Direct and immediate access to their doctor is part of what Dr. Abe Malkin's patients pay for. Concierge practices like his tout first class, round-the-clock medical care. Malkin rarely silences his cell phone, so as not to miss anything, or anyone.
But since the COVID-19 vaccine made its U.S. debut, Malkin says his entire team has been "bombarded" by calls asking when they can get it, or if their names might be bumped up to the priority lists.
Some simply ask whether it's possible -- others ask if there's a purchase price.
The vaccine's slow and uneven rollout has worn public patience thin, and fomented fears that affluence may expedite access. Now, as expanded eligibility amplifies demand, while reserves run short and wait times grow longer, experts warn that the wealthy and the well-connected may be further incentivized to exploit the ensuing chaos -- and those who can pay for the privilege have been shopping for a way to get their arms ahead in line.
"I get call after call every day now, people saying, 'I'm going to join whichever practice is able to get me the vaccine first,' and they're willing to pay a premium for that access," Malkin, the founder of Concierge MD in Los Angeles, told ABC.
"With five-star prices, expectations are higher," Dr. David Nazarian of My Concierge MD in Beverly Hills told ABC. "These people are used to having things when they want it."
Boutique medical practices like these offer personalized, executive care -- for a fee. The annual cost runs anywhere from $5,000 to tens of thousands, depending on the practice. And some patients are now offering to pay even more if it means getting a fast-tracked vaccine.
"They offer to make a donation to charity, the hospital, or just pay extra," Nazarian said. He and Malkin tell ABC News that they've heard offers upwards of $25,000 to jump the line -- all of which they've politely declined.
"Babe, can i come w sis and husband and one other ... for vaccine … do you have it," read a text message from an actress and social media influencer that was sent to a concierge service and obtained by ABC News.
"Not yet, and it's only going to be distributed to at-risk populations first," the concierge service replied.
"These are people who, when testing first came out in March, wanted testing. When hydroxychloroquine was in short supply in April, they wanted hydroxychloroquine. When Regeneron was announced, they wanted that," Malkin said. "This is just the latest example."
Asking doesn't mean getting -- and in interviews with ABC News, concierge doctors maintain they've held firm to their local prioritization guidance, and experts say that so far abuse of the vaccine rollout has not run rampant. But a few high-profile cases have drawn national condemnation, and authorities say they're carefully watching for any signs of unethical line-cutting.
Real estate mogul David Mack, who is vice chairman of the Morse Health System Board of Trustees and also sits on the Palm Beach Country Club's Board of Governors, acknowledged that he and his brother Bill Mack, who is also in real estate, had "assisted" with MorseLife's vaccination campaign -- but refuted reports that this was a "targeted effort to vaccinate members of the Palm Beach Country Club."
In a statement to ABC News, the brothers said that the shots had been administered "in full accordance" with the governor's executive order that shots be given to medical workers, residents and staff of long-term care facilities, and adults 65 and older.
Since 2016, the Palm Beach Country Club Foundation has contributed at least $75,000 to MorseLife Home Care, according to tax filings.
Walgreens, whose staff was on site providing vaccines at MorseLife, said it was unaware that any shots were being given unfairly.
"Walgreens was led to believe that the individuals receiving the vaccine were either residents or staff," a Walgreens spokesperson said in a statement to ABC News. "We are disappointed to learn that ... some recipients of COVID-19 vaccines at this facility may not have qualified as defined by the state's guidance."
MorseLife did not respond to numerous requests for comment by ABC News.
Florida Sen. Rick Scott has called for a congressional investigation, calling it "absolutely disgusting and immoral that anyone would take vaccines intended for nursing home residents to distribute them to their friends."
Democratic State Rep. Omari Hardy, who represents the area of West Palm Beach that includes MorseLife, denounced facilities appearing to be "selling access to the vaccine."
"I'm concerned, going forward, that we don't have a robust plan to make sure that the distribution of this vaccine is equitable," Hardy said.
"What we've got is a breakdown in the equitable distribution, which has caused distrust in the entire public forum," Republican State Rep. Mike Caruso, whose district covers Palm Beach County, told ABC News.
MorseLife is not the only instance of alleged preferential treatment of which Caruso says he's been made aware. Baptist Health South acknowledged to ABC News that "established Baptist Health supporters" have been among those prioritized for the vaccine despite limited supplies, adding that they had been "reaching out to eligible high-risk members of the Baptist Health community" who "meet criteria" for the shots. Recipients were "age 65 or older" in high-risk groups, a spokesperson for Baptist Health said.
"Doctors have called me up and told me this was happening," Caruso said. "This diamond, platinum access to vaccine for foundation members or contributors -- that's just wrong."
With expanded eligibility, Malkin said concierge doctors anticipate "a lot more wiggle room" in their ability to prioritize preferred clientele for the shot -- even as competition to get the vaccine intensifies.
And with expanded vaccine eligibility leading to a shortage of shots, experts anticipate that the competition to get the vaccine will intensify.
"It all leads to more jostling and a scramble to be the first," Arthur Caplan, professor of bioethics at New York University Grossman School of Medicine, told ABC. "The system has always had special pathways for the rich -- and chaos helps facilitate acceleration and exploitation of those loopholes."
"That seeds anger," Caplan said. "And a real perception that behind the scenes, the rich are greasing the skids on a life-or-death situation."
As a result, the very doctors whose brand boasts the ability to circumvent some of the health system's stresses with elite care now find themselves staving off "VIP syndrome" requests from their A-list patients, in order to hold the line on medical ethics.
"It's a complicated time because we definitely want to follow the rules and we understand how complex a rollout this is," said Andrew Olanow, cofounder of Sollis Health, a concierge practice operating in New York, the Hamptons and Beverly Hills, which has been administering the vaccine to front-line workers and other high-risk patients at their New York location.
Some states have strict penalties for anyone offering sweetheart access to the shots; New York Gov. Andrew Cuomo and California Gov. Gavin Newsom have both threatened line-skipping sanctions and the revocation of the right to practice for any unethical vaccine administration.
Newsom noted that the temptation to allow line-jumping could grow as subsequent phases are rolled out.
"Not every individual may hold themselves to those higher ethical standards of the Hippocratic oath, which they've taken," Newsom said in late December. "We are mindful of that."
Ultimately, Olanow said, medical providers will still be the gatekeepers when it comes to sorting through gray areas like a patient's self-identified comorbidities or their essential-worker status.
"Providers of the vaccination will have to do their best to validate patient claims in terms of what their risk factors are, and that they're essential," Olanow said. "A good doctor or a good practice does what's right, not what the patient demands."
This report was featured in the Tuesday, Jan. 26, 2020, episode of “Start Here,” ABC News’ daily news podcast.
"Start Here" offers a straightforward look at the day's top stories in 20 minutes. Listen for free every weekday on Apple Podcasts, Google Podcasts, Spotify, the ABC News app or wherever you get your podcasts.