Opinion: It’s Time to Address One of the Leading Causes of Health Care Complications: Racism

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Kira Johnson died 10 hours after a routine C-section in 2016 at a Los Angeles hospital. The medical cause — and the subject of her family’s ongoing wrongful death lawsuit — was hemorrhagic shock due to massive internal bleeding. 

But there was another contributing factor, according to Kira’s husband: Racism. Charles Johnson filed a civil rights lawsuit last year alleging that his late wife received improper treatment because she was Black.

It’s becoming increasingly clear, according to new research by the RAND Corporation and MedStar Health, that Kira and her family are not alone. 

The effects of racism, including chronic stress, neighborhoods lacking high-quality food and health care, are widely acknowledged to contribute to poor health overall. But it’s only recently that researchers have begun to quantify how much more likely Black patients are to experience routine, preventable medical errors — what the medical field calls “patient safety events.”

Women of color, regardless of income or education, are 3 to 4 times more likely to die during childbirth than other women. And Black patients are significantly more likely to experience negative outcomes in hospital settings, including post-operative infections like sepsis, hemorrhages, pulmonary embolism or respiratory failure. 

Part of this is because of where Black patients are able to access care. Black families are less likely to be admitted to hospitals classified as “high quality.” But even when in the same hospital for a coronary bypass, for example, Black patients die 17 percent more frequently than white patients. Just as troubling: Research shows medical staff are less likely to report harmful events involving Black patients.

The reason for these inequities is simple: systemic racism. 

Congress and the California legislature have both passed laws trying to address these issues by increasing protections for women like Kira. Last fall, state Attorney General Rob Bonta launched an inquiry into California hospital systems’ health care algorithms, part of an investigation into whether software systems driving decisions about patient care may be harming Black patients. 

But more action is needed. Our new study — which included interviews with more than a dozen experts in patient safety and equity — found many health care facilities still do not have a culture where staff feel comfortable speaking up about patient harms, particularly those rooted in racism. Black nurses and Latinx clinicians say they fear backlash when calling out unsafe conditions. Kira Johnson’s family has made this same case against the hospital, quoting a surgical technologist working the night she died who said she often says “an extra prayer” for Black patients who come into the operating room out of fear they won’t receive proper care. 

As a first step, health systems must acknowledge racism’s role in patient harm and medical errors. That starts with more systematically collecting race, ethnicity and other data on both patient health and patient safety — which, incredibly, is not required today.

The Attorney General’s investigation may help raise awareness about implicit bias in health data systems. But the state needs to hold health system leaders accountable for fixing these issues. Policymakers should move forward on their own initiative to require public reporting of health outcomes and patient safety by race. 

Health system leaders also need to create a culture committed to dismantling racism, where staff can speak freely when patients aren’t getting equitable care. This begins with a diverse leadership team and workforce — buttressed by structures that ensure diverse voices are heard and respected. 

This fall, California’s only historically Black college, Charles R. Drew University, will launch its own medical school with the aim of training doctors in cultural humility to improve care in underserved communities. Many of the state’s existing training programs share the same goal.

But it is not enough just to build a new workforce pipeline. Before the next generation of workers arrive, every hospital in California should be providing professional training to existing workers that incorporates antiracism training and education on disparities in patient safety. Hospitals, clinics and medical offices need to hire patient advocates who can help speak up when patients receive substandard care. 

Kira Johnson spent her last 10 hours after giving birth wondering why she was getting so cold, waiting for a test that never came, unaware of the massive internal bleeding that would kill her. Her family remains convinced things would have been different if she wasn’t Black. 

We may never know for sure. But we should know this: We have to do better.

Angela D. Thomas, who holds a doctorate in public health, is vice president of Healthcare Delivery Research at MedStar Health and an adjunct associate professor at Georgetown University.

Dr. Lucy B. Schulson is a practicing internist, assistant professor of medicine at Boston University, and an associate physician policy researcher at the nonprofit, nonpartisan RAND Corporation.

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