142 Background: The person deemed a VIP is generally considered differentiated from the average person by virtue of fame, notoriety (positive or negative), or success through talent, tenacity or simple luck. Because society often views VIPs as special, this can generate strong feelings ranging from excitement and awe to resentment in those who encounter a VIP. VIPs and/or their entourage may request or demand special attention. The unique factors associated with caring for a VIP can jeopardize patient safety and optimal care of the VIP patient. Methods: Typology associated with the labeling of VIP patients will be used as a framework. For example, an objective VIP patient is someone who is indisputably famous or notorious. These individuals are typically in the public eye such as a famous actress, professional athlete, elected official or rock star. Persons who are subjectively designated as a VIP are usually labeled by a person of power or authority such as a hospital administrator or the Development office and they are largely unknown until they are so designed as a VIP in a specific facility. They may be the brother-in-law of the hospital CEO or a major benefactor who has a low or unknown public profile. Both objective and subjective VIPs pose problems because of the expectations placed on staff whether implied or explicit. Results: This presentation will review typical operational problems and named syndromes that are associated with the medical care of the VIP patient. These syndromes typically outline how the whirlwind of activity and expectations surrounding a VIP patient can cause a flummoxed staff to make decisions that can lead to worse care for the patient. Conclusions: For example, ‘Chief Syndrome’ is a demand, request, or intentional substitution for the “top person” in a department to provide care to the VIP patient. Problems can result if the top person, or chief, has been behind an administrative desk for the past five years and they are not as practiced as a usual provider who sees patients daily. Other cautionary notes and preventable actions that can lead to sub-optimal care of the VIP patient will be presented.