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Caring for government dignitaries: Report from an ED physician
Some rules broken, but never at the expense of other patients
As former chief of emergency medicine for the largest hospital and medical treatment facility operated by the U.S. military South Korea, Sean O'Mara, MD, JD, treated many senior level government officials and dignitaries.
"It was generally recognized within our military leadership that a bad medical outcome in one of these individuals would be critically important to avoid," he says. "We usually went out of the way to provide very good care for these people who had quite an influential position over our government hospital."
As the senior emergency physician, O'Mara typically would care for VIP patients. "While we purported to provide high quality care for everyone, I think it would be safe to say that VIPs were probably given greater scrutiny than the typical person," says O'Mara. "It would also be safe to say that no one else's care was compromised for the sake of a VIP, which would understandably also potentially be quite problematic for our hospital command." O'Mara currently practices emergency medicine on a full-time basis in Winchester, VA and works as a consultant in legal medicine and homeland security.
VIPs on an individual basis
During medical examinations and histories, O'Mara says that questions or interventions were never intentionally omitted. "Instead, I would opt to simply operate under a heightened level of sensitivity over how they might perceive certain questions or exams," he says. "I have had to perform rectal exams and other challenging exams on extremely important people and believe I have done so in a very sensitive and dignified manner."
In addition, VIPs were generally given expedited care to accommodate their unusual time requirements. However, this was done by adding additional resources to avoid delaying care for the patients already waiting in the ED.
"We would simply bring in an extra doctor and nurse to care for the VIP, so the on-duty physicians and nurses would not be directed from caring for other patients," says O'Mara.
On one occasion, O'Mara got a call from an official asking him to care for a "government representative" having chest pain. "I was informed that they were important, but not adequately informed of their exact seniority," he says. "When the patient arrived, I was astounded to find that they were in just about the highest level of government service one could aspire to and few ever achieve."
The patient clinically required admission to the hospital, but needed to have their medical workup and care completed earlier than the ED could with its existing resources. The patient needed to be discharged from the hospital to meet with the President and the Secretary of Defense within hours.
This would require an employee to be brought in two hours earlier. Following policy, O'Mara consulted with a senior physician about the special accommodation. "This physician directed me to not do anything special for this person, and instead offer them to stay within our schedule or simply leave," says O'Mara.
For the first time in his military career, O'Mara knowingly violated a directive from a senior officer in his chain of command. "I simply was unable to get beyond what would have been the loss to our country, had this person been allowed to leave prematurely and consequently experienced a bad medical outcome from a lack of proper treatment," he says.
This interesting case makes the point that every VIP treated in the ED must be considered on an individual basis, so long as special accommodations do not adversely impact other patients, says O'Mara.
"Ultimately as medical professionals, we need to be able to sort through the added layers of complexity which oftentimes accompanies VIPs seeking medical care," says O'Mara.
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