Kendra Outler, MD, MPH
Founder, Uzima Health & Wellness
say her name
Dr. Susan Moore, an Indianapolis physician took to Facebook before she died of COVID-19 to document her struggle to get her White physician to respond to her complaints of pain and suffering. She stated instead of listening to her, when she asked for remdesivir (a treatment for very sick COVID-19 patients requiring oxygen) and pain medications, the doctor told her that she was not sick enough and that he was not comfortable giving her more pain medications. It was insulting as “he knew I was a physician.”
She stated what we as minorities experience when we encounter the hospital: We expect to be treated differently- our symptoms are explained away and known treatments are delayed or simply not offered. Furthermore, communication is brief or poorly delivered. Often times, Black patients are not able to advocate for themselves but this one knew what to ask for. Say her name. It is Dr. Susan Moore.
April is National Minority Health Month. This month marks more than a year that COVID-19 has changed the lives of people like Dr. Moore’s family, my family and so many others forever. Even when there is a decrease of virus particles in the air, we will still be inhaling grief. COVID-19 has illuminated the health disparities that have made communities of color more susceptible to death from preventable conditions. In the earliest part of the pandemic, patients who were obese or had underlying conditions such as hypertension, diabetes, asthma or cancer had the highest death rates from COVID-19. What the data will never be able to demonstrate is how many patients were sent home from emergency rooms or if hospitalized had their care delayed. How many did not get oxygen, steroids, remdesivir or monoclonal antibody therapy in time?
Dr. Moore said during her dying days, “I put forward and I maintain, if I was White, I wouldn’t go through [this]. The hospital that she accused issued a statement. It read: “As an organization committed to equity and reducing racial disparities in healthcare, we take accusations of discrimination very seriously and investigate every allegation… We stand by the commitment and expertise of our caregivers.” In summary, even as a medical doctor, she as a Black female patient fighting for her life, was somehow mistaken. Dr. Susan Moore told the truth.
A recent study entitled “Hospitalization and Mortality among Black and White Patients with COVID-19” examined the records of 3626 patients in the Ochsner Health Medical System in New Orleans, Louisiana, between March 1, 2020 and April 11, 2020. This time period is the height of the pandemic. Their study sought to gather information about racial and ethnic differences in outcomes from COVID-19. The data painted a clear picture of heavier hospitalizations of Black patients who in addition to COVID were suffering from obesity, diabetes, hypertension, and chronic kidney disease. Of the 326 patients in this study who ultimately died, 70.6% of them were Black, non-Hispanic patients. Interestingly, the study concluded that being of the Black Race, was not independently associated with a higher mortality; when all variables like insurance, and clinical presentation were made equal. In New Orleans or NOLA, a city that has a long struggle with access to education and health, how can the data make everything equal. Like the hospital in Indianapolis where Dr. Moore was treated, the authors of this study stand by their conclusion that being Black had nothing to do with dying from COVID-19.
As we now struggle to get communities of color vaccinated, the many public service announcements often quote that Black people are afraid of the medical community because of the Tuskegee Experiment. We are afraid because of the Henrietta Lack story. The problem with this analysis, in my opinion, is that it places the nexus of the problem on the people who are affected and absolves the institution of health care in the United States.
There is a fixable problem within the healthcare delivery system that needs to be addressed. Denial that our medical system has racism woven in it and not ghost of the past that Black people need to get over is the problem. What we need to confront is institutional racism that is the result of the total of policies and procedures that are created and enforced. We need to examine the behaviors and practices engaged in by the institutional members that perpetuate unequal treatment in medicine. And yes, sadly, that would include doctors and healthcare providers.
Before COVID-19 blew into existence, a plethora of researchers and authors conducted scientific studies that demonstrated clear racial differences in the experiences of Black patients when they encounter the health care system which is predominately White. Schulman et al.,in their landmark study showed that Black women who had the same presentation as White men for cardiac chest pain were the least likely to be referred for cardiac catheterization.
Dr. Haider, a trauma surgeon who is world renowned for his work on the impact of race on health disparity and surgical outcomes, came to the conclusion that when controlled for social economic status, Black patients have a higher trauma mortality and race was indeed an independent risk factor. He like so many others have consistently advocated for more investigations and action on the impact of racism implicit or explicit on the care of patients.
Adding to the validity of these studies are findings by Dr. Van Ryn. Based on her study about difference in outcomes in hospitalized Black veterans, there is sufficient evidence for the hypothesis that provider behavior contributes to racial disparities in care.
She explains in her paper “Paved with Good Intentions” how public health and medical providers create health disparities in several interconnected ways. They intentionally or unintentionally reflect or reinforce societal messages regarding a patient’s value, compliance, and deservingness. For example, the sickle cell patient who needs pain medications ends up in the emergency room frequently because his primary doctor has labeled him a drug -addict. Secondly, providers can communicate lower expectations of patients in disadvantaged social positions. Consider the pregnant Black woman who misses her appointments because she relies on public transportation. Ultimately, these first two factors drive the final problem whereby providers influence their patients’ expectations for future treatment or help from the provider. If all of these factors are consistently negative, patients and communities disengage from their doctors and health care systems.
What’s her name? It is Dr. Susan Moore. I watch her video and she looks into the camera and tells us boldly, “This is how Black people get killed, when you send them home and they do not know how to fight for themselves.” Her video is not unlike the videos of George Floyd, and with the oxygen blowing into her nose she is saying “I cannot breathe.” The doctor and the institution he works for might call it a miscalculation of how sick she was, but the evidence by dedicated researchers is that this was a clear demonstration of how racism and bias contribute to preventable deaths in Black patients.
In her memory, this National Minority Health Month, April 2021, the medical community should ask the painful question, Is it us?