Paul Beaty  /  AP
Ordinary patients in a busy hospital emergency room may wait for hours, but VIPs such as corporate donors, hospital administrators or a board member's brother-in-law will likely be bumped to the front of the line, doctors say.
Image: JoNel Aleccia
By JoNel Aleccia Health writer
msnbc.com
updated 9/30/2011 8:06:48 AM ET 2011-09-30T12:06:48

In a country where the average emergency room wait now tops four hours, it’s a rare American patient who doesn’t wonder whether a hefty hospital donation or a family connection may be the secret to getting speedier care.

Now, it turns out, the answer appears to be yes, at least according to a pair of small but telling surveys that conclude that being a VIP in the ER does come with certain perks.

In a letter published in this week’s Annals of Emergency Medicine, Dr. A.J. Smally of Hartford Hospital and the University of Connecticut reports that more than half of the 33 emergency department medical directors in his state said they routinely provide so-called “expedited” care to influential people.

He's not talking about celebrities, politicians or the occasional superstar basketball player. When they show up, it can shut down an entire ER.

Instead, it's locally important people in a position to help a particular medical center who get a little extra attention: corporate donors, hospital administrators, or, say, the brother-in-law of the president of the board of directors.

Such big-wigs are typically allowed to jump to the front of the ER line, or to be put in a private room for a consultation instead of standing in a hospital hallway.

Extra attention to a VIP? You bet
The practice isn’t limited to Connecticut. A survey of 100 emergency department doctors nationwide conducted by Truth on Call for msnbc.com found that 84 of them had given or would give extra attention to an influential patient, such as a famous person or hospital donor.

To be clear, the medical care itself is not in question."That is absolutely not the issue here," Smally said.

Emergency triage protocols mandate treating the sickest patients first, no matter their social status, explained Smally, who is a professor and chief of the Division of Emergency Medicine. .

But when it comes to making high-ranking patients more comfortable, more quickly, the fix is in.

“Somebody calls and says so-and-so is coming in, can you make sure they get good care,” Smally said. “We bump them up a notch. If everyone is waiting four hours, they might just wait one hour.”

Hospital officials say the practice, which can occur from once a month to two or three times a week, is a way of thanking community leaders and making sure their influence  — and donations — continue to help keep emergency rooms open.

But ethicists and patient advocates worry that improved access for VIPs undermines the public mission of community emergency rooms and raises sharp questions about health care equality.

“It’s not fair at the micro-level and I’m not sure it’s fair at the macro-level,” noted Laura Weil, former director of the Health Advocacy Program at Sarah Lawrence College in Bronxville, N.Y.

“You can be in pain, or just feeling horrible, and see person after person be treated ahead of you.”

But to the head of the Association for Healthcare Philanthropy, a 5,000-memeber organization dedicated to boosting donations, tending to contributors when they’re sick or injured is just part of doing business.

“It is true, we pay attention to our donors,” said Bill McGinly, president and CEO of AHP, who says most development departments are alerted when VIPs enter their hospitals. “They’ve gone above and beyond. We recognize that their contributions can make a difference to the community.”

In some cases, that care can border on coddling. At Norwalk Hospital in Norwalk, Conn., donors who contribute $100,000 or more are known as “Navigators” who receive not only a place at the front of the line, but top-tier attention as well.

“We help the family in any which way that we can,” said Carol Brennan-Smith, communications manager for the Norwalk Hospital Foundation. “If their cell phone has no juice or they need a battery charger. It can be ‘I want lemonade, I want a Ben and Jerry’s Cherry Garcia ice cream.’ If we can do it, we will.”

Not all front-line staffers endorse such treatment. Smally’s survey and research letter was, in part, a response to an attending doctor who objected to providing expedited care to a visiting VIP.

“He was a very righteous doc in the ED who thinks we should do the right thing at all times in our lives,” said Smally.

Such grumbling is common, but to Smally and other ED docs, there’s little moral dilemma. Dr. Michael Carius, chair of the emergency department at Norwalk Hospital, home of the “Navigators,” said he’s confident that no one is harmed by the practice — and that it actually may wind up doing greater good.

“This is a way of building good will so that when there is a need the hospital has, there’s this favor bank,” he said. “It’s a way of paying it forward.”

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