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How NYU’s Emergency Room Favors the Rich

42 points by LastNevadan 4y ago

hoppyhoppy2 4y ago
Paywall-free "Gift Article" link: https://www.nytimes.com/2022/12/22/health/nyu-langone-emergency-room-vip.html?unlocked_article_code=fK24_LlA-Xm54qQLgZNtUSpNGfGXZyIwh20tnLJU9jYwCjchUJgbPlJYcXsE1fFZNu-OfLUW3Erle07jc8gIlak8DQKEiceYttyAykdOwzsllrYMf7tq9xoD0za8zuL-lZvjleZIdn8jn6hi3hPmL2sTmAdHtpZAS6Yv4NqLhIXXzNGY2CVhdy8VU9ZzJ6kpCE_ZGM5m33neSIpNFLjFthIDgBi9wLnVxDk_ZLta2dsIjY-QD3AYitm4GRr3Pm9hqB18nYB741qOX4P_mLLL_spfg0G10U2PFZcSHQ8a8K1T_gJuKFhl5Dua_fUHe3oqvTLA1Ab3sSHJFGsjc86yOcx_-wkRRrc&smid=share-url https://www.nytimes.com/2022/12/22/health/nyu-langone-emerge...
jensgk 4y ago
If that is how it is, then be public about it. Don't pretend to treat everyone equally. Pretending otherwise is the most despicable issue regarding this.
bradleyjg 4y ago
These hospital systems aren’t even just hospitals anymore. They are gobbling up medical practices at a high rate. 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.
supriyo-biswas 4y ago
https://archive.ph/dqdhL https://archive.ph/dqdhL
mattzito 4y ago
I used to live down the block from this hospital and used it frequently, and I feel like the article has it backwards. In one of the examples they cite, the person given favorable treatment raised $3 billion for the hospital - that does not seem unreasonable, to show a little gratitude to not just a major benefactor, but the person whose name is on the literal hospital. 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.
- _8j50 4y ago
  If it was in a non-medical setting I would agree but in medicine a patient's financial contribution or political status should not be a factor of consideration. even if they have been threatened they can hire protection after all and the government can add extra protection as needed. All patients should be safe and secure equally, women who are threatened by an abusive spouse or people injured/targeted by gang shootings don't get that treatment now do they? Even the hospital owner should be treated with the same ethical and procedural considerations. Every doctor and nurse is seriously educated on this.
  - mattzito 4y ago
    People whose safety has been threatened or been injured by a spouse and are at risk absolutely will be placed in a room with security, what are you talking about? 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).
    - _8j50 4y ago
      > ... it doesn't seem to have stuck. 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".
  - jjulius 4y ago
    >... women who are threatened by an abusive spouse or people injured/targeted by gang shootings don't get that treatment now do they? 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.
smeej 4y ago
How many people do you think the hospital can treat with the $3 billion (yes, with a B) that Langone helped raise? Or even just the $200M he personally donated? 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.
- Retric 4y ago
  If you took longer to treat him after he raised that money, he can’t then go back in time and stop himself from raising that money. Presumably the argument should be around his future actions not his past ones. 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.
  - sokoloff 4y ago
    It doesn’t just influence his future actions, but rather the future actions of all possible large 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.
danielfoster 4y ago
It shouldn’t be a surprise that a hospital would seek to help its donors, but the fact it was put on probation by an accreditor of residencies speaks for itself. NYU seems to have directly interfered with doctors’ professional independence to prioritize non-urgent donor care.
SnowHill9902 4y ago
NYT became a shitty opinion outlet with just a good name.
- deleted 4y ago
  [deleted]
jordansmithnz 4y ago
I’ve seen a similar thing happen at another well known NY hospital. My wife was waiting to give birth with all beds taken up. A couple walks in, very unhappy that there is a wait, and we exchanged some conversation with them. It was quite apparent they were from wealthy families. She had requested to be induced, after being a couple of days past her due date (extremely normal for a first pregnancy). 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.
- jbandela1 4y ago
  > they were there for a voluntary c-section. 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.
  - jordansmithnz 4y ago
    Now that I recall more clearly, I got this part wrong… they had requested an early induction (not a scheduled c-section). Unsure if that changes things, but they weren’t going straight to an operating room.
    - vrc 4y ago
      Usually inductions are scheduled too. At least in my family’s case it was.
brady8 4y ago
Interesting to see Dr. Anand Swaminathan quoted - he is a prominent, highly regarded figure in CME/CPD (ongoing education) for ER docs nationally and internationally, with a large Twitter following.
docdocgoose 4y ago
Receiving VIP care sounds like an unalloyed good, but it’s more complicated. 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.
tssva 4y ago
After my daughter was born her mother and her were put in a labor and delivery VIP room which was also an infectious disease room. I didn't know using infectious disease rooms as VIP rooms was an industry standard practice until reading this. 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.
Incipient 4y ago
Don't get me wrong corrupting the key tenant of triage isn't good, but I feel like this article really glosses over the below. Blimey you lot need to fix your healthcare system. It's busted. "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. "

42 points by LastNevadan 4y ago

Paywall-free "Gift Article" link: https://www.nytimes.com/2022/12/22/health/nyu-langone-emergency-room-vip.html?unlocked_article_code=fK24_LlA-Xm54qQLgZNtUSpNGfGXZyIwh20tnLJU9jYwCjchUJgbPlJYcXsE1fFZNu-OfLUW3Erle07jc8gIlak8DQKEiceYttyAykdOwzsllrYMf7tq9xoD0za8zuL-lZvjleZIdn8jn6hi3hPmL2sTmAdHtpZAS6Yv4NqLhIXXzNGY2CVhdy8VU9ZzJ6kpCE_ZGM5m33neSIpNFLjFthIDgBi9wLnVxDk_ZLta2dsIjY-QD3AYitm4GRr3Pm9hqB18nYB741qOX4P_mLLL_spfg0G10U2PFZcSHQ8a8K1T_gJuKFhl5Dua_fUHe3oqvTLA1Ab3sSHJFGsjc86yOcx_-wkRRrc&smid=share-url https://www.nytimes.com/2022/12/22/health/nyu-langone-emerge...

jensgk 4y ago

If that is how it is, then be public about it. Don't pretend to treat everyone equally. Pretending otherwise is the most despicable issue regarding this.

bradleyjg 4y ago

These hospital systems aren’t even just hospitals anymore. They are gobbling up medical practices at a high rate. 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.

supriyo-biswas 4y ago

https://archive.ph/dqdhL https://archive.ph/dqdhL

mattzito 4y ago

I used to live down the block from this hospital and used it frequently, and I feel like the article has it backwards. In one of the examples they cite, the person given favorable treatment raised $3 billion for the hospital - that does not seem unreasonable, to show a little gratitude to not just a major benefactor, but the person whose name is on the literal hospital. 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.

_8j50 4y ago
If it was in a non-medical setting I would agree but in medicine a patient's financial contribution or political status should not be a factor of consideration. even if they have been threatened they can hire protection after all and the government can add extra protection as needed. All patients should be safe and secure equally, women who are threatened by an abusive spouse or people injured/targeted by gang shootings don't get that treatment now do they? Even the hospital owner should be treated with the same ethical and procedural considerations. Every doctor and nurse is seriously educated on this.
- mattzito 4y ago
  People whose safety has been threatened or been injured by a spouse and are at risk absolutely will be placed in a room with security, what are you talking about? 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).
  - _8j50 4y ago
    > ... it doesn't seem to have stuck. 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".
- jjulius 4y ago
  >... women who are threatened by an abusive spouse or people injured/targeted by gang shootings don't get that treatment now do they? 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.

smeej 4y ago

How many people do you think the hospital can treat with the $3 billion (yes, with a B) that Langone helped raise? Or even just the $200M he personally donated? 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.

Retric 4y ago
If you took longer to treat him after he raised that money, he can’t then go back in time and stop himself from raising that money. Presumably the argument should be around his future actions not his past ones. 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.
- sokoloff 4y ago
  It doesn’t just influence his future actions, but rather the future actions of all possible large 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.

danielfoster 4y ago

It shouldn’t be a surprise that a hospital would seek to help its donors, but the fact it was put on probation by an accreditor of residencies speaks for itself. NYU seems to have directly interfered with doctors’ professional independence to prioritize non-urgent donor care.

SnowHill9902 4y ago

NYT became a shitty opinion outlet with just a good name.

deleted 4y ago
[deleted]

jordansmithnz 4y ago

I’ve seen a similar thing happen at another well known NY hospital. My wife was waiting to give birth with all beds taken up. A couple walks in, very unhappy that there is a wait, and we exchanged some conversation with them. It was quite apparent they were from wealthy families. She had requested to be induced, after being a couple of days past her due date (extremely normal for a first pregnancy). 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.

jbandela1 4y ago
> they were there for a voluntary c-section. 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.
- jordansmithnz 4y ago
  Now that I recall more clearly, I got this part wrong… they had requested an early induction (not a scheduled c-section). Unsure if that changes things, but they weren’t going straight to an operating room.
  - vrc 4y ago
    Usually inductions are scheduled too. At least in my family’s case it was.

brady8 4y ago

Interesting to see Dr. Anand Swaminathan quoted - he is a prominent, highly regarded figure in CME/CPD (ongoing education) for ER docs nationally and internationally, with a large Twitter following.

docdocgoose 4y ago

Receiving VIP care sounds like an unalloyed good, but it’s more complicated. 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.

tssva 4y ago

After my daughter was born her mother and her were put in a labor and delivery VIP room which was also an infectious disease room. I didn't know using infectious disease rooms as VIP rooms was an industry standard practice until reading this. 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.

Incipient 4y ago

Don't get me wrong corrupting the key tenant of triage isn't good, but I feel like this article really glosses over the below. Blimey you lot need to fix your healthcare system. It's busted. "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. "