Hatzolah and Ezras Nashim: a Halachic Analysis

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    By Rabbi Yair Hoffman for 5TJT.com

    There is a major controversy occurring in Boro Park now between an all-female Basic Life Support First Responders Agency and Hatzolah, for those who are following the news.  Hatzolah is a remarkable organization that has literally saved tens of thousands of lives.  Ezras Nashim was an organization formed in 2012 specifically to treat and arrange for the transport of women who would prefer dealing only with females – for reasons of modesty.  They have recently applied for ambulance status to operate in Brooklyn and join 21 other ambulance agencies registered in Kings County.  Hatzalah is actually against this application of Ezras Nashim, believing that it will sow confusion among people who need emergency care. A number of Rabbis from Brooklyn have also voiced opposition to it.  The issue came to the fore at a recent hearing about the matter in Brooklyn.

    WHAT IS THE HALACHA?

    But what is the halacha?  Does the possibility of sowing confusion trump the very valid concern of Tznius and possible embarrassment of the women?  Are there other factors at play here?  Does the existence of a second ambulance agency jeopardize the ability of the first one to adequately provide for its patience?

    Before we get to the underlying halachic issues, there are three possible resolutions to this conflict:

    • Ezras Nashim could be allowed to work as a second ambulance force serving the community.
    • Ezras Nashim could be disallowed to operate as an ambulance force, and rather continue to function as a BLSFRA, and use the city’s 911 ambulance service for transport.
    • Something could be worked out where Hatzalah could dispatch Ezras Nashim volunteers to tend to women who request women only. Thus far, this third possibility has not been placed on the table.

    And now the halachic issues:

    TZNIUS

    The first issue deals with the matter of Tznius, modesty.  There is a debate between the Rambam (Hilchos Issurei Biah 21:1) and the Ramban as to whether the prohibition of kirvah to a forbidden woman is a Torah prohibition or a Rabbinic one.  However, both Rav Shlomo Vosner zt”l ( responsum Vol. IV Siman 167) and in his shiurim (YD SIman 195)  and Rav Ovadiah Yoseph zt”l in his Taharat Habayit (Vol. II 12 footnote 46) forbid a women from being treated by a male physician (and presumably an EMT as well) if there is a possibility for a female one.  This is true even if there is a significant cost associated with seeing the female physician and even if the male doctor (or medical practitioner) is better.  This opinion is based on the halachic positions of the Bais Yoseph (195) and the Bais Shmuel (Even HaEzer 20:1).

    On the other hand, the Shach, the Kreisi uPleisi, and the Darchei Teshuvah (YD 197:8) all permit the use of a male physician when it is medically indicated.

    Of course, when it is life or death – pikuach nefesh – searching for a medical practitioner of the same gender is considered a chassid shoteh. The question is one of pre-planning so that it not happen at the outset.  When it is not a matter of life or death – is where the majority of the issues arise.

    Most American Poskim are lenient in accordance with the Shach’s position, and that has become the normative halachic position.  Based upon this, some Poskim (including some of those who have signed onto the letter against the Ezras Nashim application) have ruled that there are Tznius issues the other way, in having women respond to emergency ambulance calls.  Legally, all medical people cannot refuse to attend to the medical needs of any gender.

    WHO IS FIRST?

    The second issue deals with the rights of the first versus the second.  There is no question in halacha that the first always has precedence over the second.  It is for this reason that a recent attempt to start a second Hatzalah organization in Williamsburg has been summarily rejected by many Poskim in Williamsburg – because it could cause serious damage to the existence of the first.

    THE TUR VERSUS THE MEIRI

    The idea of the rights of the first over the second is found in the Gemorah in Sanhedrin (32a) according to the Tur’s Girsah (CM 272) – regarding the arrival of two boats passing through a river.    The Gemorah uses the verse of Tzedek Tzedek Tirdof to give preference to the first to arrive.  By the same token – if the existence of a second ambulance agency would jeopardize the first – then the first one has the right to request that the second one not form.  In secular parlance, we can understand this idea as “first come, first serve.”

    There is no question that Hatzolah has a remarkable track record of serving our community in its life-saving efforts.  They are literally angels in a very difficult environment and have saved and extended the life of tens of thousands of patients.  It is also an organization that has channeled unprecedented chessed.

    The Meiri’s understanding of the Gemorah in Sanhedrin, however, stands in contrast to the idea of “first come first serve.”  He understands the words “te’unah vesh’ainah te’unah” the loaded one versus the one that is not loaded – the one that is loaded takes precedence as trumping the one who is first.  In other words, if one can stand the pressure while the other cannot – the one that cannot goes first.  Otherwise, everything else being equal, the first to arrive goes first.  One could perhaps make an argument that Hatzolah would easily survive if there were two organizations, but Ezras Nashim might flounder – based upon this Meiri, but then the issue arises as to whether we Paskin like this Meiri or not.

    It seems to this author that the Tur’s position has become the normative position in halacha – rather than that of the Meiri.  [This is notwithstanding the Rambam Hilchos Sanhedrin 21:6].  The matter, however, should be brought to our leading Poskim.

    WHO IS BETTER?

    There is no question that Hatzolah has and will retain a faster response time than any other new ambulance service.  This is due to a number of factors, beyond the scope of this article.  Often response time is key.  Should this be a factor?  On the other hand, most of the Ezras Nashim EMTs have had non-mandatory extensive training in neo-natal resuscitation and have completed certification programs in this area.  If Ezras Nashim does become an ambulance agency, their response time will be slower than that of Hatzolah because of various grandfather clauses in New York State law.  Now the difference amounts to approximately 6 minutes according to the papers placed before the EMS board.

    CHILLUL HASHEM

    The fourth issue is that of Chillul Hashem.  We must always be on guard to avoid causing the media to make a desecration of the Divine Name. When Torah organizations are labelled by the media as “misogynistic” Heaven forbid – this is a chillul Hashem.  On this account, it is necessary for all parties involved to strive as much as possible not to be the source of a desecration of Hashem’s Name in any action that one embarks upon.  The media is notorious for attempting to portray anything that a Torah organization does in a negative light.  Sometimes, in our attempt to do what is right, we can inadvertently trample upon this very important Torah value of avoiding chillul Hashem.

    This author has read the entire application of Ezras Nashim to the EMS board and can state that there is no accusation, chas veshalom, against Hatzolah, notwithstanding reports in the media – otherwise.

    Both organizations have Torah authorities that have written letters in support of them. Ezras Nashim has Rav Elya Ber Wachtfogel Shlita, Rav Wosner zt”l, and Rav Yitzchok Zilberstein shlita.  And Hatzolah has 49 signatures on what they have planned to file.  These opinions should neither be negated nor dismissed.

    It is this author’s opinion that the desires of women who wish to be treated only by their own gender be taken into account, somehow.  Studies in the relevant medical journals show that showed that 8.4% of women actually prefer a male ObGyn, while 53.2% prefer a female ObGyn, and 38.5% have no gender preference.

    As a parenthetic note, the very name “Ezras Nashim” has a double entendre that has been missed by the New York dailies.  The standard definition of the Hebrew means “assistance for women.”  But there is a second meaning too.  Ezras Nashim is the designated area for women in both the Beis HaMikdash as well as synagogues throughout Jewish history.  The subtle implication of the double entendre is that this is an area exclusive to women – where men do not belong.

    In an unofficial survey of a number of Rabbonim, women, and medical professionals, taken by this author – the overwhelming preferred resolution to this was that some sort of cooperation between the two organizations be worked out – as in the third resolution presented at the beginning of this article.  One person even related that when Hatzolah was originally conceived, the idea was that a separate group of women be formed to deal with women – like the original Shifra and Pu’ah in Sefer Shmos.  The Pupa Rebbe’s letter highlights this concept.  Skver Chassidim also promulgated a women’s only EMT program a while ago.

    It is this author’s opinion, after speaking to some legal experts, that it is highly unlikely that the EMS board will deny the application.  If this is the case, then perhaps efforts should be made to come up with a compromise where all of klal yisroel will benefit.

    The author can be reached at yairhoffman2@gmail.com

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    53 COMMENTS

    1. I have 1 simple question: why is hatzolah men “fighting” to help women deliver babies?
      all hatzolah members are erlicha yiden, who don’t look at women in the street,
      why fight to touch women at giving birth, when they can hand over this job to a group of women EMT’s?

    2. 49 Rabbonim signed and you don’t think any of them thought of your idea? Obviously they hold it’s not acceptable.
      And let’s be honest: the founder has other motives in this. 1 being she’s a big woman’s rights activist and this is her way of getting a platform.
      Us frum Yiden don’t live in her derech.

      • I believe most, if not all of these 49 Rabbonim think that its untznius that women drive.
        If you are so supportive of these Rabbonim, why dont you ask them if you can have a smartphone & be on the internet, and comment on this site.

    3. when you need urgent medical help you take the first one to come. When you need expert medical care, you look at the skills of the doctor; not at the sex.

      This whole thing is stupid, but many people are stupid, so we see them make issues out of nothing…..

    4. many comments in recent articles are full of misinformation, cheap anonymous pot shots ; let me add my 2 cents i am not a H. member
      1. boropark hatzoloh DOES NOT BILL INSURANCE – ask your neighbors if they were ever asked for insurance card ( personally im not against them billing)
      2. an org that has served us 24/7 literally yom kipur & tishabeav day & night for free , and we are so easy to bash , ridicule… w/o giving the benefit of the doubt. is there anybody here that hasnt heard the helpless scream ” CALL HATZOLOH” its embarrassing that they even need to make an auction to cover expenses
      3. flashing lights , the glee of that lasts how long … you think at 2am jumping into sneakers & racing in the cold is because of lights????
      much more to say but now to the substance;
      1. every seemingly good intention needs to be weighed in the big picture as an example when the askonim wanted to open the ” pool hall on ave M the gedolim were divided you had a benefit for the at risk teens yet how would it effect the boys who still had one foot in yeshiva….would it make individual teens into a “group” here to the ramifications need to be considered , and after weighing the sides it is NO despite good intentions.
      2. ob/gyn calls – what percent of calls are ob related , how many home deliveries do u think bp has in a year.. maybe 2 a month . most woman in bp use ob groups w/ mostly male docs. most members never even got called to a home birth.
      3. real field experience.. on a moments notice an emergency responder needs to take charge and make decisions in tense situations this comes from a lot of field experience
      4.there is an undertone by many in their group of real feminism as rav moshe zatzl writes in a teshuva regarding womans minyan groups that although the specific request was NOT ASUR the motivation behind comes from a treifa makom ayim shom

      nshei cares has a successful doula program which is very much appreciated and useful they can easily have expanded that to include some of the ezras noshim emts to offer help or support for ob issues w a phone number.
      as far as the other neighborhoods new square is an extremely tight community where everyone knows everything …and a ton of ob kein yirbu so there its like the doulas here ..as far as washington heights it was pikuach nefesh since there was a huge aging population with serious medical needs and very little young coverage
      home births are dangerous and should be discouraged lastly rav hoffman your article should mention that although halachic research is encouraged vetorah hu…BP has many many rabonim leading and advising their perspective kehilos and should decide on issues affecting their tzibur

      • Unfortunately I have used Hatzulah in the passed a few times and always did they ask for my insurance card!! I’m not saying it’s right or wrong. I myself on one occasion helped them fill in my insurance info on their forms. They’re a wonderful organization and I dunno what we would do without them, but there’s a whl bunch of corruption going on there, including the fight between them and the Ezra’s Nashim.

      • No, actually Boro Park most certainly does bill insurance, they just don’t “balance bill” the patient.
        (all of Hatzolah is now billing insurance)
        #4: I disagree with comparing women’s minyanim with ezras nashim. There are women with medical emergencies who would prefer being treated by other women. It’s simply a bad analogy.

          • I had to call Crown Heights Hatzalah and Mill Basin Hatzalah about 2-3 years ago and never not one of them asked for insurance info.
            Mill Basin Hatzalah sent a letter asking for a donation afterwards.
            Crown Heights Hatzalah didn’t even do that, they sent out a survey asking how they did and if there’s anything they can improve.

            I always wondered why they don’t bill the insurance. Maybe they started more recently. B”H haven’t needed them in the past few years.

    5. I don’t get what the problem is for someone who’s making the phone To request a female technician they know the state of mind there in (if it’s life and death)

    6. (b’mechilas kavod harav) I believe that there is an an important omission in your initial analysis of the situation: The funding available in the community is finite. In the same way that support for persons abused decades ago was missing for fear they would sue and the community would lose yeshiva buildings that would have to be repurchased, here the community would be called upon to support the huge bills that would come with an entirely new organization, with very expensive equipment, ambulances, and so on. The staggering amounts that Hatzala has raised and used would need to be replicated, but from whom? The same donors again and again, and this would for most lead to fewer donations to other things. Too many people are already struggling to add more “Mosdos” to the list. The only answer would be your third option, for mixed-gender Hatzala crews, but what rabbi is brave enough to support that?

    7. I want to share a very funny story I watched a scenario from ezra’s noshim
      I was walking in boro park and I heard tons of sirens it was shomrim running to a call. All of the sudden I see in front of me an ezras noshim car stop and a woman comes out and starts running down a block I and so did shomrim run I ran to see what is this whole commotion, long and behold the ezras noshim lady ran after a loose puppy she started yelling I got him!
      It was hysterical
      Now who knows how far thi organization will take womans rights to? Next will be womans shomrim? They dont have the same professional skills hatzalah does. And no man is interested in any woman during birth!

      • Sorry to say, but there is a larger number of responses from Hatzola guys to a woman giving birth, as it is legal p0rn. There is a tally amongst the insiders on who & how many births they have seen. Maybe not all Hatzola guys, but most would run to see a birth quicker than anything else.

    8. I was originally very pro the women. The article by a Hatzolah member helped me change my mind a lot. Though, the arguments about confusing stickers were inane and childish.
      As Rabbi Hoffman spoke about, there’s a solution to this problem.
      The bigger problem is everyone likes to see things in black and white. So it becomes an issue of response times, level of care etc.
      We know most calls are not emergencies. People, especially in our community have a low threshold for calling Hatzolah. Some of the biggest Zchusim they earn is that when a frequent flyer calls or a kid with a minor cut they still respond with a full heart and don’t complain about it.
      There’s no reason why if Hatzolah responds to a pregnant women and she’s alert and talking and sitting up that they can’t dispatch Ezras. By the time the EMT assesses the situation and asking questions a women (who’s better trained in these issues) is on the scene. If the women needs to be examined Ezras is there to do it. Response time is not an issue because Hatzolah is responding. Level of care is not an issue because Hatzolah and all its resources are there. Obviously, if it’s an emergency Hatzolah treats them.
      This will also answer the question many have about Ezras Nashim. Whether they are out to help women with Tznuis or do they have a feminist agenda. If they are willing to piggyback with Hatzolah then it’s about Tznius, if not it’s probably about feminism. If Ezras piggy backs they will have a lot fewer calls and less exposure. Are they ok with that? They should be if it’s only about Tznius.
      This will also put pressure on the Rabbonim. Many women in the community feel sidelined and literally “Air brushed” out of society. The Rabbis constantly talk about Tznius. The women feel that their pleas were casually dismissed by the Rabbis. Is it really so hard to understand that a women who leads a life of Tznius doesn’t want her husband’s Shabbos drinking buddies staring at her in a non-emergency? Where do they draw the line? Is Hatzolah EMT’s examining their friend’s wives more Tznius then a women (who is better trained in these issues, which is a very important point) interacting with men in limited situations? If an EMT responds to a call and isn’t sure what to do and knows a doctor lives next door they will ask the doctor (male or female) for help. Why is a women that’s better trained in women’s issues any different?
      This issue shines an uncomfortable spotlight on the community. It shows we are a community (& sadly a lot of America is the same way) which is incapable of compromise and swallowing our pride and ego even when it will benefit the community and provide our women with the feeling that we value them and take their concerns seriously.

    9. Heard several times from Hatzolah members when an obgyn call comes in, there s a higher then usual response. Hatzolah is very aware of this fact and internally speak about it. It does not have to be for the obvious reason that first pops into the mind, it can also be that the call is more interesting then the call from the same old drooling man who can’t get out of bed not feeling well. Hatzalah volunteers work with aderinlin as we see car crashes also gets more attention. Same with the cops.
      HATZOLAH IS WRONG ON THIS ISSUE – They should have a special unit for woman’s issues, with woman volunteers. What is wrong to propose this protocol – anyone closest should respond first and if it life and death situation deal with it right away , if they see they can wait another meager 4 minutes for the woman volunteers to arrive, then wait and leave the room as soon as treatment starts and only assist getting her into the ambulance. Let the woman take her to the hospital. Many, many, woman are very embarrassed by charedi men dealing with her in her vulnerability. Some woman even embarrassed going to the mikvah whare another female is seeing them in a state of undress. Many woman do not realize they can kindly ask the attendant leave the room until they are in the water and can keep their arms at neck level when she does comes in (some young just married woman are very embarrassed to pass the mikvah lady in the the street or meet them at a wedding). Many young boys are ashamed to meet their Rebbe in the mikvah. It is easy to say grow up, but each person deals with their own inhibition and fears. Why can’t Hatzolah understand this – many woman simply do not wanting a man there, full period.
      Another point – To those woman not wanting a man treating her giving birth, the male Hatzolah members put her in a position of greater anxiety, causing the danger to increase a bit. Isn’t it a bit of irony, to encourage the woman to “relax” and not hyperventilate…. when 6 guy with beepers are watching her.
      To the holy Rabbonim who promote the problem of tzneis, that men and woman are coming together with their own cars to an emergency call of life and death. If the male member has an issue with woman and might get too friendly with her (which can lead to other problems) maybe, just maybe, Hatzolah is not the place for those men. Why should woman have to suffer just because some men have a problem wanting to start up with every member of the female race. Remember our Rabbonim are exclusively from the same gender and think much alike.

    10. I am in full agreement with Yossi Ginzburg above. So tired of people contributing to whatever tugs at their heart. Economics 101: There is “x” amount of dollars for “x” amount of cause. A community has many needs and only so much money. No one should unilaterally decide to bind a community to an expensive venture for the sake of a handful of women who might utilize the service annually. I have another suggestion. Why not arrange for the services of trained midwives who will be called upon for emergencies. Their skills will be sharp and up to date, as they are using them constantly. The community can raise the funds to pay a trained midwife for the emergencies they are called out on. Then Hatzolah will be called for transport to the hospital. Issue solved at an affordable price!

      • Your argument about money doesnt even start . There is already a womens organization for this. There arent any more calls because of it, they are just distributed between the organizations. Hazola is a strictly run organization, just trying to keep on top of everything. If they would have allowed women to join, specifically for womens calls, then they would not have had to start their own organization.
        Combining the organizations would save everyone hassle & money & machlokes.

        • My suggestion is very different. We thank Mrs. Freier for bringing the issue to our community. Her heart is in the right place always. However, Hatzola’s rav has said no. We need to respect that. I believe having midwives on call will solve the matter. The idea of woman running about in ambulances etc. is a very modern one and I am afraid it doesn’t take very much to understand that this way encroaches on the tznius of a woman!

          • So you believe that these E.N. women should run to the call when someone is giving birth (not in an ambulance), but then stand at the side and hold her hand while the male hatzola guy takes care of the frum lady giving birth?
            I wonder what you think of the frum women doctors who work at Maimonides & all over the world, or the frum women who are on Hatzola in other places.

            • I believe trained midwives should be on call for emergencies and paid for the calls they attend by the community. Then Hatzolah should be kind enough to provide transport. What is hard to follow?

          • …”However, Hatzola’s rav has said no. We need to respect that.”. Um no we do not need to respect them. I will not respect the same Rabboinim who have caused thousands of people to go OTD, who have protected pedophiles etc…. Sorry they have LOST our respect. Game over. In 2019 with the internet and everything we now know that many Rabbonim cannot be trusted anymore. They have covered up so much when no one was looking.

            • Yes, we understand. You’ve got daddy issues, so you think it’ll help to take it out on the rabbonim. Where the truth is simply that you’re looking for an excuse to do whatever you want, like the Jews of the era of the first Beis Hamikdash, who, as Chazal tell us, turned to idol worship because that would then “liberate” them from the strictures of halachah about forbidden relationships.

    11. There’s a couple of comments here that are absolutely not true.

      #1 Hatzolah will never ask for an insurance card. They don’t even have the ability to bill insurance companies directly. Hatzolah made the decision several years ago due to the astronomical rising costs of operational insurance.

      #2 Hatzolah responds to an OBGYN emergency the same way they respond to ANY emergency. Priority calls (which am OBGYN call can be) gets a faster response time.

      #3 Anyone who has ever worked in EMS knows what goes on between male and female EMT’s and Paramedics. The rabbonim of our community decided that they wanted to avoid similar situations.

      #4 Ezras Nashim was a good idea for non serious medical calls. The delay in care for a serious medical call can be fatal.

    12. I believe trained midwives should be on call for emergencies and paid for the calls they attend by the community. Then Hatzolah should be kind enough to provide transport. What is hard to follow?

    13. The comparison of a male ob/gyn to a hatzolah member in an emergency is not a great comparison. A male ob/gyn is a professional that a woman goes to see in an office and is someone she will not meet on the street in front of her house or on her way into/out of shul or even on a chol hamoed trip with her kids. what happens when the woman meets the hatzolah member who delivered her baby, on the treet a few days or weeks later?

      • The situation you refer to is remote at best. To date, no one has died. There are other ways to solve this issue without a team of women running all around the neighborhood. This too is not tzniusdig. It is shocking that we have come to a time and place where this is not even understood!

    14. First of all, I don’t see what the problem here is. Most Hatzoloh members are just load and go EMTs and should not be dispatched to a woman actually giving birth. Paramedics should be the only ones dispatched to a woman giving birth and there are very few Hatozloh members who are trained for this. As a matter of fact, I would be very surprised to find if any of the Ezras Noshim are in fact paramedics. That being said, if there are trained paramedics in Ezras Noshim, they should be the only ones called for a woman in labor and male paramedics should be called if no Ezras Noshim paramedics are in the vicinity.

    15. As per a previous VIN article:
      Meeting was held with Rabbi Yechezkel Roth, a prominent posek in Boro Park known as both the Karlsburg Rav and the Satmar Dayan. At that meeting, four women representing the new effort, along with several rabbis, presented their case to the rabbinic leader. “Rabbi Roth listened for at least an hour,” related one of the meeting’s attendees. “He explained that historically the miyaldos (mid-wives) were women, and we see in our community that in the Chevra Kadisha, we have men attending to men and women attending to women. Our shuls are separate, our weddings are separate and there is no reason for our emergency medical corps not to function in the same way, not only in childbirth but in other medical situations as well.”

      • I agree but in an emergency situation like childbirth, only a paramedic should be dispatched. Preferably a female one but if a male paramedic is closer, then he should be dispatched as a childbirth can become a serious emergency very quickly.

      • Rabbit Roth said to act separately. This certainly means not to call Hatzolah for backup which would certainly negate the “separate” of his statement. But is separate feasible? Can women function separately in emergencies? Can they lift a stretcher with a 200 pound woman down three flights of stairs?

    16. DATA;
      does anyone have some data info;
      1. in the past year how many emergency home births has ezras noshim delivered ?
      2. in general how often is hatzoloh called where its so late that they cant even fly to the hospital and need to deliver at home
      3. the overwhelming majority of units are ehrlich & sensitive
      4. in skvere do the lady units or team / drive an suv w lights & radios?
      of all the many problems bp has and we have many from chinuch to parnassa from mental health to gitin shiduchim to machla in all its forms….. was the rare home birth a BURNING issue if these woman want to help their rabonim can give a whole list of worthy endeavors that are desperately needed

        • Who are you and who do you work for? I am one of “these women”, and I find the concept of the Esras Nashim somewhat off the wall! The cost of this program cannot be justified when only a handful of women need the service annually. Mrs. Freier can do whatever she wishes in her own personal life. She can run for judge and even for president! But to unilaterally decide for a community about how the community should function might be a little too bold for most of us. I for one, fear that if the Ezras Nashim does get off the ground, a woman will lose her choice of who to call. She will not be allowed to call Hatzolah for fear she will be labeled “modern”. Isn’t this what happened with every other chumra in our community? You have now heard from one of “these women”!

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