How NYU’s Emergency Room Favors the Rich
nytimes.com
nytimes.com
Which is better for the individual people who might (and I stress "might," since the hospital denies it) have to wait slightly longer on a day he needs care? To wait slightly longer there, or to wait slightly longer because they had to route to a different hospital that's struggling to deal with the demand?
If you remove Langone from the situation, you're not simply left with "everybody gets seen one person sooner." That's a small-picture view. You're left with "many of these people just can't be seen here at all."
I'm not saying people have to like the rich. I'm just saying if I'm next in line after him at NYU Langone hospital, I'm glad I have that hospital to go to, even if that bumps me to 2nd priority in the room.
As to the hospital, “The octogenarian had stomach pain, and Room 20 was kept empty for him, medical workers said.” “One doctor was surprised to find an orthopedic specialist in the room awaiting a senior hospital executive’s mother with hip pain.” This is a larger disruption than just the time he was physically being treated so presumably it’s more than just a one person delay.
Sure one possibility is they have more space than workforce so keeping the room empty has minimal downsides, but maintaining a separate space for VIP’s requires more overhead than an empty room. Essentially you need to decide if anyone showing up is a VIP and that slows everything down even when there aren’t VIPs. “Major trustee, please prioritize” is vastly more disruptive than just putting someone ahead of a line.
“It’s the fact that I am getting multiple calls, from multiple people, asking me to drop everything to treat a V.I.P.” If nothing else if the hospital wants to start “acting as businesses“ for VIPs then it should be giving up it’s non profit status and thus the tax deductions for the donors.
Further, I can’t imagine that the premise of this prioritization did not come up in discussions with the development staff as they were finalizing the details of a 10-figure donation. In that regard, this policy probably did influence his past actions as well.
Just because something is called a donation doesn’t mean it qualifies as one.
Pulling numbers out of a hat, 200k/year * 5 people * 25 years is 25 million. Though the IRS could easily define the fair market value as whatever the minimum donation to receive this level of service.
Sure running the phone number isn’t currently that expensive, but fair market value of this service is limited by their ability to provide it. They would essentially need to auction off a fixed number of slots per year and in NYC that those slots wouldn’t run cheap. Alternatively, they would need a lot of full time specialists who mostly waited around for VIP’s.
Why do we need billions in donations on top of that? Where is all the money going? Let’s ask NYU Langone executives that.
Another example is a sitting senator, who has been the target of threats in the past - probably shouldn’t be sitting out in the waiting area.
Much more concerning to me are the reports in the back half of the article where they shuffled off poor patients to Bellevue, which is already stretched thin and ends up taking the brunt of homeless and indigent ER admissions.
Every doctor and nurse is seriously educated on this.
The financial issue is more debatable, but as the article notes, there's already preference given to friends and family of doctors and nurses - so if they're "seriously educated", it doesn't seem to have stuck.
I'm not sure whether I'm more troubled by an informal policy of helping big donors the same way friends and family are or a formal policy that allows people to pay an annual fee for preferential treatment at the ER (which many hospitals have).
I agree, but the key word in my comment is "should" as in that is ethics taught in medicine school.
It seems you and others think I meant abused people don't get protection at all, it's my fault for communicating wrong. Of course they get protection once they speak up, but as far as I am aware they still have to sit in a queue like everyone else before a nurse sees them and they have a chance to speak, the senator is skipping line here. If it truly is a question of danger there are more formal and proper ways of doing it, not "hey, a senator, he'll go first".
Despite your snarky confidence at the end of that comment, this is incredibly untrue.
>Every doctor and nurse is seriously educated on this.
Yes, every doctor and nurse is seriously educated to protect abused spouses and people whose safety is at risk.
So Joe Biden shot in the arm comes after homeless guy shot in the head.
A nurse told us privately that we’re first on the list for a room as my wife was most in need of care; there was one becoming available in an hour or two. However, the other couple started complaining and calling family members. They were ushered off to a different waiting room. We waited 15 hours for a bed, and in the meantime heard someone give birth in the hallway.
A few days later we bumped into the same couple on the way out of the hospital. They’d been given a bed 12 hours before we eventually got one despite being there voluntarily.
This is the key to understanding this incident. A voluntary c-section is scheduled surgery. There is already an operating room reserved for it and staff. As with other scheduled surgeries, the patients and their families often have a pre-op waiting area where they wait for the surgery, so that there can be minimal delay getting them back to the operating room when it is ready for them.
My guess is that the determining factor in their shorter waiting was not their wealth, but rather the fact that their surgery was scheduled.
Source: Am a medical doctor trained in surgery.
Now I have been involved during medical school with a lot of them. Every one of them I saw, it was a very miserable experience for the woman. Basically, the body is not ready for birth, but you give various drugs to force the body to give birth.
These inductions are done when there is some risk to either the mother or baby. A big cause for an early induction is pre-eclampsia which can be a life threatening condition and is treated with early induction.
For inductions you have to have careful monitoring of the baby and mother because you may need to convert to an emergency c-section.
Because of all this, it is not unreasonable for the scheduled induction to be taken first.
It’s tricky to relay over a short internet comment the full experience and context - for example, hearing the phone calls the couple made to family/hospital, the full conversation the nurse had with us about priority, or the missing detail that my wife had pre-eclampsia. I guess we don’t know with 100% certainty, but having been in the situation, I’d say there is a 98+% chance that the status/wealth of the couple directly influenced how soon they were given a bed.
(Sorry to add facts after the original comment; I wanted to avoid writing something too lengthy but I can see how these details may have been necessary).
While their tax status is non profit, de facto they are profit maximizing partnerships with the profits distributed as excess comp to their executive-partner-owners.
"Giant hospital systems illegally sent exorbitant bills to Medicaid patients. They used hospitals in poor neighborhoods to qualify for steep drug discounts, funneling the proceeds into wealthier neighborhoods. "
Mortality for some conditions is higher on VIP floors because nursing is geared towards hospitality over clinical specialization/acting without deference to patient convenience.
VIPs often want to access new/off-label treatments, which can go quite poorly. VIP get all sorts of inadvisable care (“the best”; “access to experimental treatments”).
I’ve always thought about quality of care as an upside down U shaped curve: if you’re poor it’s bad, but if you’re a VIP it can also be bad. To be clear, the U isn’t symmetric, but weird things happen at the high end.
The ideal state is building a human bond with your caregiver, and in general, it will be returned with appropriate attentiveness. This is just harder when you’re poor or have complex stressors, but it also seems hard for many VIPs.
At this hospital the room was mostly used by members of the royal families of Middle Eastern countries. They like to have their children born in the US so they have US citizenship. Makes it easier to flee on short notice if needed.