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.
In September 2021, doctors were alerted that Kenneth G. Langone, whose donations to the university’s hospital system had led it to be renamed in his honor, was en route. The octogenarian had stomach pain, and Room 20 was kept empty for him, medical workers said. Upon his arrival, Mr. Langone was whisked into the room, treated for a bacterial infection and sent home.
The next spring, Senator Chuck Schumer accompanied his wife, who had a fever and was short of breath, to the emergency room. As sicker patients were treated in the hallway, the couple were ushered into Room 20, where they received expedited Covid-19 tests, according to workers who witnessed the scene. The tests came back negative.
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.
On hospital computers, electronic medical charts sometimes specify whether patients have donated to the hospital or how they are connected to executives, according to screenshots taken by frustrated doctors in recent years and shared with The Times.
“Major trustee, please prioritize,” said one from July 2020.
Dozens of doctors said they felt pressure to put V.I.P.s first. Many witnessed such patients jumping ahead of sicker people for CT scans and M.R.I.s. Some said medical specialists, often in short supply, were diverted from other cases to attend to mild complaints from high-priority patients.
Many hospitals offer exclusive concierge services to the rich. But emergency rooms are built around the premise of medical triage: that the sickest patients, regardless of their ability to pay, are treated first. Everyone else has to wait.
At NYU Langone, one of the country’s pre-eminent medical institutions, some doctors said that process had been upended.
“As emergency department doctors, we have two important skills: triage and resuscitation,” said Dr. Kimbia Arno, who worked in the emergency room in 2020 and 2021. “This system is in direct defiance of what we do and what we were trained to do.”
“The stress on providers is harmful,” said Dr. Anand Swaminathan, a physician in the emergency room from 2009 to 2018. “It’s the fact that I am getting multiple calls, from multiple people, asking me to drop everything to treat a V.I.P.”
Eleven doctors told The Times that they had resigned from the emergency department in part because they objected to favoring V.I.P.s.
Some residents — doctors in their first years of practice — complained to the national organization that accredits medical training programs. The frustrations included NYU’s “special treatment” of trustees, donors and their families, according to documents reviewed by The Times. The group’s subsequent investigation confirmed that some doctors “felt pressured to see V.I.P. patients first” and that they “experience a sense of fear and intimidation and retaliation for not expediting V.I.P. patient care.”
The Internal Revenue Service requires nonprofit hospitals like NYU, which avoids $250 million a year in taxes, to benefit their communities. A primary way to meet the requirement is to run an emergency room that is open to everyone.
But at NYU, poor people sometimes struggle to be seen. For example, ambulance workers said nurses in the emergency room routinely discouraged them from dropping off homeless or intoxicated patients. Instead, they were often shuttled to nearby Bellevue, a strained public hospital that primarily treats the poor.
A Times series this year has found that many nonprofit hospitals have strayed from their charitable roots to maximize profits. 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. Others cut staff to dangerously low levels.
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.”
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.”
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.”
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.”
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.
Dr. François acknowledged that NYU’s electronic medical records sometimes included notations describing patients as “friends and family.” But he said these labels were available for all hospital employees — even the cousins of security guards and housekeepers — and enabled employees to pay courtesy visits to such patients.
“Our friends and family do not receive different or better medical care,” Dr. François wrote. He added, “Our friends and family don’t skip the triage process, don’t jump any lines, don’t get placed in any special rooms or floors and don’t get fed any differently.”
Dozens of doctors and other emergency room staff said that, when it came to many V.I.P.s, that was simply not true.
An E.R.’s Transformation
In 2007, the New York University Medical Center was in grave financial trouble.
Were it not for royalties from an arthritis drug developed by one of its researchers, the hospital would have lost $150 million that year. The patent’s expiration was looming.
A lifeline came from Mr. Langone, the founder of Home Depot and chairman of the hospital’s board of trustees. He and his wife donated $100 million in 2008, matching a contribution they had made eight years earlier. The medical center was renamed NYU Langone.
Mr. Langone became known not just for his own philanthropy — he donated another $100 million in 2019 — but also his ability to persuade other wealthy New Yorkers to donate. Over the ensuing years, he helped the hospital raise $3 billion.
In 2012, the run-down emergency room, on the East River in Midtown Manhattan, was destroyed by Hurricane Sandy. It reopened two years later with more space and a new name, the Ronald O. Perelman Center for Emergency Services, named for the billionaire who financed its construction.
The emergency department’s longtime chair, an outspoken champion of serving the needy, stepped down in 2015. Around then, several doctors said, they began receiving requests from administrators to give priority to V.I.P.s.
“Suddenly, we started getting these phone calls that X person is coming in, they are X relation to board member, and we were given the strong sense that you had to push them to the front of the line,” said Dr. Swaminathan, who worked in the emergency room at the time.
NYU was not the only prestigious nonprofit hospital system finding ways to cater to donors and other wealthy patients.
In San Francisco, the UCSF Medical Center rewarded donors with faster access to top cardiologists. Stanford Medical Center gave wealthy patients red blankets to distinguish them from everyone else. (Spokeswomen for those medical centers said they no longer provided such perks.)
Today, top New York hospitals like Mount Sinai and NewYork-Presbyterian/Weill Cornell offer luxury accommodations and personal concierge services to patients who can afford them.
And emergency room workers at several elite academic medical centers said in interviews that, as at NYU, administrators sometimes requested expedited treatment for well-connected patients.
“The hospitals are acting as businesses,” said Dr. Renee Hsia, a professor at the University of California, San Francisco, who researches emergency room care. “They can often garner much more revenue from these patients that are huge donors.”
The V.I.P. experience in NYU’s Manhattan emergency room starts before the patient arrives.
Trustees can use a dedicated phone number — the Trustee Access Line — to alert the hospital they are coming. Administrators then call, text and send messages notifying doctors that a high-priority patient is en route, according to 30 doctors. Doctors said that even when those messages did not explicitly seek priority treatment, that was how they were interpreted.
“Just a heads up that a VIP/trustee is coming to the ED per notification from the Dean’s office and to keep an eye out for her,” one doctor wrote in an electronic chat in August 2021, referring to the emergency department. The Times reviewed a screenshot of the exchange.
Ms. Greiner, the NYU spokeswoman, said the trustee line “does not entitle any member to better or prioritized care.” She said that the V.I.P. reference in the 2021 message was “colloquial and does not correspond with any special protocol at our hospital,” and that the sender did not “ask for or expect special care, line cutting or anything of the sort.”
Doctors said they were sometimes required to carry a hospital-issued iPhone that, among other things, was logged into an email chain that alerted them to incoming V.I.P.s.
“It didn’t matter how busy it was,” said Dr. Uché Blackstock, who worked in the emergency room from 2010 to 2019. “A V.I.P. was coming, and we had to drop everything.” She left NYU partly because of frustration with the preferential treatment, she said.
Ms. Greiner said that Dr. Blackstock had never complained to the hospital about improper prioritization of patients and that Dr. Blackstock had herself alerted colleagues on a few occasions when her family or friends were in the emergency room. In response, Dr. Blackstock said there was a distinction between what she had done and what she and others perceived as institutional pressure to swiftly treat V.I.P.s.
Some patients’ electronic medical charts included reminders about their V.I.P. status, according to screenshots captured by emergency room doctors and shared with The Times.
“NYUMC BOARD OF TRUSTEE AND IMMEDIATE FAMILY,” read one note.
Another: “She is a donor and a prospect for a planned gift.”
A third: “Escort Needed” and “Daughter of Trustee.” (Some V.I.P.s were assigned employees to stand by to transport them around the hospital, according to 13 medical workers. Ms. Greiner denied that.)
Two members of NYU Langone’s board of trustees said in interviews that they had received swift, excellent care at the emergency room. They believed everyone got such treatment.
“I didn’t have to wait around for long hours for someone to come talk to me as happens in other emergency rooms,” said Bernard Schwartz, who said he had donated more than $30 million to NYU Langone. “I think that’s for all patients.”
Mr. Schwartz said he did not think his medical record identified him as a trustee. But he presumed that doctors knew who he was.
“I would be upset if that were not true,” he said.
NYU’s emergency room often has more than 100 patients at once but only 40 curtained beds, leaving many patients to be treated in the hallways.
None of the doctors The Times interviewed had ever seen that happen with a V.I.P.
One Thursday night in April 2018, workers in the emergency room got an alert that Mr. Langone would be arriving in about 20 minutes. They had to figure out where to put other patients to ensure that he could have a private room, according to two medical workers with direct knowledge of what happened. When he arrived with a two-centimeter cut on his thumb, doctors quickly stitched him up.
Ms. Greiner said no other patients were awaiting care during Mr. Langone’s visit. The two workers told The Times that the emergency room had been as busy as usual.
Emergency room workers said these arrangements for V.I.P.s sometimes delayed critical care for sicker patients.
In late 2019, doctors were racing to rescue a patient in cardiac arrest. One pushed the gurney toward one of the private rooms meant for life-or-death emergencies. Another sat atop the unconscious patient, performing chest compressions. When they arrived at the room, they could not enter — a V.I.P. occupied it. The patient survived, but two workers who witnessed the episode said the delay could have been deadly.
Ms. Greiner said, “Without the patient’s information, we cannot investigate this claim other than to say that at NYU Langone, there is one standard of care for all patients.”
The Times identified many similar examples.
For example, a relative of someone on the hospital’s leadership team went into the emergency room with chest pain and was promptly taken to a private room, even as a man experiencing a life-threatening emergency — a blockage of blood to one of his limbs — was put in the hallway, according to the accreditation group’s investigation.
Another time, at the instruction of a hospital administrator, a V.I.P. patient with asymptomatic Covid was seen by pulmonology and infectious-disease specialists who had to be pulled away from sicker patients, according to two medical workers with direct knowledge of the case.
Ms. Greiner said that The Times had not provided enough information for her to be able to respond definitively, but that the asymptomatic patient might have had an underlying illness.
Dr. Michelle Romeo, who was a resident in the emergency room from 2017 until 2021, recalled when a famous actor with a headache and low-grade fever jumped to the front of the line for a CT scan, cutting off a nursing home resident who had possible sepsis and had been waiting for three hours.
The actor requested a spinal tap, which Dr. Romeo believed was unnecessary. A supervisor instructed her to do it anyway, she said.
Both tests showed nothing wrong with the patient.
Mr. Phillips, the lawyer for NYU, said Dr. Romeo had an incentive to criticize the hospital because she had not been offered a full-time position after her residency. Dr. Romeo said she believed she had not been offered the job because she had been outspoken about issues including the treatment of V.I.P.s.
A Public Shaming
Over the years, doctors in NYU’s emergency room came to believe there could be career-threatening consequences if well-connected patients were dissatisfied with their treatment.
In October 2019, Dr. Joe Bennett was at the end of what’s known as a shift-change huddle, updating his colleagues on the patients he was handing off, when a frustrated V.I.P. approached him. The V.I.P. demanded that a family member immediately receive a CT scan, according to a doctor who witnessed the encounter and two others who were briefed on the matter.
Dr. Bennett explained that a sicker patient was the priority but that the family member would come next.
Soon after, Dr. Bennett was put on probation for what NYU said was a lack of professionalism, according to the three doctors. For months, the hospital required him to attend weekly meetings and write essays reflecting on how to provide professional treatment.
About a year later, in December 2020, Dr. Kristin Carmody, who oversaw the education of medical residents in the emergency department, was forced to resign after a patient complained about having not received the level of attention or treatment that she expected. Dr. Carmody later said in a wrongful-termination lawsuit that the patient had been designated as a V.I.P.
Ms. Greiner said that the patient’s medical record had not included a friends-and-family label and that Dr. Carmody had been pushed out because she falsely noted on a medical record that she had personally examined the patient. (Dr. Carmody denies that.)
But inside the emergency department, her ouster was widely regarded as punishment for not sufficiently catering to a V.I.P. patient.
At a heated staff meeting that month, a senior doctor said Dr. Carmody’s forced departure appeared to be the result of a complaint from “a V.I.P. person that was connected to higher-ups,” according to a recording of the meeting. The doctor added, “The clear message is anybody can be taken down.”
Around that time, top NYU officials commissioned an internal review of the culture of the emergency department, whose employees were burned out from the pandemic and unhappy with their pay.
The investigation documented concerns with V.I.P. care, according to a presentation that Dr. Robert Femia, the chairman of the emergency department, delivered to doctors.
Many doctors and nurses “dislike the current ‘V.I.P.’ process because they perceive it as disrupting ordinary work flows” in which staff triage patients based on their medical needs, one slide said. “They do not recognize that the true issue is that every patient is a ‘V.I.P.’ patient.”
‘An NYU Dump’
In the summer of 2021, a few months after Dr. Femia’s presentation, an ambulance dropped off a disheveled homeless patient at NYU’s emergency room. He had pain in both legs and was having trouble walking.
A worker checked the man’s vital signs. He was offered Tylenol and discharged, according to an email that a senior nurse later sent to more than 200 colleagues detailing what had happened.
About an hour later, the man was back. This time, he was seen in the waiting room by a social worker, who noted that it was hard for the man to lift his legs from his wheelchair. No one undressed the patient to examine his legs. He was discharged again.
It was not until later that day that the hospital admitted him. The man was diagnosed with acute kidney failure and rhabdomyolysis, a potentially fatal muscular condition.
Ms. Greiner said the case had been handled appropriately. But medical staff noted that NYU included it in an internal review process in which doctors try to learn from mistakes.
Doctors and nurses described a pattern in which homeless patients — surefire money losers for hospitals — sometimes received cursory care, even as privately insured patients with similar symptoms were admitted for urgent treatment.
For poor or homeless patients, “there is pressure to see them in the hallway or in the waiting room,” said Dr. Jeremy Branzetti, who ran NYU’s emergency-medicine residency program until last year. “I have never seen a V.I.P. patient in the hallway.” Mr. Phillips, the lawyer for NYU, said Dr. Branzetti had received a poor performance review and his contract was not renewed.
Some homeless people struggle to get into NYU’s emergency room in the first place.
Anthony Almojera, the vice president of a union that represents emergency services officers, said nurses at NYU reprimanded ambulance crews when they tried to drop off patients who appeared homeless or intoxicated.
“I had instances where the nurse’s first question wasn’t ‘What is wrong with the patient?’ but ‘How come this patient is being brought here?’” Mr. Almojera said.
Another ambulance worker, who requested anonymity because he still works with NYU, said that when he tried to drop off a drunk patient in October, a nurse demanded to know his badge number.
The pressure from nurses works: Paramedics who work on public ambulances said that instead of taking drunk or homeless patients to NYU, they routinely dropped them off at Bellevue, which is staffed in part by NYU residents.
NYU’s own fleet of ambulances, which handle some 911 calls, also take their unwanted patients to Bellevue, according to four nurses there.
“There isn’t a day that goes by that we don’t get an NYU dump,” said Kim Behrens, who has spent more than a decade as a nurse at Bellevue.
“We treat undomiciled persons every day and give every effort to do so with dignity, respect and compassion,” Ms. Greiner said. She also pointed to data showing that NYU treats thousands of Medicaid-eligible patients.
Accreditation in Jeopardy
By 2021, doctors had lost patience with the administration’s elevation of V.I.P.s, which they saw as unethical and dangerous to other patients. Some quit. Others complained to hospital administrators.
Then the Accreditation Council for Graduate Medical Education, which oversees medical training programs nationwide, received an anonymous complaint. One of the four allegations was that the V.I.P. system “teaches residents patient bias,” according to a letter the council sent to NYU in November 2021.
The accreditation council interviewed more than 50 doctors, who confirmed that V.I.P.s were regularly given priority. Citing Dr. Carmody’s ouster, they described being afraid of professional consequences if they did not give preferential treatment to well-connected patients.
The council said that climate of fear violated the group’s educational standards for medical residents. And the organization said it was unclear if NYU had taken steps to ensure that the V.I.P. process would not harm patients.
In August, the council put NYU’s emergency department on probation, jeopardizing the accreditation of its residency program. It was a rare move: Last year, of 12,740 residency programs, just 25 were placed on probation.
NYU has two years to address the council’s concerns. Losing the accreditation could cost the hospital millions of dollars a year in federal funds and doom the residency program, which the hospital relies on to keep its emergency room running.
Ms. Greiner accused the accreditation council of recycling “false” allegations about V.I.P. patients getting special treatment. The council said it stood by its findings.
Susan C. Beachy and Kitty Bennett contributed research.