I quote], “rising
rates suggest increasing numbers of medically unnecessary, potentially harmful procedures.” Since 1985, the WHO has
considered the ideal cesarean rate to be between 10-15%. The Burdett Birth Center has a rate of 15% caesarean births as
of 2022, compared to St. Peter’s 2022 rate of 36% caesareans. The WHO also published in 2019, when cesarean rates were
even lower than 21% worldwide, that[5], “deaths from caesarean sections [are] 100 times higher in developing countries.”

^[1] “New York State Taskforce on Maternal Mortality and Disparate Racial Outcomes: Recommendations to the Governor to
Reduce Maternal Mortality and Racial Disparities,” March 2019. Available at: [https://www.health.ny.gov/community/adults/
women/task_force_maternal_mortality/docs/maternal_mortality_report.pdf]

^[2] Ibid.

^[3] Donna L. Hoyert, “Maternal Mortality Rates in the United States, 2021,” National Center for Health Statistics, March 2023.

Available at: [https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.pdf]

^[4] Ibid.

^[5] “Deaths from caesarean sections 100 times higher in developing countries: global study,” The World Health Organization,
March 28, 2019. Available at: [https://www.who.int/news/item/28-03-2019-deaths-from-caesarean-sections-100-timeshigher-
in-developing-countries-global-study]

Resident / Albany, New York

September 18, 2023
Attorney General Letitia James Office of the NYS Attorney General The Capitol
Albany, New York 12224-0341
Re: Testimony regarding planned closure of Burdett Birth Center

Dear Attorney General James:

Thank you for taking time to hear personal testimony about patient experiences at Burdett Birth Center and the impacts
that closing this facility would have within the greater Capital Region. I am proud to join my community in the fight against
this planned closure by sharing my personal story and thoughts about this matter.

I am 35 years old and a resident of Albany. I gave birth to an amazing baby girl at Burdett Birth Center on July 14, 2022 (at
age 34) under the care and direction of the incredible midwives, nurses, and obstetrician-gynecologists who practice there.

My pregnancy was healthy and uncomplicated, and my baby was born full term at 41 weeks without medical induction or
intervention. The prenatal care and support I had access to throughout my pregnancy at Capital Region Midwifery was
unparalleled. I became a regular patient of the midwives before becoming pregnant with my daughter I had previously
suffered a miscarriage. The experience of working with my previous provider in Albany to heal from this was traumatic,
and ultimately led me to seek women’s healthcare and support elsewhere. I understand and acknowledge how incredibly
privileged I am to have had this choice, and I believe the kind of healthcare the midwives and nurses offer at Burdett Birth
Center is a human right.

When you begin to prepare to give birth by educating yourself about the physiological process, you quickly learn that
whatever you may plan for may not go according to plan. I am no exception to this. I went into spontaneous labor exactly
one week past my due date at 2:00 in the morning. This is not uncommon for many women, and it should be noted that the
time of day that labor begins can often present an added logistical challenge depending on one’s location and proximity
to a labor and delivery unit. One of the midwives at the Burdett Birth Center was there to answer my call right away and
provide guidance on what to do despite the time of night. My husband and I had taken a birthing course and were working
with an experienced doula, but we were not prepared for my labor to begin with strong contractions accompanied by
excessive and concerning bleeding. When we arrived at the hospital shortly thereafter as directed, a nurse was waiting for
me and was ready to assist me despite a full ward of other laboring patients. The nurse immediately examined me and
my unborn baby with my express consent. Despite the bleeding, she assured me all was well, and told me I was already
2 centimeters dilated. Although I wasn’t formally admitted to the hospital yet, we were allowed and encouraged to wait
in the triage area while my labor progressed. Several hours later, my labor had advanced to a regular pattern and I was
formally admitted to the hospital. We were never rushed or mistreated during this time. I was made to feel comfortable
and safe. A comfortable and safe environment is absolutely crucial for giving birth. Once I was formally admitted to the
hospital, the nurses and midwives made sure to review my birth preferences and medical history with me. My preference
was to have an unmedicated birth and everyone who cared for me that day respected this desire. I was allowed to
move around freely and be in control of my birthing process, all while receiving careful medical monitoring and support
throughout.

Just as my labor began with an unexpected event, it continued as such. I progressed through the active labor stage quickly
but stalled as I reached the final “transition” stage before pushing. We didn’t know it at the time, but I stopped dilating at
9.5cm because my daughter was presenting with her hand positioned next to her face, her umbilical cord wound tightly
around her wrist. I stayed in this transition stage for over four hours and once again, I was never rushed or pressured
during this time. The midwives allowed an open dialogue where I remained the decision maker for myself and my baby.
We opted to manually break my water and try a series of other techniques to help my daughter continue to move down
through the birth canal and allow me to transition to the final pushing stage. I don’t believe I would have had this choice at
a different hospital. When it finally came time to push, the midwives and nurses helped me into a comfortable position and
provided supportive measures to assist me and protect me from injury. My daughter was ultimately born shortly after at
6:54PM with no major complications. Immediately afterwards, I was carefully stitched and examined right away by one of
the obstetrician-gynecologists on call that evening. She made sure my bleeding was controlled and that I didn’t need any
additional special medical attention. The nurses who took care of me that night were attentive, kind, and incredibly caring.
My doula, who was once a labor and delivery nurse herself, often told me afterwards that the skill, knowledge, compassion,
and kindness of everyone who cared for me that day – especially the midwives and doctor – enabled me to have such a
positive outcome. I agree with her completely. Both she and my husband were also treated with kindness and respect the
entire time as they helped me through my labor. It truly takes a team of people working together to deliver a baby.

Immediately after my daughter was born I was able to establish breastfeeding right away with the guidance and support
of the nurses and lactation consultants at the hospital. Throughout the rest of my time as a patient in the birthing center
I was also able to speak with the lactation consultant when I needed, and she continued to offer support about a month
later over the phone when I experienced some feeding difficulties with my infant. At 14 months old, my daughter is still
currently breastfeeding, and I believe the support we were offered in the beginning of our journey together enabled us to
be successful at this. The pediatric staff and nurses also cared for my baby in a kind and attentive way and we were safely
discharged to go home just two days later.

As a resident of Albany who has access to personal transportation, I want to make it clear that I had the extreme privilege
of choosing to birth at Burdett Birth Center because the evidence- based Midwifery model of care aligned with my goals to
have a birth without medical intervention (if possible) and I was able to travel a distance to get there. Other hospitals in the
region have much higher rates of birth interventions and Caesarian deliveries, which can result in undue complications for
birthing people and their babies, and lead to disproportionate rates of maternal morbidity and mortality. The risk is even
higher for women of color. Every birthing person deserves the same level of care I received regardless of their race, class,
background, or privilege. St. Peter’s/Trinity Health is ignoring its mission to serve the underserved by threatening to close this facility. Giving birth is one of the most transformative experiences a person can ever have, and it shouldn’t be a process through which corporate hospitals profit. I would hesitate to give birth again should Burdett close its doors for good. There is simply no other facility like it in the area. I feel very strongly that every person who gives birth should have the same positive experience and treatment that I had, no matter what happens as their story unfolds.

While many families who live in other capital region cities like me also choose to birth at Burdett Birth Center because of the
model of care, many seek its services because of the location and because there are simply no other options in Rensselaer
or Columbia/Greene Counties. Burdett serves an extremely urban and underserved population in its direct vicinity, but
also residents in some of the far-reaching surrounding rural areas who find themselves even further distanced from other
Capital Region hospitals. The midwives and nurses at Burdett regularly assist people who may not have had access to
prenatal care, and therefore need special attention, assistance, and expertise. These vulnerable people in our community
are those we need to protect the most. The existing emergency department at Samaritan Hospital is not equipped to
handle consistent safe delivery of babies. Permanently closing the Birth Center will result in higher rates of maternal
morbidity and mortality in the immediate area and beyond. We must maintain quality care for all in our underserved and
urban communities. We must also keep this facility open because the midwifery model of care matters, and so does the
choice to opt for this type of care.

Burdett Birth Center is one of the most valuable resources our community has, and St. Peters/Trinity Health should not be
allowed to close it. Its closure will not only harm women and their families in the surrounding area, but also cause undue
strain on other area hospitals that are already completely overburdened. Please do everything in your power to prevent
this closure from happening. The community is counting on those in positions of power to listen and take these concerns
seriously.

Thank you for your time and consideration. My family and I are grateful for your concern.

Sincerely,
[redacted], Albany, New York

Raona Roy, President, The Howard & Bush Foundation

We are submitting this testimony to express our deep concern about the proposed closure of the Burdett Birthing Center.

We believe the proposed closure would be detrimental to our community where infant and maternal mortality are already
higher than in the surrounding area and the State. Removing the birthing center from Troy and its reliable and ready
access to vulnerable mothers and their families who need and rely on them and the community that supports them is
unconscionable. We hope this proposal will not proceed in its present form, but instead we urge St. Peter’s Health Partners,
local and State government, and the community to work together in good faith to sincerely address the needs of the
community and families that depend on these important services.

The Howard & Bush Foundation is entirely focused on improving the quality of life for residents of the City of Troy and
Rensselaer County. For 60 years we have awarded grants to local not for profits for innovative and strategic projects
that address community needs and encourages service providers to work together to achieve the greatest good. In that
regard, St. Peter’s Health Partners and its predecessor entities have received over $1 million dollars from the Foundation
over the years for both capital and service programs and we have been pleased to support these important services for our
community. Our most recent grant was awarded in May to Samaritan Hospital and the Eddy Foundation for infant supplies
for the Healthy Families initiative.

On behalf of the community we serve, and considering the promises made at the time of the St. Peter’s merger, we are
dismayed at the calculus, the secrecy, and the lack of community consideration and understanding in the proposal to
close the Burdett Birthing Center. We urge that the birthing center remain open in its Troy location that provides reasonable
access to the women, their infants and families of Troy, Rensselaer County, and beyond.

Respectfully,
Raona Roy, President

Steven D. Hanks, M.D., President & Chief Executive Officer of St. Peter’s Health Partners and St. Joseph’s Health

St. Peter’s Health Partners
Dear Attorney General James:

Thank you for allowing Samaritan Hospital and St. Peter’s Health Partners (“SPHP”) to submit this statement for the record,
in connection with the hearing being conducted by the Office of the Attorney General on September 18, 2023, regarding the
proposed closure of maternity services at Samaritan Hospital.

We appreciate your concern for the residents of Rensselaer County and the greater Capital Region, and we are always
mindful of the effects of changes in the healthcare system on the community. At St. Peter’s Health Partners, our mission is
to serve as a compassionate and transforming healing presence within our communities, and our vision is to be a trusted
health partner for life. In carrying out that mission, we lean on our core values, which include safety, justice, reverence for
the dignity of every person, and a commitment to those experiencing poverty.

SPHP’s leadership team and Board of Directors made the decision to close the Samaritan Hospital maternity department
in order to more safely, efficiently and economically deliver services to our patient community. In order to operate an
integrated health system with finite resources and an aging population with more acute healthcare needs than ever
before, difficult choices must often be made. In making this particular difficult choice, we have been buoyed by the
knowledge that we have honored our values throughout the decision-making process. Subject to the Certificate of Need
(“CON”) closure process, and informed by the conclusions of the health equity impact assessment that we voluntarily
commissioned for submission with the closure plan, our leadership team and Board of Directors strongly believe that
making this difficult decision to close is in the best interest of ensuring the current and long-term health needs of our
communities and the hospital are met. Thus, we remain committed to standing by their decision.

I will discuss in further detail the background on Burdett Birth Center (“Burdett”) and the factors that led to the decision
to close the maternity department, and will touch on the process we have followed both before and after making the
decision. However, at the outset, I want to share these facts regarding the closure:

• Every doctor and midwife employed at one of our Troy locations will continue to conduct their practices in the
  community, right where they are today.
• All prenatal, postnatal and pediatric care we now provide in the City of Troy and in Rensselaer County will continue,
  unabated.
• No woman will need to change her provider as a result of the closure, whether for herself or for her newborn.
• There are three delivery centers within reasonable proximity to Samaritan Hospital: Albany Medical Center (20
  minutes), St. Peter’s Hospital (22 minutes) and Bellevue Woman’s Center (24 minutes).
• 75% of pregnant women who reside in Rensselaer County already have their deliveries outside of the county.
• St. Peter’s Hospital has the capacity to absorb the entire volume of deliveries now being performed at Samaritan
  Hospital, and we intend to use that capacity to its fullest. Each of our Troy-based ob-gyns and midwives has privileges
  at St. Peter’s Hospital. Doulas are welcome to attend deliveries at St. Peter’s Hospital.
• We will ensure that every woman in our obstetrical and midwife practices who needs transportation assistance for
  her delivery will get that assistance. The need for transport will be assessed at the first prenatal visit.
• We will continue to provide all of the services to all of the patients we are currently serving. Only the site of the
  delivery is changing. No one is being left uncovered.

Burdett Birth Center

Prior to 2010, Samaritan Hospital was a subsidiary of Northeast Health, a Capital Region not- for-profit health care system.
It offered maternity services through its maternity unit on the second floor of the hospital building. In June 2010, Northeast
Health, St. Peter’s Health Care Services and Seton Health System entered into an affiliation agreement which, among
other things, called for the formation of a new health system parent entity, St. Peter’s Health Partners. The transaction was
eventually completed on October 1, 2011. Relevant to Burdett, the affiliation agreement provided that:

Northeast Health and its affiliates would remain secular, but would comply with the Ethical and Religious Directives for
Catholic Healthcare Services (the “ERDs”); and

Prior to completing the affiliation transaction, Northeast Health would form The Burdett Care Center (later renamed
Burdett Birth Center) which would be located in the former Samaritan Hospital maternity unit. Burdett would offer
maternity services, as well as male and female sterilization services (e.g., tubal ligations) that Samaritan could no longer
perform.

Accordingly, Burdett was formed as a not-for-profit corporation with its own board of directors, and with no corporate
relationship with Samaritan Hospital, SPHP, or SPHP’s parent, Catholic Health East (later Trinity Health Corporation). To help
launch Burdett, Samaritan provided it with $5 Million in start-up funds, in a trust. It also conveyed the physical space of its
maternity unit to Burdett, as a condominium unit, with a no-interest mortgage. Burdett also contracted with Samaritan
Hospital to provide an array of administrative services, at cost.

In 2011, Burdett was established by the Public Health and Health Planning Council (“PHHPC”). However, due to concerns
about the financial viability of the new hospital, the Department of Health (“DOH”) took the unusual step of issuing it only
a five-year operating certificate, rather than the usual operating certificate that does not provide for an expiration. Burdett
started operating on October 31, 2011.

For nine years, Burdett operated as an independent hospital providing maternity services. From the outset and
continuously thereafter, it incurred financial losses on operations due to declining delivery volume, unfavorable payer
mix, low Medicaid rates, fragile referral sources and high malpractice costs. In 2016, DOH renewed Burdett’s operating
certificate, but, due to concerns about its financial survivability, provided for only a three-year renewal.

Samaritan tried in many ways to assist Burdett in improving its financial situation. In particular, it repeatedly deferred
collecting amounts owed by Burdett to Samaritan under the mortgage and administrative services agreement.
Nevertheless, by 2019, and nearing expiration of its operating certificate, Burdett faced financial insolvency.

Samaritan, in an effort to preserve delivery services in Troy, proposed to DOH that Burdett merge into Samaritan. At that
time, Samaritan was able and willing to absorb projected Burdett losses, in order to buy time for an attempted turnaround.¹
In 2020, despite their expressed skepticism, DOH and the PHHPC approved the proposal. On October 1, 2020, Burdett
merged into Samaritan, and became Samaritan’s maternity department. The department does not offer tubal ligations or
other ERD-prohibited services, but per DOH direction provides information to women on how to access such services.

In 2020, as Samaritan began pursuing its efforts to improve the viability of services in the maternity department, the health
care world changed drastically, with the COVID-19 pandemic negatively impacting all health care facilities.

Staffing shortfalls and continued financial losses

The effects of the COVID-19 pandemic on the nationwide healthcare workforce are well- documented, and SPHP and
Samaritan Hospital were not immune. Samaritan has struggled to ensure consistent staffing of the maternity department,
which has put a strain on the hospital’s ability to provide safe and high-quality care to women in labor. So far in 2023,
Samaritan has needed to transfer laboring mothers to other hospitals because of staffing shortfalls at a rate of about
46 per month, double the rate of such transfers in 2022. Our top priority is and always has been patient safety, and
disproportionate staffing ratios are detrimental to the quality of care we provide. In addition, the increasing need to
transfer is placing an escalating burden on our community’s limited EMS resources.

As another example, in 2022, faced with significant recruitment and retention challenges, SPHP’s dedicated anesthesia
group was forced to consolidate its providers into serving St. Peter’s Hospital only, and SPHP responded by forming its own
employed anesthesia group. Staffing of that new group has been extremely challenging, as has staffing of other clinical
positions. While emergent Cesarean sections can be performed at Samaritan, Troy obstetricians and their patients have
most often chosen to have non-emergent Cesarean sections performed at St. Peter’s Hospital.

In SPHP’s 2022 fiscal year, the losses incurred through operation of the maternity services unit at Samaritan Hospital,
inclusive of providers, anesthesia and fixed costs, totaled $2.3 Million. Losses continue to grow annually, compounded by
staffing shortages, stagnant reimbursement, low utilization and declining birth rates.

The decision-making process

Much has been made of the role of Trinity Health (“Trinity”) in the decision to close the Samaritan Hospital maternity
department. SPHP’s affiliation with Trinity is instrumental in navigating the complexities of the modern health care
landscape, and our relationship with Trinity benefits this community. As provided in Samaritan Hospital’s Bylaws, Trinity has
authority to approve the consolidated operating budget for SPHP, but that budget is first created in a process led by SPHP
operational and financial leadership, and then reviewed and recommended by SPHP’s Board of Directors.

Our local leadership and Board of Directors have a substantial voice in our organization’s management and governance,
and retain much decision-making authority with respect to the services we offer. The decision to close the maternity unit at
Samaritan Hospital was made by the Board of Directors, on recommendation of the hospital’s leadership. In other words,
the decision was made by people who live in and understand their community.

Importantly, the Board’s approval was preceded by a formal discernment process. The discernment was conducted by a
group of 15 participants, including various operational, financial, human resources and mission leaders, plus one of our
independent Board members, with two meetings held over the course of a month. In reviewing the closure proposal, the
central question centered on how the proposal aligned with SPHP’s mission and core values. Various concerns were raised,
not unlike those raised by many members of the community, such as how Troy citizens would access delivery services, and
maintaining the presence of our obstetrical and midwife providers in Troy. In the end, discernment participants determined
that approval of the proposal, subject to the taking of various measures intended to maintain access, was consistent with
SPHP’s values and mission. This discernment was reported to the Board, and it informed the Board’s decision.

How SPHP is addressing the needs of expecting mothers

While deliveries will cease being performed at Samaritan Hospital,² we plan to maintain all other prenatal, postnatal,
emergency and pediatric services currently being provided in the City of Troy and Rensselaer County. Samaritan will
continue to operate ob-gyn and midwife practices at their present locations.

Our obstetrical and midwife providers in Troy will advise their patients that they perform their deliveries at St. Peter’s
Hospital, and patients will have the option to seek other providers if they prefer to have their delivery at Albany Medical
Center or Bellevue Woman’s Center. At St. Peter’s Hospital, a full range of maternity services will be available, including
accommodation for doula-assisted births. At Samaritan Hospital there has always been the possibility that mother and
baby will become separated in the immediate postpartum period, if the baby requires a higher level of care. This possibility
is significantly reduced at St. Peter’s, with the availability of its neonatal intensive care unit in close proximity to the
maternity unit, which is better for mother and baby.

We understand that transportation can be a challenge for women in the City of Troy who are in labor. Of course,
transportation to Samaritan Hospital is presently a challenge for some laboring mothers too. Nonetheless, what may
have been a 5-minute or 10-minute drive to Samaritan Hospital, may become a drive of more than 20 minutes to St. Peter’s
Hospital or alternate facility. Our closure plan that will be submitted to DOH will include provision for transportation
assistance. Each patient entering one of our obstetrical or midwife practices will, on first visit, have a safe plan of delivery
established. That plan will include arrangements for transportation to delivery, for those who need it.

Other considerations

We appreciate the concerns regarding the effect this decision may have on people of color and underserved communities.
Addressing health equity is an important part of SPHP’s mission and strategy. This is not a case of a health system favoring
a facility in a more affluent and less diverse location. In fact, there is very little difference in the racial profile of patients
delivering at Samaritan Hospital as compared to St. Peter’s Hospital.

As part of the Troy community, St. Peter’s Health Partners is deeply invested in meeting its health needs. Even though it was
not initially required, we proactively agreed to perform a health equity impact assessment. Following the guidance of DOH,
we engaged the services of an independent, external agency with a health-equity focus to complete the assessment.

Health care providers continue to be impacted by adverse secular trends, including advanced age and the prevalence of
obesity among the pregnant population, which means a larger portion of the dwindling number of pregnancies are high
risk, and require care in more sophisticated centers, like St. Peter’s Hospital and Albany Medical Center. Combined with an
overall decline in birth rate, these trends simply accelerate the decline in the number of pregnant patients appropriate for
delivery in centers like Burdett.

The Medicare Wage Index (“MWI”) adjustment is not a windfall, and it does not unburden SPHP from the enormous
financial challenges it faces. The MWI adjustment brought this region into parity with other parts of the U.S, following many
years in which Capital Region facilities suffered from lower federal reimbursement, but it brings us only part-way toward
ensuring we can continue to provide safe, compassionate, appropriate care to the communities we serve, well into the
future.

Many are viewing our decision to close the maternity department in Troy in isolation. But our challenges are much greater
than those presented by financial losses on this one service. We have been forced to take other cost-cutting measures
as well, including the consolidation of some physician practice locations and discontinuing some higher-cost, lower-reimbursement
procedures.

We continue to experience an inexorable shift from inpatient to outpatient care. While this transition aligns with patient
preferences and has the potential for cost reductions, it also erodes the financial bedrock of many not-for-profit health
systems, like SPHP. High-margin inpatient procedures have traditionally offset the cost of less profitable but essential
services. As outpatient services grow, the potential for offsetting revenue diminishes, placing further strain on our financial
health.

Technology, the double-edged sword of modern healthcare, presents yet another challenge. While advancing patient care
and outcomes, the increasing costs and rapid obsolescence of medical technologies are making it difficult for not-for-profit
health systems to keep pace. We are in a constant race against time, struggling to invest in the latest technologies, lest our
care quality falls behind.

Arguably the most debilitating trend is the shift from commercial to government payment. Public reimbursement models
fail to cover our costs, despite extensive measures taken to reduce expenses through vertical and horizontal integration
and aggressive cost reduction strategies. The commercial payment model has historically enabled us to balance our
books, cross- subsidizing the lower reimbursement rates from Medicare and Medicaid. As we see an increasing patient
demographic reliant on government-funded health coverage, our financial stability becomes ever more precarious.

The landscape will continue to grow even more challenging as we grapple with competition from non-traditional
healthcare providers, including retailers and private equity-backed ventures. Armed with deep pockets, these entities
cherry-pick profitable healthcare sectors, leaving not- for-profit health systems to shoulder the financial burden of less
profitable but essential services.

Our organization faces a broad array of long-term challenges, and our Board of Directors and administrative leaders must
try to confront all of them.

The hearing

We appreciated the invitation of Assistant Attorney General James Sheehan to attend the September 18 hearing in person,
to give oral testimony. We are very interested in the public viewpoints that will be presented at the hearing, and all along we
have actively engaged community leaders, providers and staff in order to explain our decision, and to get their feedback.
However, the hearing was announced less than two weeks in advance. When asked by our legal counsel, Mr. Sheehan
confirmed that a representative of SPHP would be subject to questioning by Mr. Sheehan and/or his staff at the hearing. In
light of the lack of opportunity to prepare or be represented by legal counsel, and statements by your office regarding the
possibility of legal action, we respectfully declined Mr. Sheehan’s invitation.

Conclusion

The great bulk of care provided to women bearing children is delivered in the prenatal and postnatal setting. There will
be no impact to prenatal or postnatal ob-gyn or midwifery access in Rensselaer County. The robust, high-quality care our
practices provide will continue without interruption. Samaritan ob-gyn and Capital Region Midwifery will remain open
and continue to provide their unique services to patients. SPHP colleagues at those practices, including doctors, midwives,
physician assistants, nurse practitioners, nurses, and support staff, are a vital community resource, and they remain
committed to providing patients the same services that are offered today well into the future.

SPHP’s goal is to provide the best experience, care, and outcomes possible for all our patients. By consolidating maternity
services at St. Peter’s Hospital, the possibility that the expectant mother would need to be transferred to another hospital
due to staffing challenges is mitigated. It will also reduce the number of transfers for newborns who need NICU services.
Delivering at St. Peter’s Hospital increases the likelihood that both mother and newborn can remain in the same facility,
should there be a need for an additional level of care or services.

It is imperative that we achieve financial viability now so we can continue to fulfill our mission in the long term. We stand by
our decision.

St. Peter’s Health Partners has a long history of excellence in caring for the health needs of all women in the Capital Region.
That is something we are especially proud of and dedicated to continuing, and why we remain committed to ensuring that
prenatal and postnatal services, as well as women’s gynecological care, will continue at St. Peter’s Health Partners in Troy
regardless of the birthing center’s planned closure. The planned closure of the maternity department will not negatively
impact this history of excellence in care, but it will enhance services for all of our community.

Thank you again for this opportunity to contribute to the record.

Sincerely,
Steven D. Hanks, M.D., MMM FACP FFSMB
President & Chief Executive Officer of St. Peter’s Health Partners and St. Joseph’s Health
Trinity Health New York

¹ Samaritan Hospital’s willingness and desire to come to the aid of maternity services in Troy in 2019, despite projected
financial losses from the services, cannot not be construed as a promise to maintain services indefinitely into the future.
Samaritan Hospital, in fact, made no such promise.
² While it is by far the least desirable delivery scenario, Samaritan’s emergency department providers are capable of
managing any laboring mothers who may present in the emergency department.

Jayana LaFountaine / Troy, New York

How often do you pause to dream about the future? When you do, do you see Black and Brown people?

I come from a lineage of Black women who moved mountains to support the emergence of life, uplifting and empowering
other Black women through birth work, creating communities of care to center these lives when they were purposely
discarded and forgotten. By the time I became a Birth Doula, I knew that I would become responsible for preserving Black
and Brown legacies. I would be responsible for ushering in new generations of Black and Brown people. I knew that inviting
new life to enter this world should be full of choice and free of coercion. Standing by idly was not and is not in my DNA. If I’m
going to move mountains like those that came before me, that means I need to get comfortable with using my ancestral
gifts and voice for good.

As a Black birth doula, I have many Black clients coming to me fully immersed in fear fueled by their own lived experiences,
the experiences of other women in their lineage, and on data that speaks to high maternal and infant mortality rates
amongst Black birthing people. This fear is fortified by the distrust of doctors within Black and Brown communities due
to a long history of medical violence, where providers only view them as a number on a chart and completely dismiss
their humanity. These women and birthing people alike seek out Doulas because they know the first step to better birth
outcomes is rich with proper support, advocacy, and space to make their own decisions. Each client receives emotional
and spiritual safety, personalized education and resources that align with their needs. With these understandings and my
personal feelings as a Black woman, it is and continues to be challenging for me to enter hospitals for myself and in support
of my clients, and expect there to be positive birth outcomes.

Burdett Birth Center over the years has held space for birthing people to access their power and have complete bodily
autonomy. The staff at Burdett believe in and practice informed consent. They welcome Doulas and understand the
benefits they provide to a birthing person and the overall birthing experience. When medical emergencies arise beyond the
Midwives scope of work, they work in collaboration with obstetricians to ensure safety for the birthing person and baby.
Burdett’s staff has completely altered my views on hospital births, and the potential for success. They have, in my opinion,
created a culture rooted in care, consent, and the preservation of peoples choice and overall humanity.

The second client I ever had as a Doula was a Black woman. She came to me at 38 weeks pregnant with her second
child. Her first birth was an emergency C-section. She hoped this time around she could have a vaginal birth. During our
intake she mentioned that her OBGYN told her that she would likely need another c-section. I knew that Burdett had low
C-Section rates and they accepted and encouraged vaginal births after a cesarean. With this information, my client chose
to transition her care to Burdet.

In the weeks leading up to her birth we had many conversations on the importance of self advocacy, continued childbirth
education, and comfort techniques to help ease labor pains. When we finally arrived at Burdett the energy was welcoming
and supportive and immediately put me and my client at ease. Each person that entered her room introduced themselves
and explained what their role would be. Everyone responsible for her care read her birth plan and expressed sharing the
same goals as her, a safe vaginal birth. Any time someone was speaking it was thoughtful, informative, and coercion
free. There was nothing that was off limits for explanation if she didn’t understand what was said. There was no negative
language suggesting that her body was deficient for birthing. No fear-induced language suggesting that something might
go wrong if she didn’t do as she was told. Her body language, tone of voice and methods of coping were not policed by
any of the staff. My client was able to remain present in her body, and be focused on giving birth.. She was given space
to trust her own body and power. When the baby’s heart rate started to decline as labor progressed, a midwife came in
and calmly expressed her concerns and presented viable options. All of these things combined made space for my client
to be an active participant in her birthing experience, and make an informed decision on her own terms. To make a long
story short, we did indeed have a safe vaginal birth that ended with a healthy mom and healthy baby. All of this was made
possible by the attentiveness and care put forth by Burdett and its staff.

Burdett serves as a viable blueprint for what maternal healthcare should look like in a hospital setting. I have yet to
experience that level of consistent care, consideration and respect at neighboring hospitals, and my clients have expressed
the same. St. Peter’s would be doing a disservice to more than just a community by taking away such a vital resource.
Per their mission statement they are here to serve the poor and the most vulnerable. A closure would create poor timing
in transportation to neighboring hospitals , heighten the presence of unnecessary medical interventions, it would incite
negligence, obstetric violence, and aid in the rapid rise of maternal and infant mortality in our community. These are only
a handful of the looming problems... let’s not forget the staff at Burdett... and staff at neighboring hospitals who continue
to be overworked and underpaid. The persistent barriers to proper maternal healthcare in this country is inhumane, and
should be considered a violation of human rights. What are we to do but fight when the future is on the line?

Jayana LaFountaine - Birth Doula and Photographer

Esther Patterson King, Co-Chair of the Board of Directors, BirthNet

I am Esther Patterson King. I am the Co-Chair of the Board of Directors of BirthNet, a birth justice organization, that is
committed to eliminating the inequities in birth outcomes for all childbearing people. I am also a Community Doula who
has been doing birth work in New York State for over 20 years, and I and the Board members of BirthNet strongly oppose
the proposed closing of the Burdett Birth Center in Rensselaer County. We oppose the closing for many reasons. Chief
among those reasons is that the Burdett Birth Center offers Black, Brown, and low-income families a choice in where they
receive prenatal care and how and where they want to give birth.

Closing Burdett would leave many families in and around the Capital region without viable options in maternal health
care. This is unacceptable! To force families to give birth in a hospital that they are neither familiar, nor comfortable with is
unconscionable. Burdett birth Center is frequently chosen because it is a midwife led practice that offers maternal health
care in a smaller, safe, comfortable, supportive, and caring environment where the patients and their families know their
providers and know that they are a part of a practice that values them as individuals, respects them, and hears, and
addresses their concerns. They choose Burdett with confidence knowing that the midwives and staff that they see will be
with them through their pregnancy, birth, and beyond. I have friends and colleagues who have given birth at Burdett and
the satisfaction they have with their birth experience cannot be matched at a large hospital. The rationale we’ve heard
for proposing the closing of Burdett is that it is a financial burden to the Trinity Health Corporation. An effective maternity
center will not be profitable because beautiful, joyous, non-surgical births are not meant to be profitable. We cannot
choose profit over people when it comes to the provision of maternal health care.

Closing Burdett would place additional barriers and burdens on families who are already marginalized and historically
underserved. We have all heard the appalling statistics about the maternal mortality and morbidity rates of Black and
Brown mothers in this country. Closing Burdett Birth Center would literally put the lives of the people who would have
chosen Burdett in jeopardy. I know with every fiber of my being that the closing of Burdett Birth Center is unethical, against
what I as a member of the board of BirthNet believe, and absolutely not in alignment with the promotion of health equity
for all. We must not let Burdett Birth Center close. Thank you.

Planned Parenthood Empire State Acts

Dear Attorney General James,

It is with great concern for the Rensselaer County community and the patients of Burdett Birth Center (“BBC”) that we at
Planned Parenthood Empire State Acts (“PPESA”) offer the following testimony. BBC is a unique and valued facility utilized
by thousands of patients in the Capital Region. BBC is also currently the only labor and delivery unit in Rensselaer County.
It features a collaborative model of care delivered in a midwifery-focused setting that provides safe, evidence-based, and
patient centered health care, and a majority of the deliveries at BBC are covered by Medicaid.

PPESA is the independent, non-partisan, non-profit organization that represents the Planned Parenthood affiliates in New
York. Our local affiliate, Upper Hudson Planned Parenthood, is proud to provide sexual and reproductive health services
in the same communities served by BBC and knows first-hand what a significant role BBC plays in the broader health care
system in Rensselaer County, and for thousands of patients living nearby. Over the past few months, they have heard from
concerned patients and community members regarding this potentially devastating loss of reproductive and maternal
health care if St. Peter’s Health Partners (“SPHP”) follows through on plans to close BBC. PPESA shares these concerns, as we
know that the consequences of the closure will be significant and will disproportionately impact Black and brown patients,
LGBT+ patients, patients experiencing poverty, and those lacking childcare and/or safe means of travel.

It is unconscionable that an organization that purports to uphold a mission of serving the poor and most vulnerable would
move forward with plans to close BBC without consideration of the broader community and the true impact of the loss of
services. There is no evidence that BBC patients would continue to have access to equivalent patient-centered care from
other area providers, many of which are under-resourced and already at capacity. This closure would create significant
strain on other labor and delivery units and emergency services in this region, including first responders and EMS,
potentially diminishing the quality and accessibility of critical health care for thousands of patients.

Nationally and here in New York State we continue to grapple with an unacceptably high maternal mortality rate,
particularly among black women. At a time when we are called to do everything we can to improve the health and
wellbeing of pregnant and postpartum individuals we must be advancing access to quality care for all - not limiting it. The
closure of BBC will exacerbate this issue and potentially increase negative health outcomes for patients and frustrate the
State’s goals of decreasing maternal mortality and increasing health equity. It’s unacceptable that an entire region of this
state could lose critical patient-centered maternity care, potentially forcing patients to have to travel or even leave the state
to access the health care they need. It is a dereliction of SPHP’s mission and responsibilities to the community served by BBC
to move forward with closure, and we cannot allow accessible patient- centered maternal health care to disappear from
the City of Troy and Rensselaer County.

County Legislator

Dear New York State Attorney General Letitia James,

I am writing to address your recent call for public input on the matter of preserving the Burdett Birth Center in Troy, New
York. As a concerned resident of this community who is deeply committed to accessible and high-quality healthcare
services, I strongly urge you to utilize your powers to ensure the continued operation of this essential facility.

For many years, the Burdett Birth Center has stood as a cornerstone of maternal care in our region, providing unwavering
support and exceptional services to expectant mothers and families alike. Its dedication to personalized care, evidence-based
practices, and the creation of a comforting, home- like atmosphere has earned the trust of countless families in our
community.

The potential closure of the Burdett Birth Center raises grave concerns about our community’s access to comprehensive
maternal care. Should this facility shut its doors, expectant mothers and families would be compelled to seek alternative
options, potentially subjecting them to increased travel distances and limited choices. Such a scenario could give rise to
unnecessary hardships, heightened stress, and potential risks during a pivotal period in their lives.

Additionally, it’s worth noting that the Burdett Birth Center plays a vital role in our local economy by providing employment
opportunities to skilled healthcare professionals. Its presence contributes significantly to the overall well-being of
our community. The closure of this center would not only affect the healthcare landscape but also have far-reaching
consequences on the livelihoods of these dedicated professionals who have tirelessly served our community.

I understand that healthcare decisions involve intricate considerations, including financial sustainability and resource
allocation. However, I believe that the well-being and needs of our community must be paramount. I respectfully urge you
to explore all potential avenues to ensure the continued operation of the Burdett Birth Center, whether through funding,
partnerships, or other forms of support.

Furthermore, I encourage you to continue to maintain open and constructive dialogue with all stakeholders, including
the dedicated staff at the Burdett Birth Center, midwives, doulas, community members, and representatives from local
organizations. Their collective insights and expertise can offer invaluable perspectives and innovative solutions to help
safeguard this vital healthcare resource.

On a personal note, my wife and I welcomed our daughter into this world at Samaritan Hospital in 2019, and the staff at the
Burdett Birth Center helped make it an amazing experience.

This December, we are planning to welcome another child at Samaritan Hospital, as it has been the location for her OB/
GYN care during her pregnancy. We can’t think of a better place to safely experience the miracle of birth, than Samaritan
Hospital!

In conclusion, I implore you to recognize the profound significance of the Burdett Birth Center ni providing essential care
to our community. The preservation of this facility is not merely a matter of convenience; it is a matter of safeguarding the
health, well-being, and choices of countless families in Troy, Rensselaer County, and the surrounding areas.

I appreciate your attention to this pressing matter and have faith in your commitment to serving the best interests of
our community while preserving essential healthcare services. I eagerly anticipate a positive resolution that ensures the
continued operation of the Burdett Birth Center.

Thank you for your time and consideration.