By Sarah Kliff and Jessica Silver-Greenberg

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.”