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.