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How NYU’s Emergency Room Favors the Rich

nytimes.com

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Re: How NYU’s Emergency Room Favors the Rich

#31

Post by _8j50 »

mattzito wrote: post #12
_8j50 wrote: post #9

Earlier quoted context omitted.

If it was in a non-medical setting I would agree but in medicine a patient's financial contribution or political status should not be a factor of consideration. even if they have been threatened they can hire protection after all and the government can add extra protection as needed. All patients should be safe and secure equally, women who are threatened by an abusive spouse or people injured/targeted by gang shooti…

People whose safety has been threatened or been injured by a spouse and are at risk absolutely will be placed in a room with security, what are you talking about? The financial issue is more debatable, but as the article notes, there's already preference given to friends and family of doctors and nurses - so if they're "seriously educated", it doesn't seem to have stuck. I'm not sure whether I'm more troubled by an i…

> ... it doesn't seem to have stuck.

I agree, but the key word in my comment is "should" as in that is ethics taught in medicine school.

It seems you and others think I meant abused people don't get protection at all, it's my fault for communicating wrong. Of course they get protection once they speak up, but as far as I am aware they still have to sit in a queue like everyone else before a nurse sees them and they have a chance to speak, the senator is skipping line here. If it truly is a question of danger there are more formal and proper ways of doing it, not "hey, a senator, he'll go first".

Re: How NYU’s Emergency Room Favors the Rich

#32

Post by Retric »

sokoloff wrote: post #29
Retric wrote: post #28

Earlier quoted context omitted.

Detailed arrangements would likely be tax fraud on a tax deductible donation, so I doubt they made such things explicit. Just because something is called a donation doesn’t mean it qualifies as one.

The amount which is tax-deductible is the amount donated, minus the fair market value of any goods and services and received. If Foo donates $3B for a non-profit hospital in exchange for a promise to slightly bump the priority and treatment Foo and Foo's family, I'd estimate that at least $2.999B of that was tax-deductible. (Is the promise of better treatment worth more than $1M of NPV? I don't think so.)

He donated 200M, the fair market value of priority treatment at a hospital for himself and family via a special phone number for decades could represent a significant fraction of that 200 Million.

Pulling numbers out of a hat, 200k/year * 5 people * 25 years is 25 million. Though the IRS could easily define the fair market value as whatever the minimum donation to receive this level of service.

Sure running the phone number isn’t currently that expensive, but fair market value of this service is limited by their ability to provide it. They would essentially need to auction off a fixed number of slots per year and in NYC that those slots wouldn’t run cheap. Alternatively, they would need a lot of full time specialists who mostly waited around for VIP’s.

Re: How NYU’s Emergency Room Favors the Rich

#33

Post by jbandela1 »

jordansmithnz wrote: post #21
jbandela1 wrote: post #19

Earlier quoted context omitted.

> they were there for a voluntary c-section. This is the key to understanding this incident. A voluntary c-section is scheduled surgery. There is already an operating room reserved for it and staff. As with other scheduled surgeries, the patients and their families often have a pre-op waiting area where they wait for the surgery, so that there can be minimal delay getting them back to the operating room when it is re…

Now that I recall more clearly, I got this part wrong… they had requested an early induction (not a scheduled c-section). Unsure if that changes things, but they weren’t going straight to an operating room.

This sounds like a scheduled induction.

Now I have been involved during medical school with a lot of them. Every one of them I saw, it was a very miserable experience for the woman. Basically, the body is not ready for birth, but you give various drugs to force the body to give birth.

These inductions are done when there is some risk to either the mother or baby. A big cause for an early induction is pre-eclampsia which can be a life threatening condition and is treated with early induction.

For inductions you have to have careful monitoring of the baby and mother because you may need to convert to an emergency c-section.

Because of all this, it is not unreasonable for the scheduled induction to be taken first.

Re: How NYU’s Emergency Room Favors the Rich

#34

Post by jordansmithnz »

jbandela1 wrote: post #33
jordansmithnz wrote: post #21

Earlier quoted context omitted.

Now that I recall more clearly, I got this part wrong… they had requested an early induction (not a scheduled c-section). Unsure if that changes things, but they weren’t going straight to an operating room.

This sounds like a scheduled induction. Now I have been involved during medical school with a lot of them. Every one of them I saw, it was a very miserable experience for the woman. Basically, the body is not ready for birth, but you give various drugs to force the body to give birth. These inductions are done when there is some risk to either the mother or baby. A big cause for an early induction is pre-eclampsia wh…

I don’t want to discount your experience here, but it seems unlikely to me that what happened followed ordinary medical prioritization.

It’s tricky to relay over a short internet comment the full experience and context - for example, hearing the phone calls the couple made to family/hospital, the full conversation the nurse had with us about priority, or the missing detail that my wife had pre-eclampsia. I guess we don’t know with 100% certainty, but having been in the situation, I’d say there is a 98+% chance that the status/wealth of the couple directly influenced how soon they were given a bed.

(Sorry to add facts after the original comment; I wanted to avoid writing something too lengthy but I can see how these details may have been necessary).

Re: How NYU’s Emergency Room Favors the Rich

#35

Post by _8j50 »

sokoloff wrote: post #16
_8j50 wrote: post #9

Earlier quoted context omitted.

If it was in a non-medical setting I would agree but in medicine a patient's financial contribution or political status should not be a factor of consideration. even if they have been threatened they can hire protection after all and the government can add extra protection as needed. All patients should be safe and secure equally, women who are threatened by an abusive spouse or people injured/targeted by gang shooti…

If a person P has enabled the hospital to exist at all, it seems somewhat reasonable to serve them ahead of some set of people who would otherwise be served first (in the absence of P’s presence) but not served at all (in the absence of P’s existence/fund-raising).

Except when that is unethical. Service in this case is relief of pain and saving a life, so the only thing the code of ethics in medicine allows to be a factor in that decision is who needs treatment most urgently.

So Joe Biden shot in the arm comes after homeless guy shot in the head.

Re: How NYU’s Emergency Room Favors the Rich

#36

Post by kcplate »

thatfrenchguy wrote: post #20
jordansmithnz wrote: post #15

I’ve seen a similar thing happen at another well known NY hospital. My wife was waiting to give birth with all beds taken up. A couple walks in, very unhappy that there is a wait, and we exchanged some conversation with them. It was quite apparent they were from wealthy families. She had requested to be induced, after being a couple of days past her due date (extremely normal for a first pregnancy). A nurse told us p…

Someone needs to make a name and shame website for this frankly.

Ahh yes, because bullying people on the internet is such a positive thing for society—-especially when done solely based on rumor, assumption, and when there is an incomplete understanding of all the facts of the situation.

Re: How NYU’s Emergency Room Favors the Rich

#37

Post by tssva »

After my daughter was born her mother and her were put in a labor and delivery VIP room which was also an infectious disease room. I didn't know using infectious disease rooms as VIP rooms was an industry standard practice until reading this.

At this hospital the room was mostly used by members of the royal families of Middle Eastern countries. They like to have their children born in the US so they have US citizenship. Makes it easier to flee on short notice if needed.

Re: How NYU’s Emergency Room Favors the Rich

#38

Post by Incipient »

Don't get me wrong corrupting the key tenant of triage isn't good, but I feel like this article really glosses over the below. Blimey you lot need to fix your healthcare system. It's busted.

"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. "

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