IN RE: the Application of Maimonides Medical Center (2026)

The following papers were used on this petition: NYSCEF Doc Nos. 1-10, order dated Sept. 2, 2026.

Upon the foregoing papers ¹ , having heard oral argument ² , and due deliberation having been had, the within petition is determined as follows.

Introduction

Petitioner Maimonides Medical Center ("Maimonides") commenced this special proceeding against Respondents A.R. and E.R. pursuant to Public Health Law § 2801-c for a judgment directing the discharge of C.R., the infant child of Respondents.

Background

C.R. is a three-month-old male, born on XX XX, 2026, with complex medical conditions, such as severe hypoxic-ischemic encephalopathy ³ ("HIE"); C.R. is dependent on a tracheostomy and mechanical ventilation, and on a gastrostomy tube ("G-tube") for nutrition. Physicians at Maimonides have determined that C.R. is medically stable in that he is at his neurological baseline and no longer needs acute care. However, A.R. has been uncooperative with Maimonides' attempts to place C.R. in a skilled pediatric nursing facility, according to the hospital.

Maimonides states that C.R. was admitted to their Pediatric Intensive Care Unit (PICU) from Rutland Nursing Home on June 28, 2026, for evaluation of increased work of breathing and heart rate, with a differential that ruled out sepsis. His bloodwork, urine, and tracheal cultures were negative. The child had minimal spontaneous movement, no cough or gag reflex, and fixed pupils, which appear to be his neurological baseline according to multiple examinations. C.R.'s ventilator, tracheostomy, and G-tube needs are stable and are of a kind routinely managed outside an acute-care hospital, in a skilled nursing facility equipped for ventilator-dependent pediatric patients. Maimonides has sought discharge since July of this year.

Maimonides states that there are only ten pediatric skilled nursing facilities in the state of New York who accept infants on a mechanical ventilator who are G-tube dependent. Maimonides conducted the discharge planning required by federal and state law and two appropriate placement options with availability accepted C.R.⁴

As of the date of the hearing, however, these options were no longer available. A third facility, Sunshine Children's Home and Rehabilitation Center in Ossining recently has become available.

A.R. had requested that C.R. be placed at St. Mary's Healthcare for Children, but upon reaching out, Maimonides's social work department was informed that there was no availability and there existed a long waiting list. The care management department informed Respondents of the placement options available, but they refused to accept any facility recommended by the hospital. A.R. was provided with the opportunity for paid transportation to the facilities (so that she could tour); she initially agreed but failed to follow up. Whenever staff spoke with her, she deferred all questions, stating that she must speak with her husband, E.R.; E.R. did not attend any meetings, nor did he visit C.R.

An inter-disciplinary meeting was held with A.R. regarding C.R.'s discharge on July 22, 2026. A.R. explained her belief that C.R. would benefit from a higher level of care and requested that C.R. be transferred to a "hospital-based facility," as opposed to a nursing facility. Specifically, she requested a transfer to New York Presbyterian Hospital Columbia University Medical Center. A transfer request was made on July 19, 2026, but it was refused since Columbia could not provide additional services from what Maimonides was providing. A.R. then demanded a second MRI, but the attending neurologist explained that another MRI would not be medically necessary for two reasons: (1) C.R.'s condition had worsened and (2) C.R. already had an MRI at the time of his birth, at Downstate Medical Hospital.

At this same meeting, staff informed A.R. that once C.R. was discharged from the skilled nursing facility, C.R. would be seen by a neurologist on an outpatient basis. Hearing that, A.R. demanded that Maimonides provide her with G-tube and mechanical ventilator training and secure her family housing as they are undomiciled,⁵ which Maimonides argued was beyond the scope of their legal obligations. On July 19, 2026, Maimonides issued a Discharge Notice, stating that C.R. no longer required care in the hospital and he would be discharged on July 21, 2026. A.R. was informed that she and her husband would be financially responsible for all expenses related to their son's stay beginning on July 22, 2026.

At the hearing, Respondents requested an adjournment to retain a pro bono attorney. This was denied by the Court. They did not offer much in the way of argument concerning the merits of Maimonides's petition. Maimonides's factual and legal allegations, summarized herein, remain basically unrebutted. As such, the Court found it unnecessary to take testimony from a doctor at Maimonides who was prepared to testify virtually.

Discussion

In the petition, Maimonides argues that C.R. is medically ready for discharge and Respondents have exhausted all internal remedies to avoid discharge. A.R. appealed the discharge determination, and the hospital's determination was upheld by IPRO.⁶

Maimonides contends that discharge is medically appropriate as C.R. is at risk of contracting pathogens in the PICU. Additionally, C.R. no longer requires acute care as he is stable, so therefore, his occupancy of a PICU bed may deprive another patient of medically necessary services. Finally, A.R.'s refusal to consent to a discharge violates the Code of Rules and Regulations of New York State at 10 NYCRR § 405.9 (h) (7) (ii). This regulation requires hospitals to discharge patients when it is safe and medically necessary to do so. Section 2801-c of the Public Health Law permits the hospital to commence a special proceeding to enjoin violations of Article 28 of the Public Health Law and the regulations promulgated, including the NYCCR provision cited above. The Court agrees with this branch of Maimonides' argument. It has been established that C.R. no longer requires acute care in a hospital setting. He now requires skilled nursing care on a continuous basis in order to maintain his neurological baseline.

Further, if C.R. were to remain in the PICU, he runs the risk of contracting an infection from hospital-associated pathogens. It is well known that common pathogens in hospitals include bacteria such as staphylococcus aureus (MRSA), pseudomonas aeruginosa, escherichia coli (E.coli), klebsiella, and clostridioides difficile (C. diff), and fungi, including candida and aspergillus, and viruses, including influenza. Considering his present condition, a significant risk is posed by his remaining in Maimonides, particularly when it is not medically necessary that he remain there.

Maimonides argues that an injunction pursuant to Public Health Law § 2801-c is appropriate as the balance of the equities weighs in favor of a mandatory discharge. Maimonides notes that both the hospital and the community which the hospital serves will suffer irreparable harm if the hospital's application for a mandatory injunction requiring C.R.'s discharge from the hospital forthwith is not granted. Public Health Law § 2805-b requires Maimonides to admit any person who needs immediate hospitalization. Thus, the hospital must ensure the availability of its scarce resources for patients in need of acute medical care, and discharge patients, such as C.R., who can be treated more appropriately elsewhere. The Court agrees with this branch of Maimonides's argument also.

Furthermore, courts have enforced a hospital's discharge of a patient who no longer requires acute care to an appropriate skilled nursing facility over the patient's or family's objection (see, e.g., Matter of New York Methodist Hosp., 25 Misc 3d 648 [Sup Ct, Kings County 2009]). Similarly, in Matter of Wyckoff Hgts. Med. Ctr. v Rodriguez, 191 Misc 2d 207, 208 [Sup Ct, Kings County 2002]), the court enforced a discharge to a nursing facility after a determination that the patient "no longer required hospital care" and that "an appropriate discharge plan had been established," notwithstanding the patient's dissatisfaction with the accepting facility.

In conclusion, the Court finds that:

(1) Respondents' adjournment request was properly denied. Special proceedings are designed to be expeditiously resolved. The need for an immediate resolution herein was in the best interest of the child.

(2) Maimonides has meticulously followed the regulatory guidelines set forth in 10 NYCRR 405.1 et seq. for discharging C.R.

(2) Respondents-parents have not been cooperating with Maimonides and already lost the opportunity to transfer C.R. to an available skilled nursing facility, to wit, Ditmas Park Care Center and St. Margaret's Center. Unless a determination is made speedily, the opportunity to transfer C.B. to Sunshine Children's Home and Rehabilitation Center may be lost.

(3) The next phase of the child's care is best served in a skilled nursing home capable of tending to the child's needs.

(4) There exists a risk that pathogens in the PICU and other locations in the hospital may deleteriously affect the child's health unnecessarily.

(5) The hospital must maintain the capacity to treat other patients with acute conditions; the infant is no longer in need of acute treatment.

(6) Maimonides is entitled to a mandatory injunction, which in effect finally determines this special proceeding. It has established irreparable harm to C.R. and the community, a meritorious claim, and a balance of the equities in its favor. All relief it has requested is appropriately granted.

Conclusion

Accordingly, it is hereby ORDERED and ADJUDGED as follows:

(a) Pursuant to Section 2801-c of the New York Public Health Law, A.R. and E.R. are ORDERED in their capacities to accept the discharge of C.R. from Maimonides Medical Center to the first appropriate and available skilled nursing facility that offers mechanical ventilation and gastrostomy tube services as may be available.

(b) Pursuant to Section 2994-r of the New York Public Health Law, the decision of A.R. and E.R., as parents and surrogate decision makers for C.R., are ORDERED to be overridden. Maimonides Medical Center is authorized to serve as surrogate decision makers for C.R. for the sole purpose of facilitating a safe discharge to the first appropriate skilled nursing facility with mechanical ventilation and gastrostomy tube services to support his needs as may be available.

(c) Pursuant to 22 NYCRR § 216.1 and 45 CFR § 164.512 (e), the Court records regarding this proceeding shall be sealed by the Kings County Clerk upon the grounds that this proceeding involves confidential and privileged information as defined by the Federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the HIPAA Privacy Regulations (45 CFR Parts 160 and 164), pending the final determination of this proceeding or further Order of this Court.

The foregoing constitutes the final decision, order, and judgment of the Court.

ENTER

HON. AARON D. MASLOW

Justice of the Supreme Court of the State of New York

FOOTNOTES

1.   . E.R. is known as [redacted], as he stated at oral argument.

2.   ..Transcripts may be procured from the court reporter (see Matter of Lewandowski v Office of Ct. Admin., 173 Misc 2d 335 [Sup Ct, Albany County 1997]).

3.   . This is a type of brain injury caused by reduced or interrupted oxygen and blood flow to the brain, often occurring around the time of birth.

4.   . C.R. was accepted by Ditmas Park Care Center located in Brooklyn and St. Margaret's Center in Albany.

5.   . The address they provided to the Court was that of a shelter.

6.   . IPRO is a non-profit which works with state and federal agencies to improve healthcare outcomes. Their determination is in Exhibit B to the Petition. IPRO is the organization's name, it is not an acronym. IPRO contracts with the State Health Department.

Aaron D. Maslow, J.