Save the NY Eye & Ear Institute

Since 1820 the New York Eye and Ear Infirmary (NYE&E), has served what is now the lower East Side, Chinatown, Chelsea, Soho and Noho and has provided its residents with exemplary health care. Sadly, this may change.

In 2013, Mount Sinai merged with Continuum Health which then owned three local hospitals: NYE&E, Beth Israel and St Lukes / Roosevelt. Since the merger, many Mount Sinai Health System administrative decisions have been detrimental to both NYE&E’s physicians and patients. Mount Sinai has without explanation, closed the NYE&E on site radiology and laboratory services. It has cancelled the trauma service. This action was especially puzzling in that the NYE&E trauma service was the only active eye trauma program in the tristate area. Mount Sinai has closed many NYE&E operating rooms, ostensibly because of staff shortages. While resident surgery is still being performed on site, the volume of private surgery has fallen. Hospital data show that the number of all outpatient visits, that is ambulatory surgery and clinic visits combined, decreased from 156,192 (in 2017) to 102,658 (in 2021). This decline in census is alarming. Rumor has that in the future other services are to be located elsewhere. Under utilization will endanger accreditation and ultimately disqualify NYE&E from Medicare and Medicaid reimbursements. It will close. Given these events, many staff surgeons and specialty physicians, e.g., glaucoma, retina experts, have left.

Any move away from the present site may affect patient care. Greater distance and increased travel time between health care providers and patients will inconvenience many older patients. More importantly, any relocation of services Northward in Manhattan will have adverse effects on the health outcomes for those patients residing in Chinatown or on the lower East Side. It is well documented that as hospitals merge and close, travel times between patients and hospitals increase. The likelihood of death associated with an acute heart attack for example increases as well. The morbidity and mortality associated with chronic heart conditions, e.g., hypertension or diabetes, also increase. The explanation for this is less obvious. These chronic conditions require regular clinical monitoring and evaluation. With downsizing and consolidation, services become less available. Physician visits become less frequent. Note, there is little documentation of the effect of downsizing on patients with eye disorders. Cataract and retinal detachment surgeries are not acute care procedures. Their outcomes may not be affected. On the other hand, patients with glaucoma as well as those with eye involvement in many chronic disorders, e.g., hypertension, diabetes and sarcoidosis, require regular evaluation. Their evaluation, like the evaluation for chronic heart disease patients, will become less available. Patient outcomes will be in peril.

Mergers and consolidation of health care facilities such as the Mount Sinai Health System that has absorbed NYE&E are becoming common within the health care industry. Ostensibly, greater concentration of patients and physicians should strengthen their bargaining power over suppliers of equipment, pharmaceuticals and other necessities and thereby decrease cost. Medical care would then become less expensive and more available. In truth, the opposite occurs. Consolidation of physicians decreases competition. When health care services are concentrated, health care costs rise while the quality of health care delivery falls. Extreme consequence are seen when private equity firms rather than health care consortiums initiate the merger process. A prime example of this is the recent closure of Hahnemann Hospital in North Philadelphia. For a century, Hahnemann served a working class population. With recent neighborhood gentrification however, the hospital real estate had become highly valued by real estate developers. In 2018 the hospital was purchased by a private equity firm, milked and finally in 2021 closed and sold to developers. Given that the site of NYE&E is now coveted by developers, it is easy to foresee a similar sequence of events here on the NYE&E campus. If all of the properties now held by NYE&E were sold as one parcel to developers, the parcel would command approximately $70 million.

Now (late 2022) Mount Sinai-Beth Israel (MSBI) has applied to the Public Health and Health Planning Council for permission to merge the two hospitals already within its own orbit, NYE&E and MSBI, into one unit. In February, 2023, the Council gave MSBI conditional approval for this merger. Approval would be contingent upon MSBI agreement not to close any NYE&E clinical programs or inpatient beds and not to change the governance of NYE&E. MSBI must solicit advice and consent from the community, a duty it has refused to fulfill ever since the 2013 merger. MSBI must resubmit a revised proposal by June 13, 2024 or the project will be tabled. Mount Sinai has floated the idea that it would move many medical practices elsewhere and build a new out patient ambulatory surgery unit at nearby Beth Israel. A look at a federal form 990 for 2017 when the census was still full however shows that NYE&E is a financially stable operation.

NYE&E should be supported, not dismantled. Ideally, NYE&E should stand alone and govern itself.

Marc H Lavietes is the Secretary of the NY Metro Chapter of Physicians for a National Health Program. www.pnhpnymetro.org