The protocol, she knew, was to call the attending physician and figure out next steps, but there was a problem. The hospital used a teleICU model, in which doctors staffed the ICU during the day, but only remote doctors were available overnight, via computer screen. Selph and the other nurses had tried to reach the teleICU doctor, but no one answered the calls.
Giving medication without a doctor’s orders risked her license, Selph knew, but not doing anything risked the patient’s life. The patient survived. Selph was so disturbed by the incident that she complained to her nursing supervisors and to the hospital’s administration that having a doctor on screen rather than in person was bad policy, but they decided to keep it for financial reasons, she says.
“They did it as a cost-saving measure because they were having trouble getting hospitalists to want to be there,” Selph says. “But I felt very strongly that it was unsafe.” (Island Health said, in a statement to TIME, that it launched a teleICU program in 2021 to strengthen the level of critical care available in its rural community. It has used a vendor to run the program, the spokeswoman said, and “any technical challenges that have arisen have been addressed directly with [the vendor] to ensure continued safe, effective patient care.”)
The teleICU model has been gaining attention recently after Conor Hylton, a 26-year-old dental student, died in 2024 after being transferred to an teleICU at the Milford Campus of Bridgeport Hospital in Connecticut, part of Yale New Haven Health. In March 2026, his family filed a lawsuit over his treatment. The complaint included an inspection report from the Centers from Medicare and Medicaid Services (CMS) that found, among other failures, that no physician had overseen Hylton’s care after he was transferred to the ICU, and that the ER physician who had been called up to intubate him did not know the way to the ICU and got lost, delaying Hylton’s treatment by crucial minutes.
The hospital in Connecticut isn’t the only teleICU where patient care appears to have suffered because of the remote setup. TIME reviewed hospital inspection reports from the last six years by the Centers for Medicare and Medicaid Services and found three other instances in which patients died or received substandard care after interacting with a teleICU doctor. In one 2024 instance in Los Banos, Calif., a teleICU physician ordered a medication for a patient whose heart rate was rapidly dropping, “but the record did not indicate it was administered,” the inspection says, and the patient died. In 2021 at a medical center in Reading, Penn., a teleICU physician ordered that a patient with COVID be intubated, but no in-person doctor capable of inserting a chest tube was available for two hours; the patient coded while the chest tube was finally being inserted. And at a hospital in Louisiana, a critically ill patient could not be transferred to another facility for care because hospital staff “failed to follow the appropriate process for after-hours when there was no in-house physician on call.” They did not know they were supposed to call the teleICU doctor, and the patient died while waiting to be transferred.
Selph says that nurses are often the ones who have to take on the duties of examining a patient and assessing them in person because a teleICU doctor can’t. That seems wrong to her. “These patients are being charged for care, thinking they are getting a physician monitoring their case,” she says. “But in reality they weren’t even assessing the patients themselves; it was the nurse assessing and giving information.”
TeleICUs first became popular in the mid-2000s after research suggested that patients in ICUs would benefit from having what’s called an “intensivist,” an expert in treating ICU patients, available 24-7, says Deena Costa, a professor at the Yale School of Nursing who has studied teleICUs. At the time, many hospitals didn’t have intensivists available overnight.
Costa, who was an ICU nurse before going into academia, says she remembers the buzz around the Visicu system at the time, but that nurses she interviewed had mixed feelings about its effectiveness. Some told her they felt micromanaged and surveilled. Since then, some studies have suggested that the round-the-clock presence of an intensivist isn’t as essential as researchers once thought because it doesn’t have an impact on mortality, she says.
ICUs on their own don’t generally bring in a lot of revenue for hospitals, says Dr. Nandita Nadig, an associate professor at Northwestern University’s Feinberg School of Medicine and a critical care doctor. But some hospitals that have other specialties that may bring in revenue, like a stroke center or a surgeon who performs bypass surgery, are required to have ICUs if they want to have those specialties, she says.
Then came the pandemic. As ICUs became filled with critically ill people and hospitals faced a shortage of critical care doctors, more facilities adopted the technology.
The benefits of teleICUs
For hospitals, the big benefit of a teleICU is that it can provide the perspective of a critical care doctor without having to pay for one to be at your facility at all hours. This is especially beneficial for rural hospitals that can’t afford to staff a critical care specialist around the clock, or for a larger health system where one virtual specialist can check in on patients at multiple hospitals.
Having a remote intensivist available to lend expertise can be useful for patients in rural areas, says Nandig. Intensivists may see a red flag that a patient should be put on a heart-lung machine, for instance, or that they need a lung transplant. They can also help patients who are in small, local hospitals stay in their communities, she says, rather than be transferred hundreds of miles to a facility with an intensivist.
One 2025 study funded by Philips found that from 2012 to 2020, hospitals with telecritical care capabilities had lower patient death rates in the ICU and shorter ICU stays. Philips customers use the technology “to extend access to intensivist expertise, support bedside clinicians, monitor patient populations and help identify patients who may need earlier intervention,” says Martijn Hartjes, an executive at Philips who leads hospital patient monitoring.
The original purpose of teleICUs seems to have been lost in recent years, Nandig says. A 2021 study found that teleICUs were actually less predominant in rural hospitals than in urban and suburban hospitals.
TeleICUs operate very differently in the U.S. than they do in other countries, says Dr. Claudia Spies, medical director of Charite Universitatsmedizin Berlin, a teaching hospital that has a teleICU. Spies, who has researched teleICUs, says that in Germany and other high-income countries, the teleICU exists to give patients access to more specialists who can weigh in on their case. But this complements in-person care; hospitals with teleICUs do not typically cut staff, she says. Instead, there is still a doctor physically present in the teleICU, who consults with the other doctors over the screen to decide how best to treat the patient.
In Brazil, teleICUs expanded during the COVID pandemic, but were primarily used to train physicians and nurses in responding to critically ill patients, rather than replacing in-person health care. The program stayed in place after the pandemic in many hospitals that did not have intensivists on site.
In his experience, teleICUs have been helpful at getting patients off of ventilators earlier than they would have been able to if they’d had to wait for a doctor to round, he says, which cuts down on infection risk. For routine pneumonia or routine heart failure, teleICUs can help local doctors more effectively manage patients, he says.
“It can go awry when they just say, ‘We’re getting rid of bedside coverage, and you just call this person who’s a long way away and doesn’t know the culture,” Scholten says.
Unfamiliar territory
After Conor Hylton died, CMS investigated Bridgeport Hospital’s Milford Campus and found that “the hospital failed to ensure quality medical care was provided to a patient who presented to the Emergency Department and was transferred to the intensive care unit.” Among other things, the investigation found that the hospital did not integrate the teleICU well into the rest of the system: there was no process for the in-person emergency room doctor to sign out to the teleICU doctor, for instance. And when Hylton went into cardiac arrest at 4:33 a.m., the only doctor who could intubate him—the emergency room doctor—did not arrive until 4:45 a.m. because the doctor did not know how to get to the ICU: proof, his family’s lawyer argues, of a system that did not plan adequately for emergencies. The nurses, teleICU doctor, and hospitalist were all unsure who was supposed to lead the code in the ICU when Hylton went into distress, according to the report. Yale New Haven Health said in a statement to TIME that “our priority has always been, and remains, providing safe, high-quality care to our patients. We remain committed to continuous review and improvement of patient safety practices. Because this is active litigation, we cannot comment on specific allegations and will address the claims in the appropriate legal forum.”
The lack of a clear chain of command between doctors in the hospital and the one in the teleICU came up frequently in CMS investigations into incidents involving this type of care. In Glenwood Regional Medical Center in West Monroe, Louisiana, an ICU patient was awaiting transfer to another hospital, but one doctor did not answer their phone, and staff failed to notify any other medical provider—including those in the teleICU, who were on call from 7 p.m. to 7 a.m. The teleICU was called later that night when the patient was in severe distress, according to the CMS report, and soon after, the patient died. The hospital’s chief medical officer later said in interviews with CMS that staff should have called the teleICU for the transfer, but the inspection report found that staff weren’t trained on who to contact. (Healthcare Systems of America, which owns Glenwood Regional Medical Center, did not respond to a request for comment.)
William Hylton says that patients, like his son, have the right to know whether the hospital they’re going to has an teleICU, and whether there are nearby hospitals that may have more in-person resources available to help patients in distress.
He hopes that Connecticut and other states will pass laws that require hospitals to divulge whether they have teleICU and offer to transfer patients to other hospitals if they can’t handle the level of care that the patient needs.
Joyce Selph, the nurse who was uncomfortable with how telehealth was administered at her hospital in Washington, now works at a hospital with in-person staff in the ICU, but she still thinks about the suffering that her patients had to go through because of the teleICU.
It bothers her that she told Island Hospital repeatedly about the problems in the teleICU and that nothing changed. She was the first to leave based on the changing model of care, she says, but since then, “there has been an exodus.” (A spokesperson for Island Health said its retention is in line with the national average and that its teleICU helps give care teams support so that patients aren’t automatically transferred to Seattle when Island Health can safely care for them near their homes.)
She also believes that patients should know more about what kind of care they’ll be getting in an ICU before they check into a hospital. “The community has a right to know, if you’re going to come in and half of your care is going to be covered by a doctor who pops up on screen,” she says. “I wouldn’t take anybody I cared about to a hospital that used an eICU at night.”
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