“People who are big donors often have a sort of golden pass."
On December 3, 2015, the Massachusetts Department of Public Health sent a complaint to one of the best hospitals on the planet, Brigham and Women's in Boston. Based on a records review and twenty-five interviews, the health department concluded the hospital violated its very own policies in order to give a VIP special treatment. In doing so, they sometimes put other patients at risk for downright bizarre reasons, according to documents obtained by The Boston Globe, who determined the patient to have "ties to Middle Eastern royalty."
During his six-month hospitalization, the VIP received meds from "personal staff" while hospital staff went along with the patient's request to ignore basic infection control practices, such as gowns and gloves, because he said they made him "feel dirty"—an exception that "placed other patients at risk."
What happened at the Brigham, however, should surprise zero people; it is how medicine for the wealthy is often practiced across the country. VIP patients, defined primarily as bank accounts with sick humans attached, call the shots, cutting the line for earlier appointments and receiving unnecessary treatments, even in the emergency room, all to fulfill that most noble calling of medicine: developing a "revenue stream."
Of course, some patients, such as celebrities or politicians, may require special treatment in order to protect their privacy, not only from fellow patients and tipped-off paparazzi but also curious or bored staff; in 2007, 27 hospital workers were suspended for looking through George Clooney's medical records after a motorcycle accident. More commonly, though, VIPs are simply people in a position to donate to the hospital.
"People who are big donors absolutely often have a sort of golden pass," says Arthur Caplan, head of the division of bioethics at New York University's Langone Medical Center. "There's a powerful American belief that money gets you more services. While healthcare likes to say that everybody is treated the same, it is manifestly false."
Though many hospitals openly pride themselves on luxe VIP floors and some are known to keep lists of donors, should ever they become "guests," there is little empirically known about how this system actually affects patient care.
In an article last month in Journal of Hospital Medicine, researchers published the first study of VIP services in an inpatient hospital setting, a survey of hospital medicine physicians. Nearly one in five believe that patient safety is worse for VIPs and about a third felt pressured to order unnecessary tests and treatments. The study's conclusion turns on its head the assumption that VIP services are better services: "Provision of unnecessary care can increase the risk of patient harm," the authors wrote.
"Among VIPs, the quality of their care may be worse, if staff are deviating from accepted standard practices," says David Alfandre, a general internist at the NYU School of Medicine who has written on the ethics of VIP care. VIPs may insist on seeing the division chief, for example, who spends most of the day in budget meetings and not doing procedures. Doctors, in turn, may skip subjecting VIPs to embarrassing or painful exams. In 1962, Eleanor Roosevelt died from miliary tuberculosis acutissima, but it may be more accurate to say she died from VIP syndrome: She had been misdiagnosed with aplastic anemia, which some speculate was because her doctors wanted to "spare this VIP patient the discomfort of a bone marrow biopsy."
What makes VIP care morally unacceptable, according to one group of ethicists, is whether "it results in worse care for other patients." But that has not been studied. The absence of data may hardly be accident: Why would a hospital want to open the door to such scrutiny?
After all, the counter-argument about VIP care goes something like: If hospitals provide better care for VIPs, then they will donate more, and ultimately that means hospitals can provide better care for more ordinary people. One paper about the University of Pennsylvania Health System's amenities unit, written by the people who developed it, reports that "philanthropy cultivated through one or more admissions is tracked over time" and philanthropic dollars help "develop services throughout the hospital that are not reimbursable or otherwise supported."
"There is truth in the idea that big donors build and add onto facilities," Caplan says. "We have a healthcare system that is underfunded and screwy. Relying on wealthy folks to charitably expand hospital facilities is probably not the best way to fund things, but it's the way things have been done for a long time."
But if doctors preferentially treat patients because they see dollar signs, what does that mean for the poor? "The public is right to be concerned about VIP patients being seen before others simply based on their social status," Alfandre says. "That would undermine the public's trust in medicine and the profession's commitment to provide a social service that is available to everyone equally."
Of course, it is a myth that medicine is available to everyone equally. It's as American as the saying that some companies are too big to fail: Some patients are too poor to treat.
According to the 2015 National Healthcare Quality and Disparities Reports, people in poor households have less access to healthcare and worse healthcare when they get it. And while Obamacare has sought to expand coverage to the lowest-income Americans, one in five still went without medical care in 2015 because they didn't have health insurance, according to Kaiser.
"VIPs obviously undermine the mythology that we have a one-class healthcare system, which is utter nonsense," Caplan says. "Look around an emergency room, if you go in there sometime, and count number of millionaires sitting there with you. Is it fair? No. Is it acceptable? Apparently."