Celebrities in the ED: Managers often face both ethical and operational challenges

Famous don't deserve better care, but adjustments may be necessary

Despite their efforts to maintain a perfect image in the press, celebrities have many of the same experiences as your everyday patients. They get sick and injured, and they go to the hospital. Often, that involves a trip to the ED. On Sept. 16, for example, movie star Lindsay Lohan was taken to the ED at St. Vincent's Hospital in New York City after she broke her wrist. On Sept. 27, Dallas Cowboys football star Terrell Owens was taken to the ED at Baylor University Medical Center in Dallas after an adverse reaction to prescription meds.

Incidents like these, of course, can happen anywhere, and one day a celebrity might present in your ED. What would you do if Lindsay Lohan suddenly was your patient? Should she be required to wait the same amount of time as a "normal" patient if the injury was not life-threatening? How would you handle the press?

Do board members, donors deserve VIP care?

ED managers with extensive experience note that such situations raise delicate ethical issues. In fact, they add, other types of VIPs such as hospital board members or large donor celebrities might be treated differently than Lohan or Owens. Celebrities might be treated differently, for example, not because they are "special," but because they have the same right to privacy as any patient. On the other hand, a large donor might be hard to ignore if "special" treatment could mean millions of dollars to your facility.

"When you're talking about a VIP or a high-profile patient, you start to tread on treacherous ethical grounds," says Joel Geiderman, MD, chair of the Department of Emergency Medicine at Cedars-Sinai Medical Center in Los Angeles. "Nobody deserves more or better or faster care." But while ethically you cannot do that, he continues, "you can give different care under an ethical framework if it's in the best interests of the patient and doesn't harm another patient."

There are definitely differences between celebrities and VIPs, adds David Goldwag, DO, FACEP, the medical director of the ED at Westchester Medical Center in Valhalla, NY. "With a large donor, that's part of deal," he says. "They do get special treatment."

If a VIP has a good interaction with your ED, he continues, that can mean millions of dollars in donations that will help you take care of many other people. "They might not wait 12 hours, and I don't think anyone is really happy with that," Goldwag notes. "I'd rather not pander to people with millions of dollars, but if they bring more money to my department, those are the decisions we make."

Celebrities, on the other hand, are a random event, he says. "It depends on how sick they are, how much of an entourage they have, and so forth," Goldwag says.

If they are not very sick, Goldwag continues, "the idea is to get them through quickly — not because they deserve it, but to limit the disruption and to preserve the environment of your department." (For more details on patient encounters involving celebrities, see the story.)

Treating the famous

As an ED manager, you sometimes will receive advance warning that a celebrity is on the way to your facility, says Geiderman. "Sometimes their 'machine' — the people around them — will notify the hospital in advance, but sometimes they just show up unannounced," he says.

"When they just come in as a normal patient and you recognize them, that's the easiest," says Goldwag. "They act like a normal patient, you treat them like a normal patient, and it can be a very nice interaction." The most difficult cases, he says, are the celebrities with an entourage.

What do you do in a case like that? Let's assume you receive notification that a well-known personality is coming or is in your waiting room, says Geiderman. "My feeling is they should be separated from the main waiting room — not because they should be seen sooner, but because they have a right to privacy and confidentiality," he says.

The Cedars-Sinai ED has some secluded areas — such as their bereavement area, or the room used by police to write up reports — that can be used in these situations, says Geiderman. "Separate care may not be better care," he insists. "That is not the goal; nobody should ever jump line in terms of someone needing to be seen sooner." In other words, if their condition allows, the celebrity can continue to wait in the secluded area.

You also should seek to maintain confidentiality when it comes to registration, Geiderman continues. "Try to register those people by initials," he advises. "If they are 'big' enough, you may want to ask if they have an alias they commonly use, or if they want one." Another alternative, he suggests, is simply to register them as John or Jane Doe.

Depending on the identity of the celebrity or the VIP, security also can be an important concern, says Goldwag. "My whole career as a director I've been in departments that are prime locations for high-level government officials," he says. "A lot of security and extra precautions must be in place should they need to come."

Depending of the size and magnitude of the celebrity, you may need to notify security, adds Geiderman. This becomes a particularly significant issue when the paparazzi show up, he says.

"There are informants — particularly in L.A. — who get paid off to tell paparazzi when celebrities are going to the hospital," he shares. "You may need extra security and in some cases you may need to have your perimeter secured. These people can be aggressive."

To keep communications secure, Geiderman continues, notify your PR department before they start getting phone calls. "Any calls that come to you should be referred to PR," he says.

Create a formal policy?

While Geiderman and Goldwag have had extensive experience dealing with celebrities and other VIPs, neither has a formal policy in place for their EDs. It's not, they say, because it doesn't make sense.

"I don't know that I've ever seen one," says Goldwag. "It's something that might be hard to police."

Nevertheless, he emphasizes, "everyone has to understand the reason for having a VIP plan, and everyone has to agree with it." You don't want to find out in 'real time' that someone has a big problem with how these people are treated, he explains. "You should discuss it theoretically as a department first, so problems do not come up later," he suggests.

"I've thought a lot about this," Geiderman adds. "We don't really have a formal policy, but maybe one should be created."

Whatever your preferred process, he continues, it should be very transparent. "It's a good idea for people in charge of the ED to have thought about it, and perhaps they should consider a formal policy," he concludes.

Sources

For more information on treating celebrities and other VIPs in the ED, contact:

  • Joel Geiderman, MD, Chairman, Department of Emergency Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Room 1110, Los Angeles, CA 90048. Phone: (310) 423-8752. E-mail: geiderman@cshs.org.
  • David Goldwag, DO, FACEP, Medical Director, Emergency Department, Westchester Medical Center, Valhalla, NY 10595. Phone: (914) 493-7000.