Good morning.

Welcome to the New York City Council hearing for the committee on hospitals, hospitals and disabilities.

Please sign.

If you wish to testify today, please fill on appearance card with the sergeant at arm.

Without further ado, cheers, we are ready to begin.

Good morning, everyone.

I'm Councilmember Shahana Haney, Chair of the Committee on Disabilities.

I'm a brown woman in my mid-30s, and my hair is tied up.

Today I'm wearing black glasses and a white button-down, and I'm seated behind a dais.

Welcome to this joint oversight hearing with the Committee on Disabilities, Health and Hospitals on Access to Reproductive Care for New Yorkers with Disabilities.

We are also hearing a package of legislation, which I will describe shortly.

Nearly one in six New Yorkers lives with a disability.

People with disabilities are sexually active at rates comparable to people without disabilities, and yet they are less likely to receive preventive reproductive health services and comprehensive sexual health education, and they experience higher rates of unintended pregnancy, pregnancy complications, and intimate partner violence during the perenatal period.

These are not differences in choices, they are differences in access.

The consequences are measurable and they are severe.

In a study of more than 223,000 deliveries across 19 hospitals nationwide, researchers at the National Institutes of Health found that compared with women without disabilities, women with disabilities were more than twice as likely to develop severe preeclempsia, more than six times as likely to experience thrombo embolism, and 11 times as likely to die.

Pregnancy should not carry those odds for any New Yorker because of a disability.

Some of the barriers behind those numbers are physical.

Nationally, only about 40% of medical offices have an accessible examination table and a wheelchair accessible weight scale.

When the equipment doesn't adjust, patients with mobility disabilities are examined in their wheelchairs or not fully examined at all.

Some of the barriers are about training.

In one survey, only about 17% of obstetrician gynecologists reported having received training on caring for patients with disabilities.

And in a separate survey of practicing physicians, only 41% felt confident they could provide the same quality of care to a patient with a disability as to a patient without one.

The city has taken real steps, and the agencies in this room deserve recognition for them.

The mayor's office for people with disabilities serves as the city's central disability compliance authority and has delivered health equity trainings to medical residents and convened health care leaders specifically on barriers facing women with disabilities.

New York City Health and Hospitals reports that 15 of its Gotham Health Clinics are fully ADA accessible.

Seven offer additional accommodations for patients who are blind, deaf, or hard of hearing, and its Morrisania site houses a fully accessible radiology suite, an $850,000 project built with city council capital funding.

The Department of Health and Mental Hygiene operates eight sexual health clinics, provides medication abortion at four of them, and provided abortion care to 1,253 patients in 2025.

A 24% increase over the prior year.

Its abortion access hub has served more than 12,000 people since November 2022, including callers from states where abortion is banned or restricted.

This work matters.

But now we must contend with federal Medicaid cuts, which are projected to eliminate coverage for an estimated 1.5 million New Yorkers and to cost roughly 34,000 hospital jobs statewide.

And the state controller has warned that the harm will be most acute at the safety net hospitals in New York City.

NYC Health and Hospitals is the nation's largest public health system and the primary safety net provider for low-income and Medicaid-dependent New Yorkers.

And New Yorkers with disabilities rely on that system disproportionately.

When the safety net is weakened, they are among the first to feel it.

There's also a federal deadline bearing down on the city's own facilities under a 2024 rule by August 9th, 2026, less than two months from today, state and local government entities that use examination tables and weight skills must have at least one accessible example of each that meets enforceable federal standards.

That deadline applies directly to city-operated health facilities, including health and hospitals and DOHMH's sexual health clinics.

And we cannot talk about reproductive access for people with disabilities without addressing the history of reproductive control exercised over them.

From a documented history of coerced sterilization to present day questions about guardianship, informed consent, and decision-making authority.

People with disabilities continue to experience higher rates of sterilization than people without.

So today we are asking straightforward questions.

With the August 9th federal deadline almost here, are the city's own health facilities equipped with accessible diagnostic equipment?

And where are the remaining gaps?

DOHMH, HH, and MOPD have acknowledged in their own accessibility planning barriers around inaccessible exam space, equipment, and communication.

Are these agencies coordinating to close them?

And on what timeline?

What disability-specific clinical training are providers in the city's reproductive and sexual health settings actually receiving and how is it being measured?

Are the sexual health clinics and the abortion access hub reaching New Yorkers with intellectual, developmental, sensory, and psychiatric disabilities?

As federal Medicaid cuts move through the safety net system, these New Yorkers depend on what is the city's plan to protect their access to reproductive and sexual health care.

We are also hearing legislation today, and we look forward to the administration's and the public's feedback on it.

Intro number 200, sponsored by Councilmember Jennifer Gutierrez in relation to creating resources for doulas.

Intro 211, sponsored by myself in relation to requiring the Department of Health and Mental Hygiene to provide information regarding fertility treatment, including insurance coverage of fertility treatment.

Intro 840, sponsored by Councilmember Kayla Santo Suoso in relation to requiring health insurance coverage for pre-implantation testing for city employees.

Intro 941, sponsored by Councilmember Linda Lee in relation to requiring the Department of Health and Mental Hygiene to develop and offer resources, clinical guidance and training on disability and accessibility in healthcare settings.

An intro 953, sponsored by Deputy Speaker, Dr.

Nantasha Williams, in relation to requiring the Department of Health and Mental Hygiene to make medication abortion available at no cost to a patient at all of its sexual health clinics.

We are also considering proposed resolution 89A, sponsored by Councilmember Gutierrez, calling on the New York State Assembly to pass A9175 and the governor to sign S2058 A9175 legislation to require each institution within the state university of New York and the City University of New York to have at least one vending machine making emergency contraception available for purchase.

Proposed Reso 108A, sponsored by Councilmember Frank Morano, calling on the New York State Legislature to pass and the governor to sign S5262A3051 legislation creating a refundable tax credit for up to three cycles of in vitro fertilization not covered by insurance.

And RESO 447, sponsored by Councilmember Santosuoso, calling on the New York State legislature to introduce and pass and the governor to sign legislation to ensure insurance companies cover the cost of pre-implementation genetic testing for Anuploys.

It's a medical term that we'll need to learn how to say.

I will now read health committee chair Lynn Shulman's opening statement.

Good morning.

I'm Councilmember Lynn Shulman, Chair of the New York City Council's Committee on Health.

I want to thank you all for being here today at our oversight hearing on access to reproductive health care for New Yorkers with disabilities.

I apologize that I could not be here in person, and I want to thank Chair Hani for holding this important oversight hearing and for reading the statement on my behalf.

New York City is a beacon in the U.S.

and across the globe for providing comprehensive access to high-quality reproductive health care.

As the federal government and other states try to roll back the right to bodily autonomy and restrict access to comprehensive and inclusive care, our city has taken a stand to ensure that anyone, no matter who they are, where they come from, and how much they can afford can access high quality and non-judgmental care for the full range of reproductive health services they may need.

DOHMH is instrumental in this area, providing information and resources for those seeking care, and directly providing such care at little to no cost at the department's six sexual health clinics located around the city.

These clinics provide essential services, including medical evaluations, STI testing and treatment, prep consultations, pregnancy tests, emergency contraception, and at some locations, medication abortion.

Today's oversight hearing focuses on meaningful access to care, particularly for the disability community.

Pursuant to local law 12 of 2023, DOHMH developed a five-year accessibility plan to improve accessibility to its facilities and services across five areas: physical access, digital access, effective communication, programmatic access, and workplace inclusion.

The plan identifies ongoing accessibility challenges across DOHMH facilities, including inaccessible examination spaces, narrow doorways, insufficient accessible medical equipment, inadequate signage, and barriers associated with aging infrastructure that predates the Americans with Disabilities Act.

And as we look to combat rampant misinformation and disinformation in the public health space, we must also ensure that DOHMH's messaging is reaching as many New Yorkers as possible.

I look forward to a robust discussion of how DOHMH plans to improve accessibility across its resources and services, including at its sexual health clinics and how it is more broadly directing resources toward realizing the accessibility goals laid out in the five-year plan.

I also look forward to receiving feedback on the legislation being considered today, the majority of which is in the health committee.

These include proposals to reduce the costs of IVF process, expand access to medication abortion and emergency contraception, improve the citywide DULA program, and educate New Yorkers about fertility treatment and insurance coverage options.

All of these bills share the common goal of strengthening and expanding access to the full suite of reproductive and family planning services for all, regardless of ability, income, or gender, and to help build a New York City where families are healthier and feel empowered to make informed decisions about their futures.

As I often say at these hearings, health care is a human right, but a right is only as meaningful as the ability to act on that right.

While I am proud that New York City seeks to protect the rights and dignity of all people to make their own decisions about their health care, we must keep fighting to eliminate barriers and to ensure meaningful access to that care.

I will conclude by thanking Chair Hanif again for holding this hearing and by thanking the representatives from DOHMH and the administration for being here today.

Now I'll pass it to Chair Narcis for her opening statement.

Good morning and thank you, Chair.

I'm council member Miss Mercedes Narcis.

I'm a black woman wearing a reddish hair and a green dress.

I'm in Beijing Green flying dress.

I'm happy to be here this morning and talking about something that's very important to all of us and folks that really need our assistant in New York City to improve their lives.

So whenever I can, I will do be present.

Today I was not supposed to be here, but when I have the opportunity, I'm here with you.

Thank you to Chair Hani for convening this important oversight hearing on reproductive health care for New Yorkers with disabilities and for inviting me and Chair Schulman and to talk about this issue.

Before I get deep in the issue, I know you all are New Yorkers.

We are very proud of the team.

Yes, NYX did it for us over 50 years.

So as New Yorkers, I want to bring that up.

Congratulations to the team and all the supporting fans that have been dying to see this moment.

So I'm very happy.

I had to add that in.

Access to reproductive health care remains a critical issue for New Yorkers with disabilities who often face persistent barriers, such as inaccessibility medical equipment.

And I know how important that is as a registered nurse and as well as a provider for health care medical equipment for many decades.

Limited communication supports is very important.

And a lack of disability, we need to have our disabled population to feel part of this important world.

We have to make sure that every support that we can keep, we give it and support and inform our population that is very important to our community.

New York City Health and Hospital, as a city public health system, play a central role in addressing this challenges by providing comprehensive reproductive and sexual health services across its hospital.

Gathering health clinics and community health centers.

These services include contraception and family planning, pregnancy-related care, abortion counseling and services, and HIV prevention and treatment, all provided regardless of a patient's ability to pay.

Over the years, HNH has made great progress in improving accessibility, reporting ADA compliance across its facilities and ongoing efforts to bring newly acquired sites into full compliance.

Several Gaffim Health Clinics are fully accessible and offer additional accommodation for patients who are blind, deaf, or hard of hearing, alongside investment in infrastructure, assistive technologies, and staff training.

This initiatives position HH as a key provider at the intersection of disability access and reproductive health care in New York City.

However, despite this advances, many individuals with disabilities continue to face barriers in finding adequate reproductive and sexual health care due to the limited availability of access equipment and specialized.

Disability-specific care from providers who have received comprehensive training on best practices for training patients with disabilities.

These ongoing barriers underscore the need for more targeted disability informed approaches within reproductive health services so that all New Yorkers can receive the best care possible.

Before I conclude, I would like to thank the committee staff for their work in preparing today's hearing.

While I'm unfortunately, I have to tell you, I cannot stay to be, I cannot stay long, but I believe the chair at Hanif will do an amazing job and make sure that we dressing all the issues that need to be addressed, and with your support, we'll do that.

Um I'm committed to this.

This is not just now.

I'm committed for uh equitable access to reproductive health care.

I mean health care for New Yorkers with disabilities.

It remains a priority for me.

And like I said, as a registered nurse, I appreciate every aspect that we can do while I'm here to address the needs that I have seen over decades.

I look forward to reviewing the hearing and debriefing with my committee staff to further and examine these issues and identify ways to improve everyone's lives in New York City.

We're part of the city.

So thank you, Chair.

Thank you, Chair.

And now I'll pass it to Councilmember Morano for his opening statement.

Thank you, Chair Haney.

Thank you, Chair Narcis, and uh all my colleagues on the committees on disabilities, hospitals and health, for hearing uh resolution 108 uh today.

At its core, this resolution is about something very simple: whether the opportunity to become a parent should depend on the size of your bank account.

And for millions of Americans, infertility isn't some abstract policy issue, it's a medical condition, it's a source of stress, it's a source of heartbreak, uncertainty, disappointment, etc.

And for many, in vitro fertilization offers hope.

It offers a chance to build the family they've dreamed about for years.

But the fact is, hope, at least in the form of IVF, is very expensive.

A single cycle of IVF can cost 15 to 20,000 dollars.

For many families, one cycle isn't enough.

Some require two, three, even more attempts before they're successful.

By the time medications, testing, and other associated costs are included, families can find themselves spending tens of thousands of dollars.

I've spoken with New Yorkers who've emptied their savings accounts, taken on second jobs, accumulated debt, delayed buying a home, or postponed other major life decisions simply to pursue the possibility of having a child.

And many never get that opportunity at all.

So the reality is that access to fertility treatment often depends on where you work, what insurance plan you have, or how much money you have available.

And that's especially true for working and middle class families, for LGBTQ New Yorkers, for cancer survivors pursuing fertility preservation, and for countless others trying to navigate an already difficult journey.

This resolution supports legislation pending in Albany that would establish a refundable tax credit covering up to 75% of eligible out of pocket IVF expenses for up to three cycles not covered by insurance.

That word refundable is important.

This isn't a benefit reserved for the wealthy.

This is designed to provide meaningful relief to the families who need it most.

I'm proud that this resolution has attracted support from members across the ideological spectrum in all five boroughs.

And looking at the sponsor list, you'll find conservatives, progressives, moderates, democrats, and republicans.

That's because the desire to have a child isn't partisan in the least.

The desire to build a family isn't partisan.

And this is about recognizing that family formation remains one of the most important goals many people will ever pursue, and that government shouldn't stand idly by while financial barriers place that goal out of reach.

So today the committee has an opportunity to send a message uh to Albany that New York should do more to support people who want to become parents.

So I want to thank all the co-sponsors, including the folks behind me, uh, the committee staff, and everyone who shared their personal stories with us.

Uh these stories are the reason this resolution matters so much.

So I uh respectfully urge the committee to support Resolution 108A and help more New Yorkers realize the dream of building a family.

Thank you.

Thank you, Councilmember.

Now I will be reading Deputy Speaker Natasha Williams's statement on her bill.

Thank you, Chairs Schulman, Narcis, and Hanif for convening today's oversight hearing on access to reproductive health care for New Yorkers with disabilities, and for hearing intro 953.

I regret that I am unable to be present today, but I appreciate the opportunity to submit the statement in support of my bill.

Intro 953 would require the New York City Department of Health and Mental Hygiene to make medication abortion available at no cost at all of its sexual health clinics.

While current law requires this medication to be available at certain clinics, this bill would ensure consistent access across all DOHMH sexual health clinic locations.

This bill is about access, equity, and consistency in care.

Reproductive health care, including abortion care, is essential health care.

At a time when reproductive rights continue to be challenged across the country, New York City must remain committed to protecting and expanding access to care.

Even small barriers, such as confusion about available services, transportation challenges, or delays in care can have serious consequences, especially when care is time sensitive.

No one should walk into a city operated sexual health clinic unsure whether they will be able to access the care they need.

Intro 953 helps close that gap.

It ensures that regardless of which DOHMH sexual health clinic a patient visits, they can expect the same standard of care.

Every New Yorker deserves access to safe, timely, and affordable reproductive health care.

This legislation helps move us closer to that goal.

Reproductive health care is not optional care for New Yorkers with disabilities, equitable access to it touches bodily autonomy, equal treatment under the law, and the ability to participate fully in their own lives.

We will not get this right by treating it as a clinical problem alone.

We have to be honest about the physical barriers that remain, the training gaps that persist, the federal threats bearing down on the safety net and the gap between what is promised and what is delivered.

Thank you to the administration for being here today and to the disability advocates, service providers, health care workers, and members of the public who have traveled to testify or submitted written testimony.

Your presence here is an act of self-advocacy, and we do not take it for granted.

Thank you to all of the staff who made today's hearing possible, including disabilities committee staff, senior legislative counsel Sarah Suther, and senior legislative policy analyst Chloe Rivera, Matt, my chief of staff, and Anisha, our legislative fellow.

I also want to recognize the council members joining us in person and remotely.

Council members Della Rosa, Wilson Morano, Marte Epstein, Ariola, Brooks Powers, Aldeball, and Nurse.

I will now pass the mic to the committee council to administer the oath to members of the administration prior to their testimony.

Will you please raise your right hand and respond verbally with I do?

Do you affirm to tell the truth, the whole truth, and nothing but the truth before these committees and to respond honestly to council member questions?

All right, you may begin your statement when ready.

Good morning.

Uh, Chair Hanif, Chair Narcis, and Chair Schulman, and the members of the committee.

My name is Nisha Agarwal.

I'm the commissioner of the mayor's office for people with disabilities.

I have short black hair and brown skin, and I'm wearing black top and slacks.

I have aphasia and I may have my handy cane by my side.

Thank you for scheduling this meeting on reproductive health care for women with disabilities.

This impacts me professionally and personally.

New York City has made significant investments in reproductive health care, and MOPD values this incredible progress.

Yet, women with disabilities continue to face barriers on these uh services that may include inaccessible facilities and health and equipment in the healthcare setting, challenging challenges on accessible communications, and segregated health care.

First, I will share some of the laws that are meant to assist women with disabilities.

In 2024, the US Department of Health and Human Services updated two rules for state and local health care settings who provide federal financial assistance with the goal to improve health care settings and civil rights protections for people with disabilities.

For example, the federal rule requires health care settings to provide appropriate auxiliary aids and qualified interpreters, real-time caption, qualified readers, audio recordings, and braille materials among other supports.

In addition, the rules also ask a timeline for states and localities to provide medical diagnostic equipment, such as exam tables, mammogram equipment, weight scales, and radiology equipment that will assist people with disabilities, especially women.

These changes will happen in August.

The rules are intent to ensure that all people receive equitable health care compared to others.

However, many healthcare settings have yet to reach this standard of care.

In practice, women with disabilities face barriers in reproductive health outcomes.

For example, a research by a distinguished women professor with disabilities reported that 81% of women aged 18 years or older without disabilities received cervical screening within three years, compared to only 67% of women with chronic mobility limitations.

In another study on reproductive health by the same author, women with disabilities were 70% less likely to other women to be asked about contraception during routine office visits because the physicians erroneously assumed that they were not sexually active.

Accessible equipment and communications alone won't ensure that women with disabilities have equitable health care.

Anti-biased training from the health community is critical as well.

I'd like to now share how the mayor's office for people with disabilities is supporting and leading this effort in concert with women with disabilities.

Last Friday, MOPD and the Deputy Mayor of Health and Human Services, Helen Artiaga, visited the NYU initiative for women with disabilities in Manhattan.

This is a health care setting focused primarily on gynecological uh uh care and um wellness services for women with disabilities.

And I went to this institution for many years after my stroke.

We toured around the hospital setting where they had um exam tables, mammography uh uh equipment, and weight scales designed for women with disabilities.

And the director shared that it may take women with disabilities more time to get into their robes, into the exam table, and out and go through the um mammogram procedure, but in the end, it was better for patients and for the hospitals.

Women received good health care, and the hospital reduced the uh missed diagnosis for women with disabilities.

Equally um compelling was the um internal process.

In procurement, for example, the hospital has questions on disabilities for potential vendors to ensure accessibility.

And the hospital is now in the process of adding data fields uh for people with disabilities alongside race, gender, etc.

The goal is on uh people uh centered design, but also helps the bottom line.

If you if you do it well, people will come.

We also um are planning a round table with women with disabilities on health care, uh, with a portion focusing on the problems that women face in the health care settings, and a larger discussion on solutions with hospitals, clinics, and providers to ensure that health institutions broadly are more excluding inclusive and accessible.

And we would love if you uh chair Hanif could join the round table as well.

Finally, I'll end with some personal reflection reflections.

Um, it was a long road to recovery for me, but it was through my family, friends, doctors, therapists, co-workers, and uh in immense community that I can now walk and talk and argue and dance.

Um, and I am very lucky for having that.

But this is also um my uh privilege.

As a commissioner, I got access to every doctor, every therapist, um, people at the highest level to help me recover.

But as I talked to um people, women um with cancer and stroke, the difference was palpable.

The place that you live, the employment that you had, the hospital that you went to, the color of your skin, all played a factor in how well you recovered and um thrived.

In the end, um, it was the access that you have, not the medical uh condition that mattered.

Our goal is to change that outcome.

Thank you so much for the opportunity to speak today.

I deeply uh appreciate the council's attention to this important issue, and I hope uh and I will look forward to answering your questions and continuing to work together.

Go for it.

Good morning, good morning, Chair Shauman, Chair Narcisse, Chair Anif, and members of the committee.

I'm Joaquina Rasina.

I'm the assistant commissioner for the Bureau of Public Health Clinics at the New York City Department of Health and Mental Hygiene.

Um I sit here, Hispanic male uh short hair, blue suit, pink and blue polka dot tie, pink and blue polka dot paca square, and joined today.

Uh with me is Amanda Alvarado, the health department director of accessibility and disability services facilitator.

She sits here in a pink suit, uh white shirt, short hair, and also wears glasses.

Thank you for the opportunity to testify today on access to reproductive health care for New Yorkers with disability.

The New York City Health Department is a leader in the country in offering cutting-edge sexual and reproductive health care.

Our six sexual health clinics offer a suite of low to no cost sexual and reproductive health services to people ages 12 and older, regardless of ability, immigration status, or insurance status.

To expand access to care.

We also offer telemedicine services through our sexual health clinics hotline.

Our sexual health services include testing and treatment for HIV, chlamydia, gonorrhea, syphilis, and MPOX, vaccination for HPV, hepatitis A, and B, meningitis, and MPOX, and preventative care like HIV pre and post-exposure prophylaxis.

Our reproductive health services encompose contraception, including emergency contraception and medication abortion.

Most of our services are available without an appointment.

We're always working to improve and expand our clinic services to better meet our patients' needs.

Recognizing our clinics are a gateway to health care for many New Yorkers.

We also offer linkage to health care providers and other resources, including through on-site licensed social workers.

Our sexual health clinics are the safety net of the safety net, reaching many people who have been historically disenfranchised by the health care system.

Of patients seen in 2025, over half reside in tree neighborhoods.

Over two-thirds reported being uninsured, and nearly three-quarters were person of color.

The department is unwavering in our commitment to providing low-to-no-cost services and creating safe, affirming spaces for all New Yorkers.

Everyone deserves access to compassionate care without barriers.

Over the past several years, the New York City Health Department has made significant progress towards improving accessibility of our services to the public as well as the internal reform to make the agency more accessible to staff members with disability.

While we have much to accomplish, we are proud to be leading these efforts, which include evaluating signage at health department facilities and implementing accessible signage, developing and implementing disability justice trainings, and renovating buildings for enhanced accessibility.

Our sexual health clinics buildings are physically accessible and we are making them compliant with the ADA Act as we renovate and retrofit spaces.

Turning to the legislation under consideration today, introduction 200 would require us to develop a doula bill of rights as well as the submission form to receive feedback from doolers.

The bill would also establish a doula advisory council to study the work of doolers in the city.

We support the intent of this legislation and share the council's goals.

We are still assessing the implementation needed for this legislation and its operational impact.

We look forward to continuing the conversation.

Introduction 211 will require us to conduct a public education and outreach campaign on fertility treatment, including insurance coverage.

The New York City Health Department is committed to ensuring that New Yorkers have access to accurate, timely information and services that support their sexual and reproductive health.

While the department plays an important role in connecting New Yorkers to reproductive care, services are primarily delivered through external health care providers, health systems, and insurance plans.

The department does not provide fertility services nor have expertise to provide information to the public.

Additionally, insurance coverage and eligibility requirements can vary significantly across Medicaid managed care plans and private insurers, creating challenges in providing information to the public.

We are happy to discuss this further after the hearing.

Next, pre-introduction 2060 would require us to create a disability competency and accessibility training program as well as educational resources for health care providers and patients regarding disability-related health care rights and resources.

The department supports the intent of this legislation.

However, we have no oversight role of health care providers in New York City as they are regulated by the state.

Further the development of comprehensive evidence, informed training, curriculum, stakeholders, and engagement processes.

Ongoing program administrations would require subject matter experts that we do not have.

Lastly, pre-introduction, pre-introduction 2088 would require us to provide medication abortion at no cost to patients at all of our sexual health clinics.

We support expanding access to medication abortion for New Yorkers alongside our full suite of sexual and reproductive health services.

We do not have we do have operational concerns that we hope to discuss with the council, including hiring challenges and constraints on physical space.

We thank the council for your commitment while we share to supporting and improving reproductive health care for New Yorkers with disabilities.

Thank you for your attention.

I'm happy to take your questions.

Thank you.

Good morning.

Good morning, Chair Hanif, Narcis, and members of the Committee on Hospitals, Disabilities, and Health.

I am Dr.

Wendy Wilcox, Chief Women's Health Officer of New York City Health and Hospitals, System Chief of Obstetrics and Gynecology, and Chief of OBGYN at New York City Health and Hospitals, Woodhall Hospital.

I am a black woman wearing black-rimmed glasses and a red suit.

I have been with New York City Health and Hospitals for over 15 years, working at acute care centers, which include Jacoby, North Central Bronx, and Kings County.

I am also joined by New York City Health and Hospitals Chief Diversity, Equity and Inclusion Officer, Dr.

Ivelise Mendez Yustiano.

She is light skinned Hispanic female wearing a blue suit and orange shirt.

At New York City Health and Hospitals, also known as HH or referred to as the system, our commitment is to excellence in health care.

Built on a foundation of social and racial equity, HH is led by standards known as ICARE, which stands for integrity, compassion, accountability, respect, and excellence.

With this ethos as a guidepost, clinical and non-clinical staff strive to ensure that all New Yorkers who walk through our systems doors are treated with dignity throughout their care experience, no exceptions.

Historically, people with disabilities have faced elevated stigma and bias across health care systems, including sexual and reproductive health.

HH is a leader in providing culturally responsive health care services and continuously strives to remove barriers for special populations experiencing a disproportionate burden of illness.

This commitment also extends to sexual and reproductive health conditions that have consistently faced delays in diagnosis and treatment, such as endometriosis and chronic pelvic pain.

Patients who seek sexual and reproductive health care are met with a robust team of clinical staff, including specialized physicians, surgeons, nurses, mental health providers, and social workers to meet patients where they are in all of their sexual and reproductive or in their sexual and reproductive health care journey.

HH's women's health clinical programs are designed to prioritize listening, validate the patient experience, and provide equitable, comprehensive, multidisciplinary care that is coordinated across the care continuum.

HH has a comprehensive obstetrics and gynecology program that provides evidence-based, compassionate care to help patients achieve their sexual and reproductive health goals.

The system accomplishes this in part through an expansive network of physicians that include subspecialty trained providers in sexual and reproductive health.

Whether a patient with complex medical conditions is seeking counseling on contraceptive options, prenatal care, adoption, or abortion care, HH staff provide care consistent with New York City's Sexual and reproductive health care bill of Rights, as well as New York State's hospital patient bill of rights.

In addition to providing these clinical services, H H maintains a reproductive health working group comprised of family planning directors, which are located at each acute care facility and Gotham sites.

This working group focuses on troubleshooting everyday clinical issues to develop system-wide standards and guidance, allowing for challenges noted at one facility to be brought to the group to proactively address them across the system.

In its ongoing efforts to find innovative ways to reduce barriers to care, HH became the first public health system in the nation to launch telehealth abortion care through virtual express care in October 2023.

The Virtual Express Care Abortion Access, also known as VECAA program, provides patients the opportunity to access reproductive health care where and when it best meets their needs and receive medication abortion at their New York City address within a few days.

If clinically appropriate, the service is available seven days a week between 9 a.m.

and 9 p.m.

and can be accessed online or by calling by telephone.

Since the program's launch, HH has had over 7,500 encounters and prescribed over 2300 people in New York City a medication abortion packet, which was then mailed to their home.

VECAA expands access to care without compromising the patient experience, offering the same compassionate, judgment-free care as in-person visits and supporting all patients in reaching their health care goals.

Treating patients with disabilities goes beyond the clinical services provided by the HH staff.

In addition to the programs described, HH prioritizes accessibility across its facilities and services to ensure individuals of all abilities can access care.

Across the system, facilities are ADA compliant and equipped with height adjustable examination tables to make transfers easier for patients with mobility limitations.

Facilities are also designed with accessibility in mind, including door frames and hallways that have been constructed to accommodate individuals who use wheelchairs and other mobility devices.

To strengthen staff capacity to serve patients with disabilities, HH has partnered with the Helen Keller National Center and the Lighthouse Guild to conduct blind and low vision simulation training to help staff better support patients navigating facilities.

To further support all patients seeking reproductive health care, HH's reproductive health navigators assist patients who may need extra support, accessing services, including transportation, escorts after receiving anesthesia, and other forms of care coordination.

The system also ensures that patients can access information and resources in their preferred format and language through the Accessible Format Directory.

Through this directory, staff across HH can provide patients consent forms in large print, braille, and also audio files in English and other top five languages at their respective facilities.

New York City Health and Hospitals remains committed to ensuring that all New Yorkers with disabilities seeking sexual and reproductive health care feel seen, heard, and respected during their visit to our facilities and system.

Through ongoing innovation and a commitment to culturally competent care, we will continue to provide healthcare services that uphold the dignity and unique needs of every patient.

Thank you again for the opportunity to testify today on this critical topic.

I'm happy to answer any questions.

Thank you.

We've been joined by Councilmembers Farias and Sanchez, and I want to pass it to Chair Narcisse for her questions.

Thank you, Chair.

One of the things I want to And Council Member Joseph.

One of the things I want to quickly ask.

That we provide care at H.

Our top site five languages are Spanish, French, Bangla, Mandarin.

Mandarin.

Okay.

One of the things I'm gonna iron out is that still going on that um doctors, providers, medical providers not talking about sexuality with folks with um disability.

For me, that's old age.

I mean, before I used to hear it, but are it still going on?

Um, well, this is research and the national level, so um, but this it was I think 2020, 22, so it's still um current.

I never can understand that.

I'm thinking like it's a human being and you think okay.

Um PD's former commissioner testified in April 2025 that inaccessibility exam rooms and diagnostic equipment, communication barriers and lack of culturally competent care remain works in progress.

Um 14 months later, which of those have been resolved?

What relevant data um can you share with this community?

I mean committees.

Anybody can add?

Yeah, so I will defer to the health department and H for specific uh uh facility related questions.

But the Mamdani's administration um takes the work very seriously and is committed to the progress.

Um, as I mentioned in my testimony, um, with the deputy mayor and I visited NYU to see good models, and we'll um do a round table with women with disabilities to continue this conversation with um community partners with lived experience.

And so um that's our our next follow-up from that.

It's all great when you talk about NYU, but truly, NYU is not a reflection of delivery care of all New York City, because we know that in a black and brown communities, that is not possible.

And I'm not blaming them because the reimbursement is sucks.

Medicaid reimbursement and all the cuts, we have more trouble to deal with.

So thank you for your advocacy and everyone here to continue fighting for that.

As of today, how many of DOHMH facilities and how many H site meet the requirement?

How many facilities and site do not currently meet that requirement?

No.

I can speak on behalf of the health department.

Um, all of our sexual health clinics that are currently operating do have ADA compliant power beds, uh ADA compliant phobotomy chairs.

Um so we are meeting that compliant in regard to the services we're providing as of for the scales, uh, all of our services that we do provide don't require um assessing for weight.

Uh so we currently do not have any um accessible skills due to the services that we currently are providing.

Okay.

And about H, Dr.

Cox, this is my gardener.

Sorry, thank you.

Um, as uh Health and Hospitals complies with all state, local, and federal requirements related to the ADA.

We're a public agency that is governed by federal CMS, State Department of Health, and New York City Department of Buildings, all of which outline the needs of people with disabilities.

HH is constantly assessing our equipment and policies to address any gaps in care as legislation and regulatory requirements are updated.

We can dive into it a little deeper, but for now I'll do your to your knowledge, um, or H.

What capital investment has H committed specifically for MDE and structural accessibility fixes such as doorway with an examining room?

So H as stated previously complies with all state, local, and federal requirements related to the ADA.

As I said previously, we're a public agency governed by federal CMS, State Department of Health, and New York City Department of Buildings, all of which outline the needs of people with disabilities.

All HH facilities have hallways that are large enough and do not restrict travel with wheelchairs.

All H hall hallways have handrails to assist people that need more stability when walking.

All H bathrooms have accommodations such as wider stalls, heightened toilets, and insulated piping below sinks.

Access ramps are installed in all HH buildings to facilitate movement throughout.

Elevators are easily operated and have ADA compliant controls.

So I'm gonna leave it as this because the chair probably will go dive into those more.

Since I have to run, guys, so I'll go to accessible medical diagnostic equipment or MDE.

Is a critical company, I mean component for equitable, reproductive and maternal health care.

Do any H labor and delivery units and prenatal clinics have accessible MDE and accessible birthrooms?

So yes, we have accessible MDE and accessible birthrooms across our system.

Um and our birthing beds are designed for safe, flexible childbirth care, and so it does um uh allow for height and height adjustment um for easy transfer um across um um you know from from the bed to other modalities, um also built-in grips uh and a labor bar for additional comfort and lay and leverage during develop uh during delivery.

So we have tried to accommodate for that.

What specific accommodation exists for patients who use wheelchairs or have limited mobility during labor?

I'm sorry, please explain that.

What specific accommodation exists for patients who use wheelchairs or have limited mobility during labor?

You start talking about it, but I just want to be specific.

Okay, thank you.

So is it are you talking about like transfer from the wheelchair to the bed so that the bed is height adjustable to allow for easier transfer?

Yeah, like if for instance, let me go.

So if a patient with disability, sometimes it's not all disabilities as a lot.

There's different parts of things that may be not, you know, working.

So maybe the lamb, it can be something else, it can be the back where the person can move.

So, do you have all the equipment required to make that person from the transferring from even be in that bed in that stretcher?

So our staff is highly trained and would absolutely assist the patient in transfer.

Okay.

And one of the things, because I used to sell DME, I was a provider for DME.

One of the things that always came across is just like some chairs are limited in size, you don't have all the size, your doors are restrictive.

You know, I've been there done it.

Register nurse and selling DME.

So that's the reason I'm going with that question with you.

Um, those chairs are provided, uh, are really suitable for all sizes.

Do you have all sizes of possibility?

We do.

Um, you know, this was taken care of a while ago where we have wheelchairs that are able to accept um certainly higher weights as well as birthing beds and OR tables that are able to.

The tables are too.

All right.

Thank you.

Uh H obstetric staff train.

You said they all train, so I don't have to ask you.

They all train and able to provide care for any disability that a person may have.

So all H staff is provided with disability awareness trainings.

In addition to that, we offer the low and blind patient experience, which provides training on navigating difficult spaces all for the patient as well as for the staff.

So this a person walk in with disabilities in any floors, they do they give instruction of what's going on, the stop being trained and will kind of give them the enough knowledge for that stay in the hospital to give them some comfort.

Because let's say if I'm blind, do you I'm aware of what's going on?

What is that from the get-go?

It's not a person with disability is not a person that just walk in like I'm I'm walking in.

They have different things, they have a lot of fear going on, especially when we come, we talk about even somebody's pregnant come to deliver, and knowing that I have a limited, you know, ability to do everything that I want to do.

Do you give provide all that from the get go?

All the instruction and so from the very beginning, we provide this training to all staff.

We also provide staff with disability ally buttons so that individuals with disability, as we know, not all disabilities are um visible.

They are able to, the step the patient is able to approach any staff and ask them about any special accommodations that they may need.

Do you have some kind of like a doula that you can partner that within the structure to make that person easy because that's a lot going on for somebody with disability delivering?

So we are open to partnering with all of the staff.

I can't have a lot of questions, but I might gotta run the you.

Okay, the US Department of Justice, titles two, final rules requires that by August 9, 2026, roughly eight weeks from the this hearing, every covered facility that uses exam tables and weight scales have at least one accessible exam table and one accessible weight scale.

As of today, how many of DOHMH facilities and how many H um sites meet the requirement?

And how many do not, if you're aware?

Who's gonna go for it?

The health department, um, all of our clinics um are compliant in regards to the beds.

Um, and as I mentioned previously, uh, we do not have scales because weight um is not necessarily uh needed for the services we currently offer.

Last time I heard this scale are too expensive, you don't know how many, but how many but now let's go back.

How many um folks with disabilities that gave birth within a year at H or in the city of New York?

If you're not buying the scale, is because how many that you deliver, and you may have the statistics saying okay, you have one, and the scale costs two million.

I'm just giving an example.

Well, we don't provide delivery services, so I'll defer to health and hospitals.

No, do you know that they're providing it?

Because if you're Department of Health, oh, we do know we work closely with our partners, health and hospitals and many other institutes across New York City.

Okay, so you don't have it, so I'm gonna turn back to H H.

I'm sorry, what was you?

Please repeat for the hospital.

Yeah, it so I'm unaware of any facilities that are not ADA compliant.

So you have scale for your old your patients.

You don't have um, you know, at this point, we would have to most I would say have scales that are compliant with ADA, right?

Not at this point, able to, you know, all right.

I'd have to get back to you, though.

Okay, no problem.

Um, because H HNH and and DOH DO HMH receive federal funds, they are covered, they are covered not only by ADA title tool, but also by H section 504 rules, which has required every MDE acquired since July 2024 to be accessible and sets its own one accessible exam table and accessible.

Oh, the scale, so and then I'm gonna go to the next one.

Uh the agency tracking compliance against both rules, and is the earliest section 504 deadline reflected in procurement timeline?

So I do know that we are tracking compliance against both rules and um that we are complying with them.

You are compliant with them.

H is constantly assessing our equipment and policies to address any gaps in care as legislation and regulatory requirements are updated.

We are tracking it.

You are tracking, okay.

My last question.

Um women and other birthing people with disabilities are 2.5 times more likely to experience um to experience intimidation that we intimidated partner violence, IPV, in the year before and during pregnancy, yet IPVs is routinely missed in screening among the populations.

Is accessible IPV screening built into well women and prenatal visits as at H and the sexual health clinics?

Yes, for health and hospitals, intimate partner violence screening is built in.

Okay, thank you.

In what ways do you work with the mayor's office to end domestic and gender-based violence to track and reduce IPV among women and other birthing people with disabilities?

H has many different representatives that serve on committees with um and GBV to track and reduce IPV across all populations, including women and other birthing people with disabilities.

And I'm gonna leave it with that.

Will Cox, you know, thank you for your work.

I have seen you follow you, appreciate you, appreciate all of you, and I'm passing back to Chair Hanif.

Thank you, Chair.

I'd now like to turn it to Councilmember Sylvina Brooks Powers while we have quorum.

Yeah, of course.

Okay, I can't say, hi, good morning, Chair.

Can you hear me?

Yes.

Perfect.

Um, and thank you for the testimonies to the agencies present.

Um, I just want to ask three quick questions, and um, just ask them at one time in the interest of time.

Um, the first is many New Yorkers with disabilities continue to report barriers when accessing reproductive health care, including in accessible facilities, medical equipment, and provider training.

What specific steps are health and hospitals and DOHMH taken to ensure that reproductive health services, including prenatal care, fertility treatment, and abortion care, are fully accessible to patients with disabilities.

Next, black women in New York City continue to experience disproportionately high rates of maternal mortality and severe maternal morbidity.

How are the city's reproductive health initiatives, including the dual services, fertility programs, and sexual health clinics being targeted towards communities experiencing the greatest maternal health disparities?

And how will success be measured?

And lastly, residents of geographically isolated communities, including the Rockaway Peninsula, often face significant barriers to accessing specialty health care services.

How are health and hospitals and DOHMH evaluate and whether reproductive health care services, including abortion care, fertility services, and maternal health supports are equitably accessible across all boroughs and neighborhoods, and what gaps have been identified in Southeast Queens and the Rockaways in terms of services from your agencies?

Thank you, Chairs.

Were you all able to get that?

I mean, I think it'd be easier to answer them one by one.

Go for it.

Absolutely.

Yep.

Oh, but if you could just ask it one.

I'm sorry.

First question, please.

Sorry.

Um, so the first one is many New Yorkers with disabilities continue to report barriers when accessing reproductive health care, including inaccessible facilities, medical equipment, and provider training.

What specific steps are health and hospitals and DOHMH taking to ensure that reproductive health services, including prenatal care, fertility treatment and abortion care, are fully accessible to patients with disabilities.

So for health and hospitals, we provide to pay uh care to all patients, irrespective of ability to pay, and certainly um I thought we had earlier outlined how um we have you know telehealth abortion services, we have services for patients with limited um site, we have services for patients with limited mobility, we have people participating on um the you know with our reproductive working group to identify site-specific issues and then bring them across the system.

We abide by our eye care values, we have trainings that people have to do on an annual basis, um, in terms of anti-bias training.

So I would say that all of that would work toward ensuring that we are offering care to all patients, including people with disabilities.

Thank you for that, and um, black women in New York City continue to experience disproportionately high rates of maternal mortality and severe maternal morbidity.

How are the city's reproductive health initiatives, including DULA services, fertility programs and sexual health clinics, being targeted toward communities experiencing the greatest maternal health disparities and how will success be measured?

Well, for the health department, the priorities are to reduce the maternal mortality uh rates uh in New York City, and we're addressing that by area of programs and services, resources we offering, including our DULA programming.

We definitely support the intent of the support and with our partners.

Uh so we are continuing assessing and we do conduct trainings uh for our staff as well, and we do have greeters along our clinics to really assess those needs, but most importantly, collaborate with our partners as well for those additional services when required for health and hospitals.

I'll say that we have long been aware of the disparities in maternal mortality and uh severe maternal morbidity.

Um, all of our acute care facilities for prenatal patients something have something called the maternal home, which really offers wraparound services to patients with identified needs for um either behavioral health issues, um complex clinical uh care issues, or um identified um uh social determinants of health and um through that care navigation health and hospitals is the largest uh referral source for the citywide doula program, uh the nurse family partnership and other um other community-based organizations that help patients.

Thank you for um that as well, and then lastly, residents of geographically isolated communities, including the Rockaway Peninsula often face significant barriers to accessing specialty health care services.

How are health and hospitals and DOHMH evaluate and whether reproductive health care services, including abortion care, fertility services, and maternal health supports are equitably accessible across all boroughs and neighborhoods, and what gaps have been identified in the Rockaways and Southeast Queens?

And I'll just you know share from a personal experience myself having gone through fertility treatment and also just through prenatal care.

I often found myself having to go to Manhattan for certain treatments and Long Island for care as opposed to being able to go locally in the neighborhood, and those were even with um largely private medical institutions because there wasn't really a presence from the the city health institutions, so I'm just interested in terms of how these two entities are evaluating whether reproductive health care services, you know, like what those look like and and what gaps have been identified, and how what's the plan of action to address those?

I can go first for the health department.

So reproductive health and abortion are cornerstones of our basic health care, and access to those services is a public health priority.

We are committed to protecting abortion and reproductive health care services for anyone who needs them.

Uh, we do have our uh hub that is a confidential hotline that connects callers to abortion care and related services and fertility treatments as well.

As for facility treatment, we do not provide, um, I could defer to health and hospitals in regards to fertility treatment.

And before health and hospitals chimed in, I'm sorry.

When you talk about the abortion services and the hotline, could you tell me what the nearest location if someone needed that type of care would be for someone out of Southeast Queens and the Rockaways?

Would they have to go into Manhattan?

Would they have to go to Northern Queens or Brooklyn?

Like where would they have to go to actually get these services?

Well, through the abortion access hub, uh, they we connect them through various partners, not just the sexual health clinics.

So we also depend on our health and hospitals as well, and many times when needed, we utilize their virtual express uh for medication abortion as well.

So at times they necessarily may not have to come in to the city depending on the type of services that they're seeking.

Um so we do coordinate based on their needs.

But if someone is seeking an abortion, they likely would have to.

Because we the only presence of health and hospitals we have.

We have a Gotham Center in Springfield Gardens, and we have a Gotham Center that is being built in Far Rockaway, which I don't believe this service as of right now is going to be one of those administered.

So, where would the nearest one be?

And council member, if you could wrap up.

Yes, I'm sorry, Chair.

So um, as I mentioned, I don't have the list of all the um, but we can assess them through the NYC health map.

Um, and uh we do work with various partners uh throughout the city, um, including in Queens, and again, for those necessary that may not travel, we heavily depend on health and hospitals for the uh telemed uh medication abortion option.

Thank you.

Um, Chair, I know Health and Hospitals is going to answer, can they answer and I'll be in there?

Yeah, sure.

Thank you.

So telehealth um abortion is located all over the city, and we certainly receive referrals from the abortion um uh you know, health helpline.

Um I will say that all of our acute care facilities, so we have two in Queens, Elmhurst and Queen's Hospital, do offer procedural abortions if that is needed.

And in terms of uh in terms of you know uh fertility treatments, health and hospitals has the ability to diagnose and treat conditions related to hormone dysfunction.

However, we do not offer any assisted reproductive technologies such as IVF or IUI.

Thank you.

Okay.

Well, good morning again.

Thank you so much for coming, and thank you each of you for your incredible service to our city.

I know you all have been a part of uh the healthcare work and supporting people with disabilities for many years now, and really deeply appreciative of your advocacy.

Um Commissioner Agarwal, thank you so much for sharing your personal experience with the system and acknowledging the privilege that both you and I have in accessing the healthcare uh needs and resources uh associated with our chronic conditions and uh really highlighting the the inequities that exist and which we are of course trying to address and solve for.

So I want to first uh get a better understanding of uh how each agency is working together.

How are you all?

How are the three of you working together to inform the conversation on uh health uh reproductive health care access for people with disabilities?

So maybe I'll start um so uh we thank you for raising that question.

We are in constant communication with um health department and H, and um Mayor's Office of People with Disabilities will continue this conversation on range of issues.

Um, for example, we um have uh disability services.

I always get the acronym wrong, disability service uh facilitators in every uh agency who are responsible for ADA compliance, um and we have regular um uh meetings every month.

Um we do um uh office hours if they have questions or concerns, and we have um convenings two times a year and arrange even a field trip for um uh DSS if they can uh get uh get that because uh you're moving from theoretical to um real-world experience on um a disability and healthcare.

So we are um always looking to strengthen our partnerships and look forward to working with um H and hospital uh department.

So more specifically uh in terms of the the day-to-day you mentioned, given the data on how many New Yorkers are living with a disability, what kind of convening has happened specifically on uh New Yorkers with disabilities?

And if there hasn't been, that's totally okay too.

I'm just trying to understand the function of uh how agencies that should be working in collaboration are um and if not, why not?

Yeah, so um one so if the if um uh DSF person asks questions or uh confusion of the different issues, um they can uh reach out to Mayor's Office of People with Disabilities, and we can help in uh resolving that question.

So that's like one way of partnering with both health and hospitals and um health department.

Um, and we do this with other agencies as well, and I think that's very helpful because um if the person has an ADA question, they can just call us with we have expertise, they have the expertise on the uh department that they work on, and so we collaborate well and it's been it's been very effective.

Hi, um so for the health department.

Um we view MOPD as a valued partner in our efforts to make our facilities and our services more accessible.

Um, MOPD sees the f oversees the five-year accessibility plan process, um, and my office, which is the Office of Access and Disability Justice at the Health Department has collaborated with MOPD to provide physical and digital accessibility training.

Um I am the DSF, and I also attend the um regular DSF monthly meetings as well as community meetings in collaboration with MOPD, and we have a digital inclusion officer and members of our communications team who have participated in digital accessibility training that was provided by MOPD.

I'll come back to you once I hear from Dr.

Wilcox.

I'll just say that we collaborate with MOPD as previously described.

Thank you.

Okay, so I'd like to uh better understand, Amanda.

You mentioned that you are the DSF at DOHMH.

What are your responsibilities?

Sure.

Um, so my responsibilities are to ensure that the agency um is in compliance with local, state, and federal ADA compliance laws, as well as to um be a liaison for the public whenever there's a concern or a complaint regarding our accessibility and to escalate those concerns to the appropriate parties within the agency.

And are those complaints coming through 311?

How are patients accessing you?

So they can come through 311 as well as an email an email address, mail, or phone.

And that's specifically about complaints or concerns about access.

Correct.

Got it.

And then what about for H your DSF?

Oh, sorry.

We have an identified individual also that is responsible for looking at any accessibility issues.

We work closely also in collaboration with the Office of Disabilities.

But in addition to that, we also have a patient grievance mechanism.

So when a patient that comes in according to the Bill of Rights, they are able to register a complaint or request for assistance.

That information is posted at all of the facilities, and we have a dedicated email for individuals to put complaints into.

And are you all tracking these complaints that are coming in?

Do you are you able to share any data with me as to how many over the last year?

So today we have had no accessibility complaints coming in through our emails.

Got it.

And how would a patient know about the patient grievance?

Sure.

So the information is posted at all of the facilities in a clearly marked area via posters.

It is also available for our patients through our digital services or external facing websites.

Got it.

So it's not such that a doctor interfacing a pay a patient would be sharing.

Here's how you can access if a patient is admitted, if the information is also included included in their admissions package.

Got it.

Could you just elaborate?

Sure.

So the so the primary barriers really for us in fertility care is you know the limitations that necessarily have in access and outcomes or referrals and diagnosis.

So it is something that despite New Yorkers' coverage and requirement, something that you know we are working with necessarily partners.

We work with do referral uh through referrals through our social workers to better understand their needs.

So when they do come into the clinic, if it is service that they're seeking, uh we try to work with uh collaborating partners on what that access may look like, uh what that cost may look like, and then kind of informed patient on that process.

So there is some in-house kind of interaction available.

It's more of us being like the referral pathway, uh, so we're the entry point for individuals and try to be the referral pathway on what's assessed on what's available throughout the city.

And it's not necessarily saying uh like giving a referral, but rather listing out options available.

Correct.

Got it.

And is anything distributed during that communication?

Uh no, it's more we try to make warm handoff via phone, social worker tries to assess uh, you know, the capability or ability to make those referrals based on what's available.

I mean, I think this is exactly the reason why we need something that's more uh formalized so that our city is uh continuing to lead on uh fertility care and treatment, especially as many of us uh seek to um go through that process for uh childbirth.

And knowing that there has been there have been conversations and there are there is a uh a referral system, I think that really speaks to why I'm I've introduced my legislation.

Now, when you talk about referral, are you referring out to an H site or are there private facilities you all are also partnered with and referring there as well?

Yeah, we're partnered with with private as well.

Um so really assessing kind of like the cost.

I think the biggest barrier for us that we're seeing is coverage, just because of the patient population that we do serve within our clinics uh predominantly tend to be uninsured.

Got it.

And you know, my bill doesn't say that DOHMH has to cover the process.

However, I think that is an important distinction as well that uh many New Yorkers who are approaching uh reps from DOHMH are uninsured.

And again, I think that speaks to why uh this awareness and education is important on our city's uh resources on uh fertility care.

Um so again, when you're when there's referrals being shared, this isn't this is like just spoken conversation, not a written correct got it, okay.

So that to me isn't helpful.

I mean, I also visited recently for uh fertility care and received a similar conversation and took down notes, and you know, it's uh it's very overwhelming, first of all, to receive uh information, particularly if uh the patient is unable to uh give birth and um then considering a process that is so expensive, and there is so little information about fertility care, uh just in general, that um the onus falls on the patient to fully understand what to expect during this process and or talk to others who have already gone through the process to better understand.

So I think DOHMH and a partnership with the two other agencies here on fertility care available and giving some attention to people with disabilities is incredibly important and I think absolutely urgent.

I think your responses really speak to uh exactly why we need to pass my bill.

I want to pass uh the mic to council member Sanchez.

Oh, she left.

Okay, she's gonna send me questions.

I want to uh pass it to Councilmember Epstein.

Thank you, Chair Hanif, and thank you all for being here.

You know, Commissioner Algoa, congratulations.

And I want to uh talk about how we got grapple with this issue.

So obviously, Moped's an important agency.

We see issues around health care related for people with disabilities across the board in really being worse, especially for women of color.

Kind of what is the agency doing to try to get in front of it?

How do we kind of system-wide change the process?

You know, I think there's a really good package of legislation here, but we have underlying problems that are really hurting uh you know women of color and women of color with disabilities, and I'm not sure we get into that.

Yeah, yeah, so this um matters for me personally.

Um so the first thing is um uh we don't want to just comply, we want to be the best in the country in the world.

Um, and so like best practices um in health and hospitals, in uh uh health department, and other um agencies like um NYU.

It was really remarkable to see that any woman could walk in and get the care they needed, and it affects the bottom line, and so I think that's very important is like sharing the the best practices, and then um we're doing a round table with women with disabilities, primarily um uh uh people of color, to explain the some of the problems, but we wanted to focus on the um solutions for hospitals um doctors um facilitators at at every level, and then we're gonna use the next steps at the end of that is like how are we gonna move forward to move this problem ahead?

And like that, it's it takes time, it's organizing, but we're trying to uh create uh uh system where it is not just compliance but it's world cross.

Uh it's part of the plan to encourage people to be hiring or setting your requirements of hiring people with disabilities so they're more sensitive to those issues.

Like what gets us over this, you know.

I appreciate the round table and I appreciate the work there, but hopefully that round table come up with a real concrete solutions about how we kind of broach this problem.

Yeah, and I think also like we do um uh employment um and we do that for job seekers and employers and um recognizing that people with disabilities want employment, and so having the interconnected uh work for health care and employment, for example, is a great um uh uh strategy to move forward.

And do you think that that could include requiring or having set asides for those uh for people of color with disabilities or people with disabilities to make sure those those entry roads are in in our government jobs?

Yeah, and so we work with um uh DCAS on 55A, which is um uh city jobs for people with disabilities that don't require an exam.

So all of the stuff can be used in employment to have people get employment, and then we have we will work with H and uh health department to do um have um uh people, uh, employers who are disabled and work in there.

And is there a procurement piece?

Because obviously part of our our government dollars isn't just around hiring, it's around procurement as well.

Yeah, so um we're not involved in the peer procurement, um, so I can't share that information, but um, we can talk to uh the um OMB on that.

I would love because obviously that's a really good opportunity as well to then, you know, not just in our hiring, but whatever procuring allows like this to be infused within our network, and in some ways, like to get to these issues requires I think a real sensitivity that unfortunately in our current system doesn't exist.

Yeah, and I mean I think like in your district, um there are uh tanya towers where there's a huge amount of um that desp deaf people and like working with city council members is crucial to like uh partnering our agencies, our agencies and our city council members.

Yeah, well, I would love to go there with you.

You know, you know, I've been working with that building dealing with issues over the years of love that partnership, but also expanded opportunities on this kind of reproductive health issues to kind of be yeah to be a partner on that as well.

Thank you.

Thank you very much.

Thank you, Chair, for your the time.

Thank you, council member.

So with the local law 12 of 2023, every agency needs to publish an annual accessibility progress report and then submit it to MOPED with the August 9th medical diagnostic equipment deadline looming.

Is Moped specifically tracking health agencies' MDE compliance through that reporting framework and would MOPD share that reporting to these committees?

Yes, so we're not um we don't get the um the um information to um moped, but we work with um H and H and uh hospital uh uh health department all the time, and we will continue that um progress.

So you're saying the accessibility progress report is not supposed to be uh submitted to MOPED?

It is not.

Got it.

Do you do you know where it is being submitted?

This is a question for health and hospitals.

Um so there is a uh site.

Um we we publish our plans on our own public facing websites, um so the plans and the progress reports are on our public facing websites.

Um I do know that Moped does have a site that has all of the accessibility plans on it.

Got it and what um what's the how are you all uh doing with the upcoming deadline?

I'll add um that we are continuing to help with um hot health and hospitals and health department to ensure that by August that will be done, and so after this meeting, certainly, and before we're gonna continue to meet this deadline, but it's not just meeting the deadline, like moving forward to make our city more accessible with women with disabilities.

And then once the reports are available, will MOPD share its observations or concerns or uh comments to the agencies?

Um, we can share that with you because um again it's very important for me that we're doing not just compliant but um getting better at doing that and so everything from the round table to this um rule all that stuff um will get more uh involved um with my leadership.

For uh DOHMH, what is informing the accessibility uh progress report?

Um so we developed an accessibility committee um that has representatives from all across the agency, and those 30 representatives help to um inform the progress that we have made and any gaps that remain.

Um and we also um work in collaboration with um any of those concerns or complaints that come through my office to ensure that they get incorporated into our accessibility plan.

That's great.

So there's an additional committee working with the agency.

Correct.

It's representatives from within the agency.

Within the agency, wonderful.

And then what about for health and hospitals?

Can you turn your mic on?

We are also in the process of putting together a disability advisory council.

It is currently working, it's not official as of yet.

However, we are also partnering with the disability index company, and we are in a process of assessing all of the areas of disability, whether it's external, digital, internal facilities, and anything else that we may be able to address.

And do you know the timeline for that disability index check?

In the next three months.

In the next three months, and then the advisory?

Oh, that is the other.

Oh, that is the advisory got it.

And are those folks uh from the agency, or is this a contracted partner?

It's multidisciplinary from the agency.

So all of our partners, so for example, digital, hospital police, facilities, anyone that has a piece in the beam.

Understood?

Does DOHMH and or MOPED coordinate with the Department of Education to ensure sexual health education curricula developed or rather delivered in schools are accessible to students with disabilities, including those with IEPs and 504 plans?

I can I can start.

So we're working with um uh DOE or NYC schools on a range of um IEPs and uh district 74 or 75 um schools and a range of issues, not just um sexual health, but we're we're discussing ways that we can work together on that, and my hope is we will um uh add health um uh for children in the the plan.

Do you know if currently there is something that the DOE is distributing?

I don't know.

I think you'd have to refer that to DOE.

And then does DOE's DSF also participate in the Did you say it was a monthly convening?

Yes, and they do, but I don't know the name.

Okay, and each agency has one DSF designated.

Yeah, and then as um Mandy said, we also have the digital accessible um facilitator.

Again, really bad with the acronyms that does uh disability um uh accessible trainings and and have the same um rhythm.

So in this instance, uh once the conversation sort of is teased out with the New York City public schools, would MLPD be playing a role in supporting them with the sex ed delivery in school settings?

Again, we're discussing a range of issues, and so we'll see what um what we focus on first, but um, this is always a consideration for us, and it's important.

I'd love to hear from Do HMH.

Um so DOE is responsible for the development and distribution of materials, the health department coordinates with DOE to contribute to the development of their sex ad materials.

Okay, so there is a collaborative ongoing partnership, it seems.

Are you able to share uh the materials that are that have been developed for DOE specifically?

So we provide the sexual health content um for their education delivery, but I don't have that today.

That's okay.

And um do you know uh is it developed by uh DOE or is it a combination because you know uh third through fifth third to fifth grade versus fifth uh sixth to eighth high school?

What do you know what sort of breakdown of information is available to the diverse age groups?

Um so I believe DOE would have to answer that.

They are responsible for the development and distribution.

We just contribute and coordinate with them on materials.

Okay.

And share what you observed, saw, and uh how you think our city should be our replicating for our city services.

So as I mentioned in the testimony, it's like external, like exam tables, um weight uh uh tables, all of that was um accessible, so all of that was was fantastic, and I seeing it in person uh helps a lot, and so um, and then internal um data sharing, including disabilities, um, including procurement, doing all of that stuff was was huge, and I think that um the director said they would love to have um other hospitals or clinics uh uh replicate their um uh their findings um and they um also mentioned that um so um the director of Rusk, which I spent a lot of time with works with another uh hospital, another um physician who does trainings for providers in healthcare settings, and it's huge, it's a huge uh uh volume, but it's like we can it's a this is simple.

You just take that training and you share it to other um hospitals in this city um and out of other cities as well.

So those are some ideas that we learned in this conversation, and we're gonna continue to take that um up.

Great.

And then for the training that is available uh for staff and healthcare workers, could you share what is included in that training regards to uh how to accommodate people with disabilities, how to work with people with disabilities?

So we work with internal vendors, inter internal partners as well as external vendors in the disability training.

Basically, what it does is allow for providers and for all staff to be able to identify different types of idea um disabilities, whether visual or not, and in addition to that, how to be more inclusive of individuals with disabilities, how to create inclusive environments, how to communicate with individuals in our low blind patient experience trainings, individuals are taught the experience that a patient has navigating a hospital system.

So the clinicians or anyone who attends is outfitted with accessories to have them feel and actually have them navigate in a world where a patient may not be able to see, may have challenges and seen adequately, and so that is done with the effort that clinical and non-clinical staff will be able to assist an individual by experiencing what they are experiencing.

And you said that this training comes from an external vendor?

Yes.

And who is facilitating the training?

The external vendor, the external vendor, got it.

And do you know how long uh health and Hospitals has been working with the external vendor?

Approximately two to three years.

Got it.

So somewhat new.

Yes.

And is the training updated?

All of our trainings are consistently monitored to ensure that they are up to date with any recent legislatures and also with the content.

And uh how frequently are employees getting this training?

This is offered on a regular basis.

We do it right now, the disability training is being offered, I want to say two to three months, every every two to three months.

The low blind patient experience, because that is heavily resourced, and it is an in-person that is held twice a year.

So we are now getting ready to do one at Jacobi Medical Center, and it is open to all staff.

Okay, so is the disability training mandatory?

The disability training is not mandatory at this time.

Got it.

So how and how would one decide to do this training?

So individuals, we try first of all, we try to make them accommodating to all.

So we try to do them during lunchtime, and we try to make them short so that they're not two to three hours, we can't take hospital care, takes precedence.

So they average about 45 to an hour and a half in length.

We make them during times that people are able to attend them, and then we publicize them through our DEI website through individual flyers.

We also do town halls where we go to all of the facilities and market all of the programs.

Why is it not mandatory?

At this point, it's not mandatory.

Um we can definitely explore that.

And can you share how many staff have received this training in 2025 or just the first six months of this year?

I don't have that information readily available, but I'll be happy to provide that.

That would be great.

And then what about for DOHMH?

And before that, I have to go.

I'm very sorry.

Thank you so much, Commissioner.

Really appreciate you and good luck.

Um so we currently have uh two disability justice trainings uh that are available to all staff, including staff at our clinics.

And is that coming from an external vendor?

No, it is not.

That's internally created.

And has there been uh an exchange uh between the two agencies about the training that your staff are receiving, given that it seems Health and Hospitals has a private external vendor?

DUHMH has an in-house created uh training.

So we are happy to partner.

We have participated in the past with trainings.

We like to offer a variety of trainings so we would keep the variety available to all staff.

Same yeah, we're happy to partner.

Got it, okay.

So look, but currently it's not as if you've exchanged the materials and said, oh yeah, we could use this, or oh yeah, like this is okay.

Um, and then is the training for a DOHMH staff mandatory?

Um it is being required for clinic staff.

We have sessions planned um at the end of the summer.

And how so it it you're saying that it takes place during the summer months or how frequently uh are these trainings offered?

The next one would be uh coming up later this summer, um, and all of our trainings are mandatory for our staff on an annual basis, so we do keep track of those individuals, especially as new individuals come on, uh, how do necessarily we accommodate those trainings?

Okay, so just to be clear, DUHMH does require its staff to uh receive this disability related training.

Correct, clinical clinical staff, clinical staff, okay.

So then um, and you said that it's throughout it's happening throughout the year, correct?

And um, would I be able to attend one of these hearings?

I mean, uh trainings.

Sure.

I I actually facilitate the training, so I'm happy to have you join one of them.

Perfect, thank you.

And then I would also love to attend an H training.

Absolutely, we will extend the invitation.

Thank you.

Okay, so um Dr.

Ivy Lease, correct?

Did I pronounce that?

I've less?

Um you said that the training is being provided at Jacoby.

Could you just speak a little bit more about uh why at that location and um it is a training rotating to different sites?

Yes, we are currently working our way through all of our facilities.

Our last training was in Queens in one of the hospitals, and now we will be at Jacoby, and the goal is to go through all of our different health and hospital facilities.

Right now we are doing them upon request.

So when an individual facility offers their site up, then we will go over to that site.

That's that particular training, the low-end blind patient experience is in person, so it requires us to have ample space to train because we do set it up as a clinical environment when it's going on.

It's a simulation program.

Understood.

And I would like to receive um just the numbers on how many individuals are participating in this training at this upcoming Jacobi training.

We don't have that as of yet.

Registration is still taking place.

We can provide that.

And what has already taken place over the last six months?

Over the next six months, we've had the the Let's Talk Disability, which is the awareness program.

That is a virtual instructor-led program, and so that is held on an ongoing basis, and then we have the low blind vision, which takes place at every different facility.

And are doctors participating in this?

What's the breakdown of whose I don't have the exact numbers in front of me, but we have all disciplines participating.

All disciplines, okay.

And again, it is uh not mandatory.

Correct.

Got it.

Earlier at the earlier in the hearing, um, Kwa Keen.

Okay, you mentioned that uh weight scales are not in your facilities, correct.

And so, you know, I I'm curious about that because um uh emergency contraception and birth control, which you do provide can very much be impacted by weight.

Yeah.

So we do assess uh by BMI.

Um so we do have two options uh based on that self-report uh the clinician would make that medical indication on which option.

So self-reported BMI correct and why does the agency think that that's okay?

Um I think it's something that we're assessing, um, so we could uh we can definitely circle back.

Got it because I mean that seems I mean, of course, we want to trust patients, um, but it also seems sort of counterintuitive, and I'd like to better understand why the agency um does not see having accessible weight skills uh as a as a need.

Yep.

I have a couple questions um from council member Sanchez that I'd like to read out.

Um for the Corona Sexual Health Clinic, could you elaborate on the renovations that have been completed and specifically the accessibility features?

Um, sure.

So the exterior and interior lobbies um uh were renovated to enhance accessibility.

Um the locations ramp and main lobby are also ADA compliant.

I'm sorry I missed the first part.

I got it.

Oh, no problem.

Um so the exterior and interior lobbies um were renovated to enhance accessibility.

Got it.

And so is there um any other construction remaining on accessibility?

Um for that particular location, um, not at this time, I don't believe.

Okay, and also these questions are from the committee.

Um, for accessible weight skills, and this is uh directed at H and H what's the process for ensuring that those with disabilities who may not be able to use standard weight scales are weighed accurately, we offer a variety of scales that um would be able to most likely accommodate um most disabilities, although I'm not at this point willing to say all.

Got it.

We would offer a variety of scales.

Okay, I would love to um check out the weight scales available, um, and would want a better sort of more accurate response on uh which uh disability communities are covered in the current equipment.

Um for the great and then for council member Sanchez.

Council member passed intro for 35 of 2024, now local law 84 of 2024 to expand same-day rapid testing for chlamydia, gonorrhea, and HIV across New York City, especially for communities that continue to experience deep inequities in rates of infection and face disproportionate barriers to sexual health care, including black and Latino New Yorkers, LGBTQI plus New Yorkers, immigrants, low-income New Yorkers, young people and people with disabilities.

The law requires three sites to be operational by February 15th, 2026, and a fourth by February 15, 2027.

Were three additional rapid STI testing sites operational by the February 15th deadline?

So we currently do have Chelsea and Fort Green operational uh Morrisanias to open later this week.

Uh it did require some construction retrofitting to support that, and we are already on plans for a corona uh quickie rapid testing in 2027.

Got it.

Okay, so then by the 2027 deadline, you will have four sites.

That is correct.

Great.

And then which community-based organizations did DOHMH contract with for the required outreach campaign, and how were those partners selected to ensure outreach reaches the communities most impacted?

Um so currently we are uh contracted and partner with Volces Latinas uh out in Queens uh to focus on a lot of the work within that space, and that was done through uh through a bid.

So just that one.

That's the current one that we currently have.

Got it, and they're doing citywide outreach or specifically is it geographically confined?

Specifically Queens, but we also work with other partners.

That's not the only partner, but that that partner we fund to do a lot of the work, um, and that was really focusing um at that time, you know, three years ago, and we launched that to focus on Latino MSM uh to really uh engage those individuals within that uh community of our services because they were they were the greatest at risk of what we were seeing in that neighborhood.

And um have your agencies audited uh reproductive health encounters for um the bias that exists that disproportionately assumes people with disabilities are not sexually active.

Can you repeat that?

Sure.

I wanted to better understand if patients with disabilities are um receiving any counter information about uh their access to contraceptive counseling and STI screening, um at the same rate that patients without disabilities are receiving.

Yeah, for our sexual health clinics, uh we have greeters um up front to really assess what their needs are when they're coming in, regardless of their ability, um, and then we would accommodate accordingly for the services they are seeking.

Got it, and for the sterilization, are you able to share data as to uh how many patients may have been sterilized over the last year?

Is that data that you all are tracking actually?

Um we can get that data because we all of our um acute care sites are family planning sites, and so we submit that data on an annual basis.

Okay, yeah.

And so off top off the top of your head, you wouldn't know about the specific sterilization that maybe.

No, but I will say, in general, with um long acting reversible contraception, the that being introduced probably now a decade ago, and big pushes from DOHMH as well as ACOG and other entities into the reproductive care world, sterilization numbers have you know probably come down a little bit because you do have access to this long acting reversible contraception.

Well, really love long acting contraception, we'll say um oh earlier in the hearing, Dr.

Ivy Less, you mentioned um uh my my colleague asked about the five languages.

You had only shared four.

It was Mandarin, Spanish, Bangla, French.

What's the fifth language?

Oh, there was a change.

So what it was five, one of them was Bantuf, and I can't recall the fifth one just to be accurate, so I can get back to okay.

That would be great.

Our original top five, the last ones changed.

And then for these um materials, um how is the is do you know if the translation or the interpretation um is through community feedback or if the interpreter is a medical interpreter?

Could you share a little bit more about the language access?

Absolutely.

So we have 24-hour seven-day services for interpreter access.

We contract that with Propio.

We offer three modalities.

We have video remote interpretation, in-person remote interpretation, and we also have um by video.

Um, in addition to that, we offer MIS classes and miss classes stands for medical interpreter skills training, and that is for staff who speaks the second language, where we then assess them in terms of their competency in that language, and then we train them to be able to provide interpretation.

And how many uh staff are qualified interpreters?

I don't have that number, but I can get that back to you.

And how frequently um are staff getting trained?

We offer the training every year.

Every year, okay, so like once annually.

Yes.

And um what what does the training include and what what are the responsibilities for that staff member?

Because I'm assuming that that staff member has a has a full portfolio already, correct?

And then providing their language access expertise.

Sure, give me one second.

So one of the things that we find, and we actually promote the program as part of their onboarding, so when they come through the system orientation, we let them know that this program is available to them.

When staff speaks the second language, we find that they're very proud to help other individuals.

So at that moment in time, immediately we start receiving requests for individuals to participate in the training.

So, in addition to that, once they complete the training, they are able to then volunteer their time if they wish to do so as a supplement to our interpreter skills that we have.

So we have our vendor partners, we have also internal internal individuals that were trained.

And then I'll pass it over to Dr.

Wilka.

Thanks.

I appreciate that.

I'm just gonna say that I think the majority of translation is done through Proprio and the vendor partners out of probably necessity.

Um but the video access is actually really amazing.

It's like the patient can see um the, you know, the person doing the interpretation and the translation, um, so can the provider, and it's actually um a very, you know, a really well-working modality.

I think that's really wonderful.

Um eighteen years ago when I was diagnosed with lupus, um, you know, I really struggled to uh explain to my parents who are limited English proficient exactly what was going on, and the hospital, which I will not name right now, did had very limited resources when it came to uh being able to talk to family members about degenerative autoimmune conditions like lupus, and so knowing that we have um uh this modernized tool and access for uh patients who would require uh interpretation services so that the medical language is understood by the family is just so so important and I'm really grateful to know that that exists.

Do you know um how often um or how uh many times this service is getting used?

So we provide over 353 languages 24 hours seven days a week, and I can tell you that every month I monitor the data it is in the millions of minutes provided.

Oh wow.

Yes.

Yeah, well we are grateful together.

And that's only interpretation, not translation.

Got it.

And then for the translated materials, are the um the staff who are trained who speak the second language, are they um providing feedback to that those materials?

We use a vendor for our translation materials.

Got it.

So the vendor creates the materials.

Is there so there's no sort of like advisory committee that's like, oh, this is jargon or this is?

We create the materials.

Sometimes the material is created in-house, it is then sent to our vendor, the vendor then sends it back where we also do a final review before actually putting it out.

Understood.

And wait, I'm sorry, it's not just for language, it's also for grade-level reading ability.

Yes.

Excellent.

And then what about for DOHMH?

Same.

Uh, we do all of our translation in-house through Office of External Affairs and we work with with partners as regards to access to language.

Uh, we have language line, we also have the interpreters and uh video video as well.

Um, for our staff, we do have competence tests in order for them to be able to translate, they do need to pass that test before they're allowed to translate.

And how frequently is that being offered?

Oh, we're continuously assessing uh because we're continuously getting new staff coming into the clinic space on identifying if that's something of their interest, uh, they have that as a second language, um, and then we'll work with our uh internal folks on getting them scheduled for that test.

And do you know how many staff members have taken this competency test?

And are you formal interpreters?

Yeah, I can get back to you on that number.

It does range throughout clinicians, nurses, registrars.

I think that's great.

I think it's transformative that we are uh we've made such uh strides in the language access uh field.

Um, and are staff members who have this expertise now also providing this extra uh service at times, are they um getting paid more than uh someone who is of their same title but is not a an interpreter?

Um I can't really speak on the pay.

I don't know, I don't I don't believe so, but that's something that we can uh assess and uh give back to you on.

What about for each and age?

Our contracts are collectively bargained, so we they are currently paid the same amount.

Got it.

I would like to know from each agency what your understanding of disability justice is.

So I can speak for the health department.

Um so disability justice is an intersectional framework that realizes that people with disabilities do not experience that identity um in isolation, and so we are working to really embed disability justice principles into our daily operations.

Thank you.

And how would you rate the city in uh being one that is uh disability just so New York City is definitely uh a leader?

Um I can speak uh more closely to what the health department is doing.

Um we have been recognized by MOPD as a leader in this space in the work that we're doing, and we continue to um try to embed disability justice into our work and transform our workplace culture, and then when it comes to the other uh other pieces related to access to health care like transportation, like when, or when a patient is discharged and their home is not um ADA accessible, um, how would you how is that interaction taking place?

So when an individual is discharged?

Yeah, I'm trying to understand like so both agencies have uh disability trainings and are equipped, it seems for the most part, to be able to provide to uh any patient it is inclusive service.

Um, however, there are other barriers that make our city uh inaccessible.

How is that conversation happening with um patients?

And also I would love to hear from H and H on the disability justice piece.

So I can speak on the for the clinics and on really that conversation is being had uh on the social work level really assessing those needs, um and if there's additional needs that they need support on our social workers are are equipped on working with various partners uh to addressing some of those needs.

So I'll start off with the um disability justice.

So our view of it is that old individuals that have a visible or invisible disability are treated with equity.

So did we respect and treat in an environment where they feel included in terms of the latter, that's part of the patient's care plans, so that is usually addressed by the social work team.

Got it.

And then do um our services uh allow for um materials or equipment to be sent home with patients, or is that coming from the health insurance?

Like let's say a walker crutches, a wheelchair.

Those are durable medical equipment would need to be prescribed.

Got it, and so that's uh approved by the health insurance.

And if a patient does request um any medical equipment, how do you all go about that?

We would write a prescription.

Okay, got it.

So um uh essentially what I'm trying to get at is like if somebody needs a cane, they get it.

Yeah, okay.

I mean, I think that's also difference between inpatient and outpatient right if it's someone who's inpatient generally before their discharge you order like a consult a physical therapy consult they come they assess they would give the patient what they need and they would work with the patient to use it prior to discharge I mean that's usually how that works.

I want to come to some of the legislation for deputy speaker Williams's uh bill on access to medication abortion could you share what the uh agency's plans are for expanding to more clinics and are you able to provide specifics which clinics when they will begin offering the service yeah so I can start off by saying that we're extremely proud of the success of our medication abortion program at the New York City sexual health clinics uh we are providing high quality high accessible care to equity priority groups uh we do have available walk ins uh medA B services um across our clinics that are providing MedA B and we do have our telehealth pathway where patients can be pre-screened uh for clinical eligibility um as for expansion uh we heavily do rely on our abortion access hub um that really helps and assess uh the individual's needs uh which location um is convenient for them and really working with our partners on linking them uh to those clinics if necessarily our existing clinics are not accessible uh we currently do not have any plans to expand medication abortion services we're currently focusing on expanding and enhancing other clinical services uh including uh gender affirming hormone therapy a pilot that we're going to be conducting at Corona Clinic uh planning on the expansion of the quickies um as well as I recently mentioned uh which corona is another location that the expansion will happen um so as a as is being discussed today we'll continue to uh continue the important work to make sure all the sexual health clinics are accessible to people with disabilities um so just to add to that uh that there are current barriers uh that are preventing us with the expansion uh so while we support expanding uh medication abortion we do have some concerns uh regarding cost capacity and clinic space got it okay and uh does do hmh have sufficient medication supply if it were to expand to all uh six clinics so we currently do not so we would have to reassess that as well and you said cost capacity and clinic space clinic space okay is critical good to know yeah um our your agencies tracking disparities in health outcomes for people with disabilities we don't currently track disabilities the same for the health department we do not currently track disability um would you consider doing so sorry just give me one second I mean I would take it back to my site and it would have to go through you got it um so right now we do not have a way to classify individuals as having a disability um so we do not track the information for people um who are coming to our clinics.

And could you elaborate on what that what that means, the classifying a person with disability?

From from our standpoint, there are so many different types of disabilities, and um it would really um encompass a wide array of things, including vision, hearing, mobility, intellectual.

I mean, it's it could it's a very wide open um area or arena.

Um so similarly, um, since disability can be an important factor in understanding a person's health needs, um, it encompasses a wide range of conditions which may or may not be visible or disclosed by individuals, um, given the complexity of defining and consistently capturing disability status across programs, uh, the health department does not routinely collect comprehensive disability data for all services.

Got it.

Again, coming back to the the stat that one in six New Yorkers live with a disability, I think it's tremendously important we figure this out.

Um I don't want to keep you much longer.

I will ask my final questions.

Um for council member Gutierrez's bill on uh the doula bill of rights, is there currently uh an advisory body or other advisory component of the citywide doula initiative or newborn home visiting program, and how does it function?

For the health department for the CDI, there are no advisory bodies.

However, CDI staff work closely with CBOs to understand the needs of the community and challenges to expanding access, insights received as part of our community engagement informs recommendations listed to our annual dual report, and we will be happy to discuss this latest recommendation with council once the annual dual report is released at the end of the month.

Excellent.

I know I asked DOHMH about uh fertility treatment um education.

Uh does H provide any materials on fertility care?

Or have available rather when patients come in with certain health conditions and discuss it with their clinician, um they do receive a discharge summary that goes along with what was discussed?

Got it, and so does that mean that if I'm asking if I'm having a conversation about uh fertility treatment with my doctor, that H has produced, we don't have pre-produced um information on that.

Okay, and then what about just generally?

Um, how is H providing information about fertility treatment and options?

If someone came in and had a hormonal um issue or other medical condition that needed to be treated, we would certainly be able to draw the appropriate lab TOS and um be able to rectify certain um certain uh parts of um in fertility, but again, we don't provide um any of the uh like in vitro fertilization or any any of the procedural things are not provided, and so certainly a clinician can go over what those procedures are about and our EMR or electronic medical record has the ability to go in from the provider view, cover different topics, and then print them out for the patient and give it to the patient.

Does uh H and H have have plans to offer fertility treatment?

H does not have plans to offer fertility treatment.

And then just from both of you as doctors, what are you seeing as the um largest barriers to accessing fertility treatment?

One word cost.

And so currently there is no formalized guidance on uh navigating insurance coverage for um reproductive health care, fertility care that each of the agencies may have in like a pamphlet.

That's correct.

Understood.

Okay, I'm gonna do one final review, and if you will just be patient with me for a minute, okay.

How does H and H ensure real-time communication accommodation such as ASL interpreters, cart captioning, and AAC devices are available for reproductive health encounters, including prenatal visits, labor and delivery and postpartum care?

So we have card services available, we also have again American Sign Language interpreters available, and they're available 24 hours seven days a week.

We have language access coordinators at each site that are responsible for being the liaison between the patients, between the interpreters and any departments that may be requesting a depart uh interpreter.

Excellent.

And is the uh ASL through video or in person?

We offer both, both.

And for do HMH around young people with disabilities, uh, they are more likely to have a parent or caregiver present throughout their visits, which suppresses private patient-centered conversations about sexual health.

Do the sexual health clinics have an explicit protocol for offering all patients 12 and older, confidential one-on-one time with the provider consistent with the clinic's stated policy of serving anyone twelve and over.

Yes, you would do.

We assess that at the beginning uh through the greeter uh and also during triage and assess and informed uh the parent that uh they will wait in waiting area for confidential services for that individual within that clinical space with the provider.

Excellent.

Well, thank you, doctors.

Mendez, Wilcox, and Joaquin and I heard Mandy.

Yes.

Sweet.

And uh really, really grateful again for your service and just your uh the depth of knowledge shared today, and I look forward to continuing our partnership.

Thank you so much.

Thank you.

Take care.

I now open the hearing for public testimony.

I want to remind members of the public that this is a government proceeding and that decorum shall be observed at all times.

As such, members of the public shall remain silent at all times.

The witness table is reserved for people who wish to testify.

No video recording or photography is allowed from the witness table.

Members of the public may not present audio or video recordings as testimony, but may submit transcripts of such recordings to the sergeant at arms for inclusion in the hearing record.

If you wish to speak at today's hearing, please fill out an appearance card with the sergeant at arms and wait to be recognized.

When recognized, you will have three minutes to speak on today's oversight topic.

If you have a written statement or additional written testimony you wish to submit for the record, please provide a copy of that testimony to the sergeant at arms.

You may also email written testimony to testimony at counsel.nyc.gov within 72 hours of this hearing.

Audio and video recordings will not be accepted.

Tracy Moreno.

You can begin whenever you're ready.

Thank you.

Good morning.

My name is Tracy Moreno, and I'm a legal intern with a disability justice program at New York Lawyers for the Public Interest.

For 50 years, NOPIA has worked alongside people with disabilities to remove barriers to equal opportunity and forced disability rights.

Nopey strongly supports Intro 941, requiring the Department of Health and Mental Hygiene to develop and offer resources, clinical guidance, and training on disability and accessibility in healthcare settings.

While federal, state, and local laws require healthcare providers to provide equal access to patients with disabilities, legal protections alone are not enough.

Too many New Yorkers continue to encounter providers who lack the training necessary to effectively communicate with patients with disabilities, understand their legal obligations, or provide appropriate accommodations.

One of the most persistent barriers identified through NOPE's advocacy is the lack of disability competency among healthcare providers.

Research has shown that many providers receive little or no formal education regarding disability accessibility, communication, or best practices for caring with patients with disabilities.

As a result, patients may experience delayed care, incomplete examinations, inadequate accommodations, and poorer health outcomes.

These experiences not only affect the quality of care patients receive, but also erode the trust in the healthcare system.

Intro 941 directly addresses this longstanding barrier by providing healthcare professionals with the tools they need to better understand disability accessibility, communicate effectively with patients, and deliver more equitable patient-centered care.

Better training will not eliminate every barrier people with disabilities face, but it is an important and necessary step towards improving health care access throughout New York City.

NOPI respectfully urges the council to pass intro 941.

We appreciate the council's continued commitment to advancing disability rights and health equity, and we look forward to continuing to work together to ensure that every New Yorker can access quality health care with dignity, independence, and equal opportunity.

Thank you for the opportunity to testify, and I welcome any questions.

Thank you.

I do have a question for you.

I'd like to understand what NILPI defines as disability competency.

Um we would say it's healthcare providers knowing how to care for, speak with, and provide information to patients with disabilities.

And uh you're saying that um NILPE's work with um some of its clients has indicated or uh uh exposed the lack of disability competency.

Yes, and through research as well.

And through research.

Could you talk a little bit more about what those incompetencies are?

Um, like I mentioned, it seems to be a lot with the attitudinal uh barriers that they have.

Uh a lot of doctors don't think that people with disabilities will want many different things.

Um they also won't have the accommodations proper, like we talked about extensively today, they won't have scales for patients to be able to use, and we think that goes along with competency.

In terms of the cultural piece, which I think is just so important and absolutely true.

Um, I I remember in college, I uh used to receive disability services from the campuses uh um program, and I used to get time and a half for exams.

And when I explained that to one professor, he just totally dismissed that I needed that service, and that is a cultural like, you know, uh reaction thinking that because I look able bodied that I must be able to complete whatever uh exam or um uh assignment according to what he thinks, yeah, and not what I need.

Um, in terms of attitude changes and like cultural shifts, what would NILP uh recommend for healthcare workers?

Like, did you from what we heard about the various trainings that are offered, which, you know, I think to me showed that they're the there are various trainings, but they're not like all interlinked in any way um or coordinated.

What would you say um would help in the changes uh specifically regarding culture?

I don't feel comfortable speaking on behalf of NILPy on that.

Okay.

Well, we can I can speak, yeah.

And we can get back to you on that.

That would be great.

Um, because I think the trainings, as important as they are, um our definition of disability justice as a city needs to be I think more um prominent, which is why it asked each agency about their definition in order to see uh one, whether they have a definition of disability justice, and then two, um, if that is uh agency-wide um being internalized for practitioners to then be able to change their internal biases on disability.

Uh is there anything else you'd like to share that I haven't asked?

No, no, thank you.

Thank you.

Thank you so much.

I will now move to Zoom.

Sorry.

Please wait for your name to be called to testify and select unmute when prompted.

Brittany or MISCI.

Apologies.

You may be good.

Good morning, and I do apologize as I had a technical issue with submitting my testimony, so I may be on your list twice, so feel free to remove me from a second time.

But good morning, council members.

Thank you for the opportunity to provide testimony today in support of introduction 941.

My name is Brittany Miskey.

I am a white female with brown curly hair.

I am wearing glasses and a purple pinstripe collared shirt with a navy blue blazer and navy slacks.

I'm a nurse practitioner by trade and serve as vice president of health care management and quality officer for Care Design New York, a New York State Care Coordination Health Home serving individuals with intellectual and developmental disabilities across the state, operating under the auspices of Office for People with Developmental Disabilities, or OPWDD, and the Department of Health.

In this role, I have the privilege of working alongside care coordination teams, community-based providers, health care partners, individuals, and families to improve access to service, strengthen advocacy efforts, and support better health and quality of life outcomes for people with intellectual and developmental disabilities.

Throughout my testimony today, I will primarily focus on individuals with intellectual and developmental disabilities, whom I will refer to as individuals with IDD.

The introduction 941 would require the New York City Department of Health and Mental Hygiene to develop and offer resources, clinical guidance, and training on disability and accessibility in healthcare settings for clinicians.

This legislation represents an important step and opportunity in the broader effort to improve access to high-quality, accessible health care services for individuals with IDD in New York State, particularly because the unique needs and experiences of individuals with IDD are too often overlooked in the development of disability education and clinical training.

As a nurse practitioner who was educated, trained, and practices in New York State, I can attest that the formal training related to IDD is minimal at best.

More broadly, education about disability, accessibility, communication needs, and the lived experiences of disabled individuals is often limited across health professional training programs, leaving many clinicians without the foundational knowledge needed to provide inclusive person-centered care.

In my own experience, my formal training consists of little more than a brief lecture referencing conditions such as Down syndrome in the context of prenatal genetic screening.

Important topics such as communication accommodations, person-first language, and adapting care to meet individual needs were largely learned informally through clinical practice and trial and error rather than structured education.

This is a common experience, and as a result, many clinicians are left insufficiently prepared to care for people with IDD across the lifespan.

Individuals with disabilities are not limited to one specialty, setting, region, or socioeconomic group.

You can keep going.

Thank you.

I appreciate that, Council.

Every clinician, regardless of practice area, will care for individuals with a disability at some point in their career.

This is especially important for individuals with IDD who may be an increased risk for chronic and co-occurring health conditions.

They may also experience delays in preventive health care screenings and cancer and late diagnosis of cancer when care is not accessible or communication needs are unmet.

Without accessible standardized training and practical clinical guidance, many providers are left to seek out this knowledge on their own, which contributes to inconsistent care and poor health outcomes for individuals IDD.

Passing introduction 941 would require the Department of Health and Mental Hygiene to develop these resources and standardize guidance.

This is also an important step towards improving health equity and health outcomes for individuals as IDD so they receive the high quality care they deserve.

Thank you for letting me go over time.

I appreciate it, and I appreciate the council's consideration of introduction 941 and commitment to improving access to high quality care.

I'm happy to answer any questions the council may have.

Okay, excellent.

Thank you.

I would like to uh know how the coordination works with families.

How are you all assisting individuals?

Where are they learning about care design?

So care design individuals typically learn about through other members of the community or when they go to obtain OPWDD waiver services.

So typically when they go to get OPWDD waiver services, so think of Day Hab Res HabCom have non-clinical services.

They're provided with two to three options for a care coordination health home to pick from.

Got it.

And then how does care design exactly like provide the service or recommendation?

I'd like to just understand why care design is important.

Sure.

What care design strives to do is advocate when we're seeing trends and lack of access or minimal access to care, whether it's due to provider education, um, accessibility, and also work to build relationships with our service providers and clinical providers in the community to explain, yes, we do have an individual with intellectual and developmental disabilities, but that bias that they may carry with them or you may see does not define them.

Here's how we can overcome that barrier challenge so they can get, for instance, a mammogram for breast cancer screening, or they can have colon cancer screening, or as we um we spoke about earlier, they may be sexually active and saying such require those preventative health care screenings to assure that they are receiving support and early diagnosis and treatment.

And then what kind of uh or what specific um areas uh are you seeing most uh in need for advocacy when it comes to uh patient care.

At this time, we are seeing continued barriers for preventive care.

Um, the idea that an individual with intellectual and developmental disabilities may not qualify or require preventive care screening because there is a bias that they have a poor quality of life, and overcoming that barrier and providing education as to what an earlier diagnosis of these chronic diseases can mean for someone with IDD, just like it is for someone in the general population.

Additionally, the diagnostic overshadowing of IDD follows folks and can often mask a diagnosis of mental health and we have seen a lot of barriers in ensuring individuals receive a mental health diagnosis and then receive appropriate services to support that diagnosis, whether it be medication management, therapy, et cetera.

And what age group uh does care design work with?

I believe our youngest member right now is four years of age, and we we manage a reprimand care coordination through the lifespan.

So I believe our oldest member is 101, but don't quote me on that.

She just had a birthday.

Well, happy birthday.

All right, thank you.

We'll appreciate it.

Thank you for your time.

I'd now like to uh call Ramona Ferreira.

You may be good.

Uh, good afternoon, everyone.

Uh, my name is Ramona Ferreira.

Uh, my colonial name, uh, sorry, my name is Guatuque Ini Inaru, and my colonial name is Ramona Ferreira.

Um, I am the founder of Safe Section 9.

Uh, Safe Section 9 is a tenant-led coalition that works to educate and activate public housing tenants, and we tackle policies rooted in colonialism that have led to discriminatory disinvestment in America's only truly affordable housing stock.

I am testifying today on behalf of myself as someone that lives with a disability, our members and neighbors throughout public housing.

We want to amplify the importance of providing accessible, equitable services for folks with various abilities and remind you that 43% of households in public housing include a person with a disability.

That's 21 points above representation in the city overall.

So disability justice matters to those of us in public housing.

We want to express our support for the really lengthy list of introductions and resolutions that you guys are looking at today.

And we also want to highlight that the most stabilizing factor in our lives as people with disabilities is our home.

We are a community living on fixed income and needing accommodations for mental and physical challenges.

And NYCHA provides this, but it must be invested in to ensure that we are safe in our homes.

This is why we are opposing Zoran's proposed budget for public housing.

His proposed budget is the largest transfer of public monies and assets in recent history, and it will destroy the only truly affordable housing we have in New York City that includes empowerment, economic support, social service resources, and front offices that know how to support us and have to support us in a specific way because of the federal mandates for public housing.

The Committee on Disabilities should recognize that Section 9 public housing is one of the most important housing resources available to disabled New Yorkers.

For many residents with disabilities, public housing is not simply affordable housing, it is a difference between housing stability and homelessness.

Unlike much of the private rental market, Section 9 provides robust legal protections that allow disabled tenants to request reasonable accommodations necessary to fully use and enjoy their homes.

And these protections include unit modifications, accessibility improvements, assistance animals, transfer requests, live and aids, and policy adjustments that support independent living.

Disabled New Yorkers face extraordinary barriers in the private housing market.

Many of us rely on fixed income through SSI or SSDI, making market rate housing unattainable.

We also face widespread discrimination, a severe shortage of accessible apartments, and significant challenges navigating the rental market.

The economics are stark.

You can keep going.

Without public housing and other housing assistance programs, many disabled New Yorkers will be pushed into housing instability or homelessness.

She was a black woman who was wheelchair ridden and a strong advocate for black maternal health.

And it would be it just wrong if I didn't mention how she personally brought to our group the awareness of the challenges for folks needing a lot of the uh infrastructure that you've been discussing today.

And she was actually from far walk away.

Um, so it was really sad to hear that things haven't improved for women like her in her community.

Thank you.

Thank you so much, Ramona, for your testimony and uh emphasizing the importance of housing stability and housing accessibility as uh an important factors to the conversation that we were having today, and uh we really um look forward to examining uh public housing and accessibility and the health care disabilities that you've mentioned in your own lived experience as one of our future hearing topics.

We really, really appreciate your uh advocacy for section nine housing.

Thank you.

Thank you.

Kimberly J.

Combs comes.

Maybe good.

Okay, and then back TM.

You may begin.

Okay.

Thank you to everyone who has testified.

If there is anyone present in the room or the Zoom that hasn't had the opportunity to testify, please raise your hand.

Oh, yeah.

Okay.

Okay.

Mbake TM.

Apologies for mispronouncing your name.

You may be good.

Hello, can you hear me?

Yes.

Thank you.

So I was trying to find everybody who wasn't letting me speak.

I'm the housing and health community organizer at the Center for Independence of the Disabled New York.

We advocate for people with uh disabilities in the fire borough of uh New York City.

And I want to take a moment and thank uh uh the chair of the disabled uh disabilities committee uh Jay Hanif because this is very important to us.

Right now I know I only have two minutes, so I'm not going to dig into the details regarding the challenges that people with disabilities change regarding uh reproductive justice and uh but I will submit a written testimony.

I just want to highlight that uh all these thoughts from uh you know virtuality issues until having the baby, uh going down to keeping it up with all the uh appointment with the healthcare provider, and I will drop a written testimony and submit it uh hopefully tomorrow or so.

Thank you.

Thank you so much so much for your testimony.

Seeing no one else, I would like to note that written testimony, which will be reviewed in full by committee staff, may be submitted to the record up just 72 hours after the close of this hearing by emailing it to testimony at council.nyc.gov.

Thank you.