Dr. Nakul Karkare is an orthopedic surgeon in Long Island, New York, and has been an active staff member with full clinician privileges at South Nassau Communities Hospital in Oceanside since January 30, 2018, when he reported for his medical orientation at the hospital. This was about 11 months before Mount Sinai Health System was officially acquired the regional hospital in December 2018. It was later renamed Mount Sinai South Nassau.
He last performed surgery there on March 7, 2019, but that lack of activity in the years since has not stopped the hospital from renewing his physician privileges in subsequent accreditation cycles. In July 2023, Dr. Karkare received the final renewal of his privileges for a period of two years. Well after that time, the hospital extended its privileges until June 30 of this year.
Beyond that, however, it appears to be prohibited.
Physicians at Mount Sinai South Nassau as well as an administrative official from the parent organization made it clear to Dr. Karkare that the hospital had new statutes and that under these statutes the hospital could no longer accept its current qualifications, which include certification from the Board of Directors of India and ACGME Accredited Scholarships in USA. He would either have to resign or appeal the opinion of the hospital’s Joint Accreditation Committee if it ruled against him, they told him, adding that appealing the decision could have disastrous consequences.
Dr. Karkare fought tooth and nail for several months, sending a barrage of emails, pointing out inconsistencies and accusing the hospital of failing to meet state and federal standards. But in an interview in April, he acknowledged that he would not file a renewal application with the hospital — the decision is not voluntary, he stressed. The hospital forced his hand.
In effect, this would mean that Mount Sinai gets what it wanted: Dr. Karkare will no longer have clinician privileges after June 30. However, if they expected him to go “smoothly into that good night”, they might have underestimated Dr. Karkare’s stomach for stirring up trouble and fighting what he sees as a blatant injustice.
He has filed numerous complaints with state and federal agencies, citing what he considers violations not only of the hospital’s medical staff statutes, but also of CMS’s participation rules and other rules relating to the Joint Commission. He spoke to several journalists. The agencies have taken note of the complaints and are engaging with him. It remains to be seen whether they conclude that Mount Sinai failed to follow the rules.
Mount Sinai South Nassau’s chief of surgery, the hospital’s chief medical officer and its director of orthopedics did not respond to emails for comment. Neither do the leaders of the parent organization – particularly the System Vice President of Medical Affairs Operations and the Vice President of Medical Affairs. After several emails were sent, a Mount Sinai spokeswoman responded saying the health system does not comment on individual personnel or employment matters. These include accreditation decisions which are considered “confidential”. The statement also said:
At Mount Sinai, all accreditation and reaccreditation decisions are made through a comprehensive and objective review process that evaluates a range of factors, including clinical performance, adherence to professional standards, and alignment with institutional policies. These reviews are conducted by medical staff committees and appropriate leadership in accordance with established governance procedures.
This article is based on materials provided by Dr. Karkare.
What the statutes of the medical staff of Mount Sinai South Nassau say
It appears that Mount Sinai South Nassau has adopted new statuses for medical staff in June 2025making certain changes regarding board accreditation that were not in previous versions of the Bylaws.
Section 15.3.2 of Part C, which deals with “Accreditation and Privileges”, states the following:
For each of the specialties and subspecialties in which he or she intends to practice the privileges set forth in the requested delineation of privileges, a physician applicant must be currently board certified or, if not currently board certified, must be currently board eligible and then become board certified within five (5) years after completing formal training in that respective discipline, as defined by the appropriate specialty board of the American Board of Medical Specialties (ABMS), the American Osteopathic Association, the Royal College of Physicians and Surgeons of Canada and the United Kingdom, and the Australian Medical Council; or demonstrate equivalent professional competence deemed acceptable by their department chair, the Joint Credentialing Committee and the Medical Board, and approved by the Board of Trustees. Any physician applicant recruited by a certifying body in another country (other than those listed above) must submit documentation to consider that certification to be substantially equivalent to the requirements of the ABMS.
Dr Done subject to previous statutes approved on June 20, 2023which did not contain this language. Indeed, it appears that board certification was quite flexible.
Board certification or board eligibility, as defined by requirements established by the specialty board in the field of medicine, surgery, and each practitioner’s specialty or subspecialty, will also be considered, unless such consideration is waived by the medical board. Individuals not certified at the time of application to the medical staff should proceed diligently to obtain board certification. These individuals will be expected to serve on their boards the next time those boards are assigned. Failure to obtain board certification in accordance with these guidelines will be considered when the applicant appears for semi-annual renewal.
A Difficult Zoom Call
On July 24, 2025, Dr. Karkare’s clinician privileges expired and expanded board certification requirements came into focus. He provided transcripts and audio recordings of a Zoom call between himself and members of the Southern Nassau Physicians dating back to Nov. 10 of last year, when he was trying to understand why it was proving difficult to get his clinician privileges renewed. During that call, Dr. Rajiv Datta, chairman of the department of surgery at Mount Sinai South Nassau, told him that his Indian certification had become the sticking point.
“I think there is a problem with the qualification,” Dr Datta told Dr Karkare. “Also, Nakul does not accept the Indian National Council as equivalent to the governing boards here. In fact, it is Mount Sinai. I am not talking about South Nassau.”
Dr. Karkare responded that he has fellowships accredited by the ACGME – the Accreditation Council for Graduate Medical Education – to “demonstrate equivalent professional competence,” and Mount Sinai’s bylaws state that “another country’s certifying body is also acceptable, but I must submit documentation for that.”
But another doctor on the call – Dr. Stelios Koutsoumbelis, director of the orthopedic surgery department at Mount Sinai South Nassau – explained that the hospital’s joint accreditation committee could not exceed the foreign board’s qualifications.
“So, if the accreditation committee felt that the qualification was [equivalent]then that would be the end of all that. But they do not consider the qualification to be equivalent. That’s why there is an opportunity for what’s called a board waiver to have an alternative pathway to accreditation,” Dr. Koutsoumbelis explained. “But it’s based on a clinical need at the hospital where there’s like a niche that needs to be filled. A bit like an emergency privilege should be granted. And after review, the committee does not believe that this is necessary. So they are not prepared to grant a waiver to the board of directors.
Since Dr. Karkare had not been active at the hospital recently, there was no way to press his case, Dr. Koutsoumbelis added.
After several back and forths on the question of the new statuses, Dr. Karkare spoke about his past at the hospital.
“And what I mean is, they’ve already accepted the qualifications multiple times at the same hospital,” he said.
Indeed, even before the 2023 renewal letterhe had enjoyed full clinician privileges since he began practicing at the hospital in 2018. Later, after he stopped performing or attending cases, his privileges were renewed. Finally, in December 2025, six months later new medical staff statutes with changes to board certification requirements have been accepted — he received notice indicating that his privileges had been extended until June 30, 2026. According to the statutes, doctors can benefit from privileges in cycles of two or three years. At least for this extension, the hospital seems to have ignored its foreign certification.
The new statutes required documentation demonstrating substantial equivalence if a physician held foreign certification outside of the countries specified in the statutes. Dr. Karkare said he never submitted additional documentation, noting that the hospital and its board, which approved his qualifications in 2018, had already accepted his qualifications before and subsequently renewed them. He said he did not know whether the hospital had revised its U.S. grants and qualifications since the new statutes were adopted.
Dr. Karkare said he consulted a New York lawyer late last year to get a legal opinion on his situation. This lawyer, after agreeing to an interview with this journalist, canceled it.
But another lawyer — though not in New York — said that if the board’s qualifications are the only point of contention, federal law might be on Dr. Karkare’s side.
“I would be surprised if Mount Sinai acts in a way that is not consistent with its requirements under the law or its statutes, but I will say that while the only party in dispute is its board certification, under federal law, under the requirements for participation in Medicare, it is said for the medical staff standard that the governing body must ensure that in no case are staff membership or hospital privileges dependent solely on certification, fellowship or membership in an agency or a specialized company,” said Susan Kratz, attorney at Nilan Johnson. Louis.
The key term is “only”.
Kratz noted:
“So when we look at 15.3.2 [section of Mount Sinai South Nassau’s June 20, 2025 bylaws]this is very specific to certification or membership in a specialized organization or society. Thus, under federal law, a hospital cannot determine the s privileges based solely on certification. So if that’s the only thing driving the dispute and the hospital’s decision that he’s not eligible for reappointment, … I don’t know how they see that as being consistent with federal law.”
On the call with Dr. Karkare in November, Dr. Datta, chair of the department of surgery at Mount Sinai South Nassau, repeated four times that the hospital’s joint accreditation committee did not “accept your qualification” and said nine times that everyone was “stuck” on that.
They told him twice he had the option to resign or appeal, but said there would be consequences.
“We don’t like to be the messengers here either, but … our hands are tied at the system level,” said Dr. Koutsoumbelis, director of orthopedic surgery at Mount Sinai South Nassau. “So you have the right to appeal. If you appeal, you go before the board to discuss it with them or they review your case, et cetera. But if they say no to the appeal, then what happens is… it’s considered a non-renewal of privileges. And a non-renewal is not good because it’s flagged in the database.”
The database Dr Koutsoumbelis is referring to is the National Practitioner Data Bank (NPDB), which is an online database of reports containing information on “medical malpractice payments and certain adverse actions related to health care practitioners, providers, and suppliers,” according to the site. the website. Congress created the database in 1986, and it is intended to be “a workforce tool that prevents practitioners from moving from state to state without disclosure or discovery of prior harmful performance.”
If Dr. Koutsoumbelis’ comment about non-renewal of privileges reported to the NPDB was intended as friendly advice, Dr. Karkare did not take it as such. He interpreted it as a direct threat.
“Applying to the national database is really like a death sentence, meaning every time you apply to another hospital it comes back,” he said in an interview.
But Dr. Koutsoumbelis’ threats/advice seem incorrect.
Kratz, the Minneapolis health care attorney, read aloud on the NPDB website: “Administrative actions that do not involve a professional review action should not be reported to the NPDB. For example: A hospital’s bylaws require physicians to be board certified in their specialty. A physician’s board certification expires and, therefore, the hospital automatically revokes the physician’s clinical privileges through action Administrative Revocation of clinical privileges is not the result of a professional review action and should not be reported to the NPDB.
Lack of activity at Mount Sinai South Nassau
A second call recorded by Dr Karkare took place on January 5 this year.
Before that second call, oddly enough, he received an email from South Nassau telling him that as of Dec. 30, his hospital appointment had been extended from the July 24, 2025, expiration date to June 30 of this year. This was despite being told that Mount Sinai did not accept his qualifications.
Interestingly, with the extension to June 30, Dr Karkare’s medical staff category appears to have been downgraded to ‘associate staff’ with full admitting and dismissal privileges, instead of ‘active staff’.
On the second call, Dr. Datta and Dr. Koutsoumbelis were joined by Dr. Alan Wong, chief medical officer and senior vice president of medical affairs at Mount Sinai South Nassau, and Anne Roberts, vice president of medical affairs operations at Mount Sinai Health System.
Dr. Wong emphasized that the hospital voted in favor of the Mount Sinai regulations and is required to follow them. He also tried to understand who else, besides Dr. Karkare, in his office was seeking a reappointment letter or accreditation for the first time.
“We need to make sure that if you request privileges, that your team, including everyone who is active on the team, has the volume to demonstrate their skills,” Dr. Wong said.
And the reality is that despite his privileges in South Nassau, Dr. Karkare has not been active at the hospital. The last time Dr. Karkare practiced at this location was several years ago – it was actually March 7, 2019. Dr. Wong asked him where he currently practices, and Dr. Karkare told him that he performs elective cases at Lenox Hill Hospital in New York, part of Northwell Health, and St. Catherine of Siena Medical Center on Long Island. His team members practice at Mather Hospital, Southside Hospital (now known as South Shore University Hospital), Peconic Bay Medical Center and St. Catherine, he said.
But he explained that he and his team would like to become active in South Nassau again and that even new team members with U.S. board certification would like to receive privileges in South Nassau.
Nowhere in that January call do they mention that as of December 30, 2025, their membership category is now at the “associate staff” level, which occurs when a physician has not met the eligibility requirements to be a member of the hospital’s “active staff.” One of these requirements is volume of activity – specifically, the physician must “participate in at least twelve (12) hospital visits per year,” according to the statutes. Depending on the statutes, hospital encounters can mean many things, but the term is not exclusive to performing procedures.
On that call, Anne Roberts, vice president of medical affairs operations for the Mount Sinai system, explained that as the parent system’s 2021 bylaws are adopted at various Mount Sinai hospitals, an additional 80 to 85 physicians, like Dr. Karkare, do not meet medical staff membership requirements. As a result, their privileges were not renewed.
She told Dr. Karkare that the system had inadvertently sent her a reappointment request in mid-December, asking her to renew her privileges, and apologized for this, given that her privileges had been extended until June 30.
They decided that all its staff members seeking privileges in South Nassau should update or submit new applications. The call ended with Dr. Wong attempting to lower the temperature through collegiality.
“What I will say is that, on the part of the medical leadership team, we are not here to cause problems for our physician members as well,” he said. “That was never our intention.”
He noted that Dr. Karkare raises questions he does not fully understand, but said he would let “the team of experts evaluate.”
No one on that call asked him to resign.
There are inconsistencies and violations, says Karkare
If we look at Dr. Karkare’s study Mount Sinai reappointment letter dated July 28, 2023 pasted below, some inconsistencies are immediately apparent. It shows the date of the current nomination cycle starting July 27, 2023, and below that, a date range: 04/18/2011 to 07/24/2025.
And then, inexplicably, a line below corresponds to this date: 01/01/2099. Dr. Karkare will have to resort to a divine elixir to live until the end of this century.
But he claims that even the start date is inaccurate: he was not even in New York on April 18, 2011, as the reappointment letter indicates. A CV he provided shows he was doing a one-year trauma fellowship at York Hospital in Pennsylvania between June 2010 and June 2011. And according to Dr. Karkare’s own records, his first day at the hospital was January 30, 2018.
According to the 2023 renewal letter, his privileges expired on July 24, 2025, but it wasn’t until December 30 of last year that he received an extension until June 30. As mentioned above, during the Jan. 5 call, Roberts apologized for receiving the renewal request after the system had already decided to expand its privileges to South Nassau. This renewal request required him to complete it within two weeks. In fact, even after Robert’s apology in January, a second mandate renewal request was sent to him on February 2, again with a two-week deadline to submit it.
This appears to contradict Mount Sinai’s own statutes which state that: Failure, without good cause, to provide all subsequently requested information at least three (3) months prior to the expiration of their current membership and/or clinical privileges, may result in the cessation of processing of the new application and the automatic expiration of their membership and/or clinical privileges at the end of the current appointment/privilege period.
Since June 30, 2026 is the expiration date of his privileges, Dr. Karkare would then have had at least until March 30 to complete his renewal application.
Meanwhile, on the Jan. 5 call with Roberts and others, Dr. Karkare explained that the hospital’s position that its board qualifications are not acceptable appears to be at odds with New York State laws, CMS participation rules, and Joint Commission laws. He also told them that revoking the privileges of 80 to 85 doctors due to the adjustment of Mount Sinai’s medical staff regulations could constitute a violation of the law and offered to help the system correct the problem.
Roberts vehemently disagreed, saying the hospital was not violating any laws, but she clearly criticized Dr. Karkare the wrong way. After the call ended, Dr. Karkare did some basic research to uncover the fact that Roberts was not licensed to practice law in New York. In her mind, she was dispensing legal advice to the Mount Sinai Health System without authorization.
It is unclear whether answering calls to discuss legal or controversial issues regarding accreditation and signing his email as JD and Esq., as Roberts did, violates New York law, as Dr. Karkare claims. But Karkare said he filed a formal complaint with the state in March.
Before doing so, he informed Dr. Koutsoumbelis and others that Roberts does not hold a New York law license. Dr. Koutsoumbelis appeared to acknowledge the error and, on January 15, sent an email to Dr. Karkare that said in part: “I would also like to note that following the recent meeting, Ms. Roberts has recused herself from any further involvement in this matter and that oversight has evolved accordingly.” »
It’s unclear whether Roberts actually recused herself. An email inadvertently sent to Dr. Karkare on February 18 shows that she was copied on an email discussing her case.
Neither Roberts nor Dr. Koutsoumbelis responded to emails seeking comment.
Dr. Karkare added that doctors in Karkare’s office, including those with American certification aine, submitted applications for admission to South Nassau as medical personnel. These requests were never processed.
Her emails complaining about poor renewal criteria used for her renewal application were forwarded to Dr. Brijen Shah, vice president of medical affairs at Mount Sinai Health System, who replied February 2. Dr Shah said the hospital was not violating any law and urged Dr Karkare to finalize his reappointment application within two weeks. This, again, appears to run counter to Mount Sinai South Nassau’s own bylaws, which, as mentioned above, allows physicians a final submission deadline of 3 months before privileges expire, which was June 30 for Dr. Karkare.
In fact, Dr. Karkare was so furious after these calls and emails that he began contacting various state and federal agencies to file formal complaints. There are too many complaints to follow up officially, but he says they are not resolved. Here are two thanks he received from the New York Department of Health and of Joint Commission.
Why did Mount Sinai want to expel Dr. Karkare?
Karkare has not been active at the hospital in terms of surgery in recent years. So from a business perspective, having an NPC (“non-player character” in video game lingo) may not have benefited the hospital. But Kratz, the attorney, said the lack of activity was more than just a business decision.
“Well, it’s actually more of a patient care issue. If you’re not seeing patients in our hospital, we can’t assess whether you can practice at the level of quality that we need to hold our physicians accountable for. So it’s not a business decision, it’s not an economic decision, it’s a quality decision.”
Kratz said inactivity combined with suddenly one’s board qualifications being called into question could be a reason for not wanting to renew one’s clinician privileges. Karkare counters that under Article 17.3.3 of the Bylaws, limited clinical activity is addressed by reducing privileges to match actual activity – not by termination of membership or denial of renewal.
This article also states: Relinquishment of clinical privileges in these circumstances is not considered the result of corrective or disciplinary action and does not require reporting to licensing and regulatory agencies.
However, the minimum of 12 appointments (which are not limited to the sole performance of an act) that a doctor must respect in terms of activity at the hospital according to the statutes was never clearly mentioned to Dr Karkare. Especially during the first call with Dr. Datta and Dr. Koutsoumbelis, while Dr. Karkare’s lack of clinical activity over the past two years was noted, the sticking point appears to be his Indian certification.
However, he has been inactive at the hospital since the end of March 2019 and has obtained renewal of his privileges even in 2023 and before. His activity level has not changed. Nord d identifying its board certification.
Would it have been easier for Mount Sinai to simply reapply at the “associate staff” level and not the “active staff” level, instead of making him believe he had no choice but to resign because he was potentially flagged in the NPDB database? Had they done so, they would have been spared Dr. Karkare’s long, incessant emails alleging a litany of violations and now potential investigations.
Without comment from a Mount Sinai official, it is difficult to guess the motivations.
Unsurprisingly, Dr. Karkare sees darker motivations at play.
“Independent doctors try to negotiate their terms, compete for patients. Employed doctors really have no control, no due process and no recourse. Hospitals make money from employed doctors and downstream revenue from ancillary revenue,” he wrote in an email. “Removing independent doctors and replacing them with employees who are entirely dependent on the institution is not a quality decision. It’s about money and control. The system is built to make fighting back more costly than surrender. The NPDB report is permanent. Hospital due process hearings are a sham. Eighty-five doctors have quietly disappeared since 2021. Most never knew the others existed. The institution counted on this isolation Every doctor who chose to resign knew this – don’t put it off.
In the meantime, he said he continues to perform surgeries at various area hospitals that are not owned by Mount Sinai.
Photo: image generated by ChatGPT
