"Very important persons" (VIPs), "friends of physicians" and Emergency Department (ED) staff and family members often receive care in front of other patients who may be critically ill waiting for care in the ED lobby. This paper explores the organizational ethics of these three select groups of patients who often obtain priority access to care in the busy ED. A specific case is provided to highlight the challenges of these complicated encounters. The organizational ethics are then explored and potential solutions are identified. This is an important ethical and operational issue that requires exploration by emergency department and hospital leaders because of the potential harm it may cause other patients and the strong negative emotional reactions by employees that can lead to decreased staff morale.