On Thursday morning January 26, the Establishment and Project Review Committee of the New York State Public Health and Health Planning Committee (PHHPC) met to decide whether or not to recommend that Mount Sinai will be permitted to go forward with its planned stripping of NYEEI services. The decision came after press-time. We will report about it in our next issue. Below is a key letter submitted by Richard Koplin, MD, Co-Director of Cataract Services.

I am opposed to Mount Sinai’s initiative to erase the New York Eye and Ear Infirmary (NYEEI) by conflating the Infirmary’s Certificate of Need with that of Beth Israel Medical Center (NYSDOH Project #222087).

After publicly pronouncing their commitment to preserve and grow NYEEI’s clinical services to our community (2013) Sinai has—without meaningful discussions or counsel with our clinical staff and leadership—systematically withdrawn many of the services that served as the glue that made NYEEI’s clinical relevance to New York’s health needs so unique.

The NYEEI’s historical relevance aside—local and national prominence, it’s 200-year history of championing specialty eye and ENT care—its specialty service platform established the NYEEI early on as preeminent in its fields: the efficient “one stop shop” for specialty Eye and ENT care embraced more than twenty-five (yes, twenty-five!) sub-specialty ophthalmic and ear, nose and throat services under one roof.
Sinai has willfully undermined strategic opportunities for maintaining specialty medical services at the NYEEI campus from the day they assumed management control of the Infirmary. With virtually no input from the skilled and learned stakeholders with years of dedicated affiliation to the Infirmary, they began a process of gutting the Institution. It has been death by a thousand cuts.

Service cuts? Where to begin? Sinai has closed the emergency room, the radiology department, the diagnostic laboratory, unhinged the voluntary staff PC to their complete control (the centerfold and historical life-blood of the resident and fellowship teaching program and supported enthusiastically by the voluntary staff). Sinai fractured the ENT department: there is no representation no representation on the NYEEI campus. The NY Eye Trauma Service was cancelled—founded in 1986 it was a prestigious and proud cornerstone to the modern-day NYEEI and the only active eye trauma program in the tri-state area. The trauma center was important especially to our uniformed services offering an expertise not found at 3 AM among the boroughs of NYC. Also, the NY Eye Trauma Service at the New York Eye and Ear Infirmary served as a keen teaching experience for our residents and fellows.

Please, ask Sinai leadership why they would devolve the institution to a minimalist specialty service profile if they did not intend to close the institution. The downstream effect from their intransigence has been predictable. We have lost a substantial number of our most accomplished specialty physicians to other institutions. Among them glaucoma, cataract, uveitis, retina, cornea, oculoplastic, and pediatric specialists.

Sinai management has operated via obfuscation and poor planning. As example, they publicly, and with much ballyhoo—including architectural drawings and mock-ups—represented a number of master plans over the past several years, ostensibly to re-establish the Infirmary only to go mum after a month or two, as if their representations never existed.

It is clear that Sinai management is failing the Infirmary. To further exemplify Sinai’s management ineptitude and failure to serve its commitment to the community our clinicians have been stunned by the drop in the surgical census for the most common surgical procedure performed at the NYEEI (and in the US among for those over the age of 65). Cataract surgery volume has fallen precipitously since Sinai took management control of the Infirmary. Not unexpectedly it is our Medicaid clinic patients that are most impacted by their indifference.

It should be transparent to all that Sinai should be denied license to combine Beth Israel’s and the NYEEI’s CONs. Instead, Sinai should redirect their efforts to make whole and continuously available to our community—on a single, unified campus—the integrated specialty medical services historically provided at the NYEEI. In referencing this requirement please ask Mount Sinai operatives “what is their plan, and will they implement it?”

Finally, I strongly urge you to consider the impact on the community when reviewing Sinai’s application.

Sincerely, Richard S. Koplin, MD
Co-Director, Cataract Service
New York Eye and Ear of Mount Sinai