Preferential Treatment in the ER?

Today’s New York Times has a well-written, informative, and potentially explosive article, “How NYU’s Emergency Room Favors the Rich.” Here’s a summary, but read the whole thing for the full scoop:

In New York University’s busy Manhattan emergency department, Room 20 is special.

Steps away from the hospital’s ambulance bay, the room is outfitted with equipment to perform critical procedures or isolate those with highly infectious diseases.

Doctors say Room 20 is usually reserved for two types of patients: Those whose lives are on the line. And those who are V.I.P.s.

NYU Langone denies putting V.I.P.s first, but 33 medical workers told The New York Times that they had seen such patients receive preferential treatment in Room 20, one of the largest private spaces in the department. One doctor was surprised to find an orthopedic specialist in the room awaiting a senior hospital executive’s mother with hip pain. Another described an older hospital trustee who was taken to Room 20 when he was short of breath after exercising.

The privileged treatment is part of a broader pattern, a Times investigation found. For years, NYU’s emergency room in Manhattan has secretly given priority to donors, trustees, politicians, celebrities, and their friends and family, according to 45 medical workers, internal hospital records and other confidential documents reviewed by The Times.

The article is probably difficult for outsiders to American healthcare to adjudicate. On the one hand, it quotes physicians who insist that NYU Langone has a list of VIPs who get preferential treatment in the hospital’s ER. On the other hand, it quotes hospital spokespersons who appear, at least at first glance, to be flatly denying that. Whom to believe?

Accusations of the kind that the doctors are making here are by definition extremely difficult to prove. An ER physician doesn’t have the luxury of documenting hospital demands to give preferential treatment to VIPs, and can be fired for speaking up about it. Meanwhile, hospitals have a strong incentive to cover up and lie about anything that whistleblowers might say. And it’s not as though the VIPs themselves are going to confess to getting preferential treatment. Coming the other way around, of course, it’s easier to make an accusation than defend against one. And it’s easier to exaggerate an accusation that contains a grain of truth than to content oneself with an undramatic assertion involving a grain-sized accusation. This, I suspect, is why such stories go in and out of readers’ minds. As outsiders to the scene, they have no way of judging the credibility of any of the parties to the dispute.

Absolute certainty is going to be hard to get, but I’ll put the point this way. I grew up in a medical family and have known dozens of physicians for decades. I’ve worked in health care myself. And I happen personally to know Anand Swaminathan, one of the physicians quoted in the story. The accusations of favoritism made in this article cohere with everything I’ve ever heard from physicians, over decades, about how American hospitals work. They cohere with everything I’ve personally seen of how they work. And I’d be willing to testify directly to Anand Swaminathan’s credibility as a source. If I had to choose between him and NYU’s official spokespersons, I would, hands down, choose him.

Beyond this, I’ve had my share of experiences with official spokespersons denying whistleblower-type accusations. I myself was pushed out of my job at Felician University when I uncovered malfeasance there by an adjunct who was a major donor to the university. The university wanted the scandal covered up; I didn’t. When I pushed them on their dubious claims and practices, the university’s official spokespersons employed exactly the same tactics as NYU’s: respond to substantive accusations by offering pro forma denials involving legalistic re-definitions of key terms; then change the subject. Read carefully, NYU’s spokespersons spend more time on circumlocutions and rhetorical pyrotechnics than on the substance of the accusations at hand. Indeed, read carefully, they don’t ever deny that preferential treatment takes place in their ER.

Example 1:

NYU’s chief of hospital operations, Dr. Fritz François, denied that the hospital favored donors, trustees and other prominent patients. He said that patients received treatment based on how sick they were, regardless of their wealth or status, and that the emergency room treated many low-income and homeless patients.

“We do not have a V.I.P. program,” Dr. François wrote in a letter to The Times. “We do not have V.I.P. patients. We do not have V.I.P. floors. We do not have V.I.P. rooms. We do not have V.I.P. clinical teams. We do not offer V.I.P. care.”

Don’t look at the paraphrase; look at the direct quote. It doesn’t deny that VIPs get favored treatment. It denies that there is an official “VIP program,” with “VIP patients,” “VIP rooms,” “VIP clinical teams,” and “VIP care.” Of course there isn’t. The crux of the physicians’ accusation is not that there is an official “VIP program,” but that there is a discreet practice of preferential treatment of VIPs that takes place under cover of plausible deniability. Denying that a “program” exists under the explicit description of a “VIP program involving VIP patients and VIP floors and VIP rooms” is beside the point. So whatever game he’s playing in his own mind, François has not in fact responded to the accusations the physicians are making about Room 20 in the ER.

Example 2:

Lisa Greiner, a spokeswoman for NYU Langone, confirmed that Mr. Langone had been treated in Room 20, which she said was “absolutely appropriate” based on his symptoms. She said the room served a variety of purposes, including privacy. She said no patient, including Mr. Langone, “has ever been treated in an isolated room at the expense of any other patient’s care.”

The first sentence of the quoted passage doesn’t deny that Langone got preferential treatment. It says that the treatment he got was clinically appropriate. But that claim has no logical bearing on whether or not he got preferential treatment. He could have gotten treatment that was both clinically appropriate and preferential. The last sentence says that no one has been treated in an isolated room at the expense of any other patient’s care. I’m not sure that I believe that, but even if it’s true, its truth is perfectly compatible with the possibility that the hospital put the onus on physicians to give preferential treatment while maintaining high standards of care for others. Unfortunately for Greiner’s PR gambit, giving preferential treatment while maintaining high standards of care is still a case of giving preferential treatment. Sorry to get all logical here, but (A & B) entails A.

Example 3:

Mr. Langone said, “As a matter of personal integrity I have never asked for any special treatment at the hospital, and they have never offered.”

He may not have asked, and they may not have offered. Yet he might still have gotten it. Funny how that works when you’re a VIP.

Example 4:

Angelo Roefaro, a spokesman for Mr. Schumer, said the protocol for the senator’s security detail was “to have the senator stay, whenever possible, in a secure location.”

Right. But if Room 20 was more secure than the rest of the ER, then Schumer got preferential treatment. And Roefaro is saying, precisely, that it was more secure. So this is less a denial of the accusation than a confirmation of its truth. That in turn raises a question I’d love to ask Roefaro: why would any one room in a hospital’s Emergency Department be more secure than any other? Aren’t they all secure?

Example 5:

Andrew C. Phillips, a lawyer for NYU, said some of the doctors who had spoken to The Times were motivated to disparage the hospital. Dr. Arno, for example, had been in a fellowship program and was passed over for a permanent job, he said. Mr. Phillips also said Dr. Swaminathan had never voiced concerns to hospital leaders about V.I.P.s.

Well, anyone can speculate out loud about malicious motives. I could, for instance, speculate that Andrew C. Phillips is a high-priced whore who’ll say anything if you put the right amount of money in his garter.  But that doesn’t address the substance of the issue involved. Outsiders may not be able to assess the substance of Arno’s or Swaminathan’s accusations against NYU, but for just that reason, they can’t assess the substance of Phillips’s well-poisoning accusations against them, either. The relevant point, however, is that the motivations that Phillips cites here are perfectly compatible with a motivation to disparage NYU because it deserved disparagement. A person can have mixed motives for telling the truth, but still be telling the truth. If only they taught such truisms in law school alongside all the sophisms they manage to inculcate.

As for why Dr Swaminathan never voiced concerns to hospital leaders, first of all, we don’t know that that’s true, and second, the most obvious explanation for its being true is the justified fear of being fired for voicing them, something that happens everywhere, everyday. Maybe he didn’t feel like becoming the Edward Snowden of metro-area health care?

I’ll let interested readers work their way through the rest of the article, and assess NYU’s responses accordingly. Personally, NYU’s claims strike me as a tedious series of deceptions and diversions, but every reader has a mind of his or her own, and is invited to use it. I should add that I do think that the truth is likely to be more complicated than the Times suggests–meaning that there are more dimensions involved than the ones discussed in the article–but that said, I’m still inclined to think that the article is essentially right as far as it goes. I’m going to try to tap some physicians, including Dr. Swaminathan, to sound off about the article in Policy of Truth, assuming they can afford the luxury of publicly-expressed candor (which I mostly doubt).

At the end of the day, that is one meta-issue that needs more discussion than it’s gotten. There’s a great deal of talk nowadays about how the Left has chilled free discourse in academia, and how terrible that is. I’m a little skeptical of this narrative, but accept it for the sake of argument. If left-wing wokeness is a threat to free and open discourse, so too is the amoral and apolitical power of HR in a company town like NYU Langone. Corporations nowadays want to “brand” themselves. Given this, every employee is co-opted into the “branding” process, which is to say that every employee is thought of by HR as an instrument of PR. Say something off-brand, and soon enough, you’re out of a job. Not exactly a recipe for a truth-tracking dialogue about the workplace.

Beyond the unquestionably important issue of favoritism in the ER, there’s the larger question of how best to expose malfeasance in the workplace. Having worked in academia and health care, I can assure readers that there are far more scandals taking place in both of these institutions than ever meets the light of day. Whatever the glories of academia and health care in the abstract, the sad fact is that real-life universities and hospitals are often sewers of vanity, opportunism, and corruption. I wish there was a better way of making that fact known than a series of he said/she said accusations that drives a lot of readers to mere skepticism. But I doubt there is.

Barring the health care equivalent of the Pentagon Papers or Wikileaks, we just have to do the best we can: weigh the credibility of the testimony we hear in light of what seems most plausible about the world we know, and make the appropriate inferences. In this case, my verdict is clear enough: the doctors are credible; the hospital is not. The question then becomes, not whether preferential treatment takes place, but whether it can be justified, and if not, what’s to be done about it. All of that, alas, is a long way off. But I’m grateful to the Times for having begun a long-deferred conversation on the topic.

Worth consulting: Dr. Swaminathan’s Twitter feed, and comment on NYU’s response to his claims.

NYU’s standard tactic in recent years is to intimidate into silence It’s no wonder that few, if any, challenged the VIP system while they were employed there; retribution was a guarantee

The views I express in this post and in the comments below are strictly my own, and do not represent the views of my employers, CorroHealth, or any other entity or organization.

7 thoughts on “Preferential Treatment in the ER?

  1. I have been treated in a NY hospital, I live in So. Florida and I am just a working guy, trying
    to find a cure for what I was told was a life treating issue. The behavior toward medical professionals during Doctor appointments, testing, and treatments was hard to watch at times. patient coming in and being upset that a “now” emergency, was in covenant. I was there two different times and believed that the patients were the ones causing the protocol to be interrupted. I did see and spoke to who I believe to be VIP’s, and they also waited. Most were nice and understanding as well.
    As a former Law enforcement Deputy, we would bring inmates and VIP’s with medicinal issues
    to the local hospital and would be brought to the same rooms, when available. Now that you mentioned it, and I think back it was a “safer space” out of the way, but still in the ER. I would say that was a good idea. ER’s have enough going on to give anyone person, care over another. My wife is an RN, and admits that people in the medicinal care field try to take care of others in the medicinal group,, when they can but never over someone in need.
    I think that every person wants to do the right thing in treating people right. Room 20 sounds like a “get them out of the way room”, and that perk is made on a case by case, needs of the staff, not the patient

    Liked by 1 person

    • I don’t disagree with any of what you’re saying. It’s part of the complexity I mentioned that the article doesn’t address. Patient behavior (or misbehavior) is a serious problem in hospitals, as you say, and there does need to be a “safe space” in the ER for problem patients, criminals, or psychiatric cases. When I worked in the OR, every now and then we’d get prisoners from nearby prisons coming in for surgical procedures, and they definitely got a form of “special treatment.” They had two armed guards from the Sheriff’s Office assigned to them–and watching over us! Usually, you’re not allowed to carry weapons into an OR, but they did. I have no problem with any of that.

      But what the Langone physicians are objecting to is line-jumping through VIP status. When you come into an ER, one of two principles is supposed to apply to you: either triage (medical necessity) or first-come, first-served (order) And medical necessity trumps order. VIP status should play no role there whatseover.

      If Lt Kevin Bolling comes into the ER with a fractured arm, and Senator Schumer comes in an hour after him with the same kind of fracture, Kevin Bolling gets treated first. You absolutely cannot call the doctors off of Bolling’s case to treat Schumer simply because he’s a Senator, and Bolling is a mere lieutenant. It doesn’t matter if you change the example so that Bolling’s direct boss comes into the ER. Bolling’s boss has the right to boss Bolling around within a law enforcement setting, but he has no special rights in an ER. Nobody does. If the boss comes in an hour after Bolling, and they have the same kind of injury, Bolling goes first, the boss goes second.

      I think it’s clear that NYU Langone is both violating this principle, and trying to deceive the public about doing it. Meanwhile, they’re trying their best to take a crap on the reputations of the people calling them out. I find it incredible that they can’t even admit that they’ve given Senator Schumer special security arrangements when he comes into the hospital. Maybe a US Senator really ought to get special security arrangements when he visits the hospital. Ordinary prisoners do. But an honest hospital would just come out and say that. It tells you something that NYU Langone can’t even be honest about something that simple.

      This is a pattern that both you and I have seen before. I saw it when I lost my job at Felician University. Scot Peterson saw it when Scott Israel turned on him and threw him under the bus after the Parkland shooting. The people running my university couldn’t admit that they had hired a major donor to teach a class when the guy was running a fraudulent grading scheme instead. The people running the Broward County Sheriff’s Office couldn’t admit that there was no way for Scot Peterson to know where the gunman was on a campus as large as Marjorie Stoneman Douglas HS, and in a situation that fast-moving and confused. Kids died, and they wanted an easy scapegoat. So what did they do? They served up lying bullshit about Scot, doubled down on it, and ruined his life. Even if Scot wins his legal cases, he’s wasted years trying to defend himself, and his reputation will be hard to restore.

      My view is, people who lie need to be called out, whether they run hospitals, universities, or Sheriff’s Offices. There’s too much bullshit in this country, and it needs to stop.

      Like

        • I’m a very blessed man, I ended a 35yr career with cancer in 2015. with a 2 to 5-year prognosis. About 9 mths ago, both Sloan Kettering NY and the UM Cancer Center gave me the green clean light. My 2 to 5-year prognoses have been cleared, I’m in year 7 and have a clean bill of health. I enjoy your writing and can get back to fighting for people who are being, abused by public servants who do not deserve to be paid with tax dollars.
          i know your life was tossed around, how are you?

          Like

          • Happy New Year. That’s an amazing story. I’m glad to hear you’ve gotten the green light. Whatever else may be wrong with our health care system, it’s my understanding that the US and Finland have the best cancer care in the world. I’ve written about my friend Carol, who survived 22 years after getting a diagnosis of a brain tumor malignant by location. Without treatment, she would have died in the year 2000. I don’t know if this link will come through (it’s from Facebook), but the son of a former student of mine had a rare form of cancer but has now gotten a clean bill of health:

            https://fb.watch/hNoxpUXu9m/

            He’s now living the life of a normal kid. So medical miracles happen, care of the people who make them. A friend of mine, William Dale, is a mover and shaker in the field.

            https://twitter.com/WilliamDale_MD?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor

            As for me, I’m both a very lucky and somewhat unlucky guy. I lost a lot in the last couple of years. Losing my wife changed me. But the truth is, I can’t really complain. I have a place to live and food to eat, I have my health, I have a job, and I have friends who are there for me. It hasn’t been easy starting from scratch in a new career, but I learn something new everyday, and I try to keep one hand in my old field. Time will tell.

            I’m still waiting to hear back from Scot’s lawyers about whether it’s OK to post the expert witness testimony on my blog. The minute I get a green light from them, it’s going up.

            Like

      • I could not agree with you more. My public servant thinking is to get the job done, tell the truth, and move on. You nailed what the Broward Sheriff’s Office did to a 32-year veteran. That said, many politicians including then Governor Scott now (senator), currently appointed sheriff tony/toney, the MSD Commission, Florida Department of Law Enforcement, Florida Ethics Commission, the Broward State Attorney, and even the Honorable Judge on the Peterson case all admit that the charges will be dropped because they don’t apply, but NO ONE will stand up and admit the Retired Deputy Scot Peterson and no LEO on the scene ever knew where the shitbag was. 911 calls went to Coral Springs and BSO/ Broward County communication issues were scheduled to be upgraded in 2006/2007, but the Parkland Mayor and City Commissioners voted not to spend the money.
        On 2-14-2018, all of the communications failures came to a head, great kids and BCSB employees 17 KILLED and 17 were INJURED. While a fix was known and the event could have been prevented, an honorable decorated public servant did the best he could with real-time intel, without the information from anyone on or off the scene.
        Shame on all parties that allow this to happen.
        Mark Eiglarsh Peterson’s attorney has an open-door policy to anyone who wants the facts he will share them. But the Victim’s families and the public attacked the Public Defenders Office because the shitbag got life instead of the death penalty. The biggest bad guy is Mikee Satz the BSA that filed charges against Peterson and LOST the death penalty case because of his over-prosecution of the case. The jury will have nightmares for years to overcome
        the pictures and crime scene visit. The world was pissed off, state the facts and move on, the defense just showed how broken the juvenile system is. He was a shitbag. How someone gets there is not the problem in this case, but not fixing it is. Thank you for your observations, god bless you have been and still are in my prayers.

        Liked by 1 person

        • Well, as you know, I’m 100% with you on what happened to Scot. I was not aware that the criminal charges against him were being dropped. I hope that’s true. It’s been awhile since I’ve had a conversation with Scot, so I’m not up to date. I think it’s bad enough that criminal charges were brought against him in the first place. The real story here is the prosecutorial misconduct involved in filing such charges. They’re too ridiculous to be worth debating.

          For the benefit of readers who may not know the background:

          If I can ever manage to resolve my own personal problems, and get my head up above water financially, I’d like to write a comprehensive vindication of Scot, not so much legally as morally. I’ll leave the legalities to lawyers, but as for the moral accusations made against him–“coward,” “child abuser,” etc.–I regard them as a historic injustice. When they write this incident up in textbooks of history and criminal justice, I’d like to believe that the truth will finally come out, and Scot will be described as the scapegoat for a lot of malicious and incompetent people.

          But I’d also like to think that once the truth comes out, people will finally ask themselves some hard questions about what they expect from law enforcement. How much risk are cops required to impose on themselves in the line of duty? We don’t expect soldiers, paramedics, fire fighters, or physicians to perform suicide missions. Is suicide what we expect of law enforcement? That’s what it sometimes sounds like to me. But that’s not a reasonable expectation.

          Even if Scot had known that Cruz was in that building, he faced a gigantic tactical disadvantage to Cruz. Cruz had the advantage of knowledge, had heavier weaponry, and had the high ground. It is very likely that any single officer who entered the building with Cruz’s knowing that he was entering would have been taken out before he got very far. That’s not a mission you can expect someone to just jump straight into. Going in as a team is one thing, but going in alone would have been madness.

          That’s a separate debate from what happened, but it’s a debate worth having at some point. I haven’t directly been shot at, but I’ve been in situations where live rounds were being fired, and the wrong move would have gotten my ass shot off. It’s easier to shoot one’s mouth off than deal with actual bullets. That’s a huge problem with the current state of debate.

          Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s