UNPROTECTED: Blacks must fight bias in health care while sick with COVID-19

Final installment in a 3-part series about Black Iowans: COVID-19, vaccines and bias in health care.

Black hospital patient. Image via Canva Pro.

Countless Black COVID-19 patients have been turned away from hospitals during the coronavirus pandemic — some multiple times — only to die later at home.

What will it take to break the cycle?

Dr. Susan Moore died of COVID-19 two weeks after pleading with a white doctor to treat her pain. Gary Fowler was turned away from three hospitals before he died of COVID-19 at home in a recliner. Tyler Fairley, 17, died of COVID-19 on Aug. 1, after one hospital discharged him twice and the staff at a second hospital allegedly blamed him for not being vaccinated, according to The Grio.

In Moore’s viral Facebook video, the 53 year-old Black doctor from Indiana said her doctor ignored her pain, made her feel like a drug addict and mistreated her because of the color of her skin.

“This is how Black people get killed,” she said, in the video made just two weeks before she died last year.

It’s a cautionary tale: During a formidable 18 months long public health crisis, Black COVID-19 patients have to battle a deadly virus — and medical racism.

Jacquie Easley McGhee, state area health chair for the Iowa-Nebraska NAACP Conference of Branches, said she’ll never forget the death of Dr. Susan Moore. Photo special to Black Iowa News.

Jacquie Easley McGhee is state area health chair for the Iowa-Nebraska NAACP Conference of Branches and director of health equity and community and diversity resources for MercyOne Des Moines Medical Center. The NAACP has received several complaints about health care during the pandemic, including:

  • Blacks worried that COVID-19 testing sites weren’t located in “convenient areas” in their communities.
  • When Blacks questioned the availability of COVID-19 vaccines for incarcerated individuals, the NAACP met with a medical director from the department of corrections to discuss the concerns. Black Iowans make up about 4% of the state’s population, but 25% of its prison population.
  • The NAACP requested Gov. Kim Reynolds collect and report COVID-19 data by race, but the data is incomplete, according to the state’s coronavirus website.
  • The NAACP met with the governor recently to discuss concerns about low Black vaccination rates. According to a recent analysis from the Kaiser Family Foundation, white Iowans are vaccinated with one dose at twice the rate of Blacks, 48% vs 24%, respectively.

Easley McGhee said she sees parallels between Moore and George Floyd, a Black man who was murdered by a white Minneapolis police officer who knelt on Floyd’s neck for more than nine minutes. Floyd’s death touched off nationwide Black Lives Matter protests against police brutality.

“I talk about her all the time. No one listened to her. She cried out for help. It was like a knee on her neck,” said Easley McGhee. “The challenges and oppression that we often feel for policing and education — the same thing can be true in health care.”

As the delta variant, a highly contagious coronavirus mutation, causes a surge in cases among the unvaccinated and threatens to overwhelm hospitals across the nation, headlines about Blacks being turned away from hospitals — like Fairley’s — have occurred. The pattern raises concerns, once again, about pandemic-related health care inequities.

Amara Enyia is a policy research coordinator for the Movement for Black Lives, a national grassroots coalition of 100 Black organizations. Photo special to Black Iowa News.

“When it comes to hospitals and implicit bias, it's just so important to know that it's actually a thing and we’re not just talking out of the side of our neck,” said Amara Enyia, a policy research coordinator for the Movement for Black Lives, a national grassroots coalition of 100 Black organizations. “These things actually happen and a huge part of the problem is that when people, especially Black people, would bring up issues of quality of care, it was dismissed or brushed aside.”

One study found Black male patients tended to do better with Black doctors, which is why some online directories like YourBlackDoctor.com want to make it easier for patients to find them. About 5.4% of the nation’s active doctors were Black in 2018, according to the Association of American Medical Colleges. With the white population in decline, and the number of Blacks expected to increase 13.4% by 2034, that means even more Black doctors will be needed to meet the growing demands, according to staffing projections by the association.

A poll by Kaiser and The Undefeated looked at the depth of Blacks‘ ambivalence toward the medical establishment.

  • 6 in 10 Blacks said they trusted doctors to do what is right most of the time.
  • 7 in 10 Blacks said the health care system treats people unfairly based on race “very often” or “somewhat often.”
  • 37% of Black mothers said they were treated unfairly while getting health care because of their race or ethnic background.

So what can Blacks — who are nearly three times more likely than whites to be hospitalized and twice as likely as whites to die of COVID-19, according to the Centers for Disease Control and Prevention — do to better their chances of fair treatment and survival?

The key to a more equitable experience in hospitals begins before patients ever pass through hospital entrances, said Enyia.

“I think that's one of the fundamental things that we can do with even more intention is forming those communities of care — networks of care in our own communities,” she said.

During the pandemic, mutual aid initiatives have emerged across the country with the goal of providing assistance to people without reliance on traditional organizations or systems, she said.

“People realized especially because of how the pandemic was handled by state governments and the federal government, they kind of realized, well, we have to take care of ourselves first and foremost,” she said.

It’s important for patients to have someone on the outside of the hospital, like a family member, friend or neighbor, who can interact with medical professionals — “who's not just going to be brushed to the side.”

Advocates, like the ones Enyia described, are needed during the pandemic — but Black patients also need help coping with existing inequities in health care like Iowa’s high Black maternal mortality and morbidity rates. Nationally, Black women are three to four times more likely to die from pregnancy-related causes than white women, according to the CDC. Even Beyonce and Serena both experienced pregnancy complications and reported they didn’t feel listened to by their medical providers. The disparity is worse in Iowa.

Iowa’s pregnancy-related maternal mortality rate is 9.4 per 100,000 live births overall. The rate for Blacks is 36.9 per 100,000 — making Blacks six times more likely to die from pregnancy-related causes than whites, according to 2020 data from the Iowa Department of Public Health.

Black maternal morbidity rates, which measure when a mother comes close to death, were the worst in the state, according to a 2020 report from the health department.

  • The severe maternal morbidity rate was 114.9 per 10,000 delivery hospitalizations for Blacks, compared to 51.2 for whites and 69.3 for Hispanics.

According to the health department, Black women have lower rates of prenatal care, lower rates of breastfeeding, lower rates of smoking, lower rates of labor being induced and higher rates of obesity, higher rates of infants born with low birth weight, higher rates of infants born prematurely and higher rates of deliveries by cesarean, compared to other racial and ethnic groups.

Jazzmine Brooks is cofounder of the Iowa Black Doula Collective. Photo courtesy of Brooks.

Cofounder of the Iowa Black Doula Collective Jazzmine Brooks is working on a doctorate in human development and family studies, specifically focusing on Black maternal health and Black mothering, at Iowa State University. She said Black women are most at risk due to “racist obstetrics” and the health care system, which is an outgrowth of slavery.

“The intuition that we have as Black parents, as Black women, as Black folks, we often are questioned, ‘Do you really feel that way?’ or “You're just being overly dramatic,” said Brooks, a researcher and full-spectrum doula who trains others. “And, that's where our pain gets pushed aside, that's where we get misdiagnosed, underdiagnosed, diagnosed with things that may not be correct . . .”

Easley McGhee has studied the issue. She said Mercy is also working to tackle the problem.

“Local women say that: ‘When I was describing my pregnancy, my physician didn’t really believe that I was experiencing pain,’” said Easley McGhee. “It’s really a documented fact that the pain level in African Americans is often dismissed.”

Getting help in the hospital

It can be stressful to bring up painful issues such as racism and discrimination — especially during a health crisis. Hospital officials at three of Iowa’s biggest health care systems, MercyOne Des Moines, UnityPoint Health and University of Iowa Health Care, said there are several steps patients can take if they have concerns, feel they are being treated unfairly or worry they are being discharged too soon. Their main advice: Tell someone in the hospital right away and ask for a patient advocate. If the concern isn’t addressed, escalate the situation to a supervisor and file a complaint.

“We want you to feel confident about what we do, but we are not perfect,” said Dr. Michihiko Goto, an assistant professor in the division of infectious diseases at the University of Iowa Carver College of Medicine. If there’s a problem, “Once we know, we will work to make the situation better.”

Dr. Michihiko Goto is an assistant professor in the division of infectious diseases at the University of Iowa Carver College of Medicine.

He said most health care providers should be able to explain what they are doing and why they are doing it.

“We want to be compassionate to the patient and respectful to people,” he said.

Courtney Greene, director of communications at UnityPoint Health, said there are a variety of ways patients can share their concerns.

“Patients can also ask to speak to the nursing manager or supervisor for the patient floor they are located on and express their concerns and ask questions,” she said, in an email.

If the patient has a care coordinator or social worker, that person can also intervene, she said.

University of Iowa Health Care’s Office of Patient Experience assists patients with their concerns. Alex Nance, its director, said, in an email: “If you’re concerned, say something. Make your voice heard. We’re here to support you.”

Find out more information about patient advocate programs at UnityPoint Health, MercyOne Des Moines and University of Iowa Health Care.

Ultimately, people have to be “advocates for their own health care,” Easley McGhee said.

Even so, being assertive and lodging complaints with medical providers doesn’t always guarantee a happy ending.

If Moore hadn’t shared her viral video, “She would have been just another lady that they overlooked because of their own inherent biases,” said Enyia.

Moore’s educational background, professional title and pleas failed to resonate with hospital personnel. An investigation cited a “lack of cultural competence” not medical care as contributing to her death, according to the IndyStar.

In the Facebook video Moore posted on Dec. 4, 2020, she felt certain race was a factor in the care she received.

“I put forward and I maintain, if I was white, I wouldn’t have to go through that,” she said.

Part 2: UNPROTECTED: Series: Vaccination Barriers harmed Black Iowans

Part 1: UNPROTECTED: Series: 'Politicized' coronavirus pandemic harmed Black Iowans

This series was made possible by a grant from the Black Press Grant Program of the National Association of Black Journalists.

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