92nd Street Y Presents: An Evening With Joan And Melissa Rivers

As F. Scott Fitzgerald wrote, “Let me tell you about the very rich. They are different from you and me.” It is an observation that holds true, apparently, even in the operating room.

The treatment of Joan Rivers at a Manhattan endoscopy clinic last month may be the latest example of what is known in the medical profession as “V.I.P. Syndrome,” in which famous or influential patients get special treatment. And surprisingly often, it is not for the best.

Dr. Barron H. Lerner, an internist at NYU Langone Medical Center, said that when he was a young doctor-in-training at another hospital and famous patients arrived, “There was always a buzz.” Doctors were warned in advance of the dangers of becoming star-struck. But in the same, albeit contradictory, breath, they were given special instructions “about what to do and what not to do, given that they were famous.”

Huguette Clark, the copper heiress, stayed at a New York hospital for 20 years despite not being sick. CreditAssociated Press

Ms. Rivers died on Sept. 4, several days after going into cardiac arrest following a routine endoscopy, a procedure that involved the insertion of a tiny camera to look down her throat into her digestive system. The doctor who performed the endoscopy allowed Ms. Rivers’s throat doctor to examine her as well, even though the throat doctor was not authorized to practice at the clinic. This was a violation of state law, according to people who have been briefed on the matter.

The New York State Health Department is investigating Ms. Rivers’s care. Neither doctor has been accused of wrongdoing or of contributing to her death. The city medical examiner has not reached a conclusion on what caused her to die.

Several doctors said that if the clinic, Yorkville Endoscopy, had granted a privilege to Ms. Rivers that they would not have granted to a typical patient, it could be seen as a case of V.I.P. Syndrome. It is unclear who coined the term, but it was described in a 1964 article by a psychiatrist, Dr. Walter Weintraub, in The Journal of Nervous and Mental Disease, where he wrote, “the treatment of an influential man can be extremely hazardous for both patient and doctor.”

For doctors, he said, “The V.I.P., cursed with the touch of Midas, arouses only resentment and fear.” Physicians, Dr. Weintraub wrote, tend to perceive V.I.P. patients as demanding and manipulative and to resent them for it, which can diminish the quality of their care.

For hospital administrators, on the other hand, he said, “The V.I.P. is more than just a patient. He is also an object to be bartered for future favors.”

Huguette Clark, the copper heiress who spent the last 20 years of her life in a series of Manhattan hospital rooms, has been portrayed as such a bargaining chip. In a pending case against Beth Israel Medical Center, the administrators of her estate contend that Mrs. Clark needed psychiatric treatment, but that the hospital preferred not to provide it and in effect kept her captive so she could be courted as a potential benefactor. The hospital said she stayed there willingly, because she felt at home, and gave it part of her fortune — including a $3 million Manet painting — out of gratitude. (Most of her $300 million fortune was donated to charity after a court battle with her distant relatives.)

Steve Jobs told his biographer, Walter Isaacson, that he regretted putting off surgery for a cancerous tumor on his pancreas, instead trying alternative remedies, while the cancer spread.


Apple founder Steve Jobs regretted avoiding surgery on a cancerous tumor.CreditJim Wilson/The New York Times

“Often with V.I.P. patients, doctors won’t say, ‘Joe Famous Person, look, you have to take your medicine or you have to come in for surgery immediately,’ ” Dr. Robert Klitzman, a professor of psychiatry and director of the masters of bioethics program at Columbia University, said.

Standing up to a V.I.P. patient can be difficult. Dr. Klitzman remembered once taking care of the daughter of a “household name” writer. “The household name was a very powerful presence and wanted things their way,” he said. “It took more gumption than I usually had to stand up and say what was best for the patient.”

Dr. Lerner said he first became interested in V.I.P. Syndrome while writing a book about breast cancer during which he researched the cases of Betty Ford, Happy Rockefeller, Shirley Temple Black and other famous women with the disease. Mrs. Ford was given a radical mastectomy, which had been the procedure of choice but was falling out of favor as women and some doctors began calling for less aggressive operations, he said. “But as the president’s wife, there was no doubt that she would receive the traditional operation,” Dr. Lerner said.

He became so fascinated that he wrote a book in 2006 about the problem, “When Illness Goes Public: Celebrity Patients and How We Look at Medicine.”

Probably the most notorious example of a doctor catering to a celebrity is the case of Michael Jackson, who died after his private doctor gave him Propofol, a surgical anesthetic, to help him sleep. The doctor, Conrad Murray, was convicted of involuntary manslaughter and spent two years in prison.

Yorkville Endoscopy has said that it cannot comment on any patient’s care. The gastroenterologist who performed the endoscopy, Dr. Lawrence B. Cohen, has resigned as the clinic’s medical director.

Dr. Gwen S. Korovin, who was identified by TMZ as Ms. Rivers’s throat doctor, was known for treating celebrities, with previous news reports listing Patti LuPone, Hugh Jackman and Nathan Lane among her patients. Don Imus, the radio host, told listeners last week that she was his doctor.

Dr. Korovin has not publicly acknowledged being Ms. Rivers’s doctor. Asked whether she had been in the clinic during the procedure, her lawyer, Michael S. Kelton, released a statement last week that said Dr. Korovin was “revered by her patients” but could not talk about them because of privacy laws.

Dr. Lerner said of Ms. Rivers’s care, “If things were going on there that were outside of the protocol, it’s certainly possible that there was V.I.P. Syndrome.” But he also cautioned against jumping to conclusions.

“Sometimes just bad things happen to famous people with very good doctors,” he said

From NYtimes.com.