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goodguyfdny OP t1_j18z0w9 wrote

Delayed Resuscitations 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.

Image Dr. Michelle Romeo, who worked in the emergency room until 2021, recalled a famous actor’s jumping to the front of the line for a CT scan.Credit...Ashley Gilbertson for The New York Times 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.

Image Doctors viewed the ouster of Dr. Kristin Carmody as punishment for her not catering to a V.I.P.Credit...Ashley Gilbertson for The New York Times 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.”

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goodguyfdny OP t1_j18zc0x wrote

‘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.

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Arvas0211 t1_j1bbkvn wrote

Worked for NYU ED in Brooklyn through the pandemic, this is all true. We had a lot less of this shit in Brooklyn but I worked with a lot of these attendings and residents. It's well known those in leadership rule through fear and intimidation and any descent will get you fired. Director of the ED Femia mentioned in the article is disliked and fired multiple attendings who spoke up for their colleagues or in favor of this culture. Good to see something is happening and NYU will get it's reckoning.

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pepperpavlov t1_j1bd2o3 wrote

All of NYU is like this, from the undergraduate school through the hospitals, law school, whatever. Image and riding on the coattails of celebrities is the goal.

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