Monthly Archives: October 2009

Hospital Mismanagement and the Perpetuation of Racial and Ethnic Disparities

This post, by the Director of NYLPI’s Health Justice Program, originally appeared on the blog of the Committee of Interns & Residents, which is fighting for the right to unionize at St. Barnabas Hospital.  You can read more about CIR’s efforts here.

Last summer, on her wedding night, Juana R. arrived at the St. Barnabas Hospital emergency department with severe abdominal pain.  A Spanish-speaker, Ms. R. needed an interpreter to communicate effectively with her providers, but she was never given one.  Instead, from the moment of her arrival at the ED, to her transfer to the ICU, to her eventual discharge a month later, she was systematically silenced by the hospital.  Invasive tests and procedures were performed without obtaining Ms. R.’s consent (she signed a litany of documents in English only).  Various medication regimens were attempted, many of which caused extreme pain and nausea, but Ms. R had no way of properly communicating these problems to her providers.  Only after legal intervention did this patient receive the communication assistance services she needed in order to understand her diagnosis and the reason for her admission.  Now, over a year after her discharge from Barnabas, Ms. R. remains emphatic that she will never again return to the hospital for care. She describes what she endured as a nightmare. [1]

As previously reported on this blog, Ms. R.’s case resulted in St. Barnabas Hospital being cited by the State Department of Health for failure to comply with public health regulations.  More broadly, her experience speaks to the ways in which poor hospital administration can compromise patient care and exacerbate racial and ethnic disparities in health care.

Well-known studies about the relationship between race and health care have focused on the individual patient-provider interaction – on how inter-personal biases and prejudices can sway treatment decisions.  However, in my experience as a civil rights lawyer in this field, I have found that institutional racism is a more salient factor than individual animus in explaining my clients’ negative encounters with the health care system.  Patients like Ms. R. are denied the interpretation services to which they are entitled not because of the ill will of particular caregivers, but because, more typically, hospitals like Barnabas are not managed well enough to have the policies and practices in place to ensure timely access to important support services – a systems failure that hurts patients and providers.

My office has also found that, across the city, health care institutions will steer Medicaid and uninsured patients, who are disproportionately people of color, into poorly equipped and under-staffed clinic settings while “better” patients (i.e. white, privately insured patients) are sent to the faculty practices.  At the broadest level, this upward redistribution of health care resources has meant that hospitals located in New York City’s low-income communities of color have closed down over the past decade, while facilities located in more affluent white communities have thrived.  In some cases, the hospitals that shut their doors had patient populations that were over 90% African-American, Latino and Asian.

Viewed in this way, the primary way to eliminate racial and ethnic disparities in health care is to overhaul the institutions that create and perpetuate racial and economic disparities within medicine.  This means more people like Ms. R. stepping forward and demanding investigations of unlawful practices at hospitals like St. Barnabas.  It also means more communities raising their voices against hospital policies that enrich some while impoverishing others.  Ultimately, it means more of us—all of us—speaking out against health care institutions designed to promote private gain over the public’s health.


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Ensuring Health Equity in Health Reform

Over 250 organizations from across the country signed on to support the inclusion of health equity provisions in the federal health reform package.  Below is the letter that was sent to the Senate Majority Leader and relevant committee chairs.  A similar letter was sent to the House side as well.

October 15, 2009

Dear Senators Reid, Baucus, Harkin, and Dodd:

As you and your colleagues continue to work on health reform legislation, the over 250 undersigned coalitions and organizations urge you to ensure that the final legislation includes provisions to address health inequities and to reduce and eliminate health and health care disparities.

A recent report from the Joint Center for Political and Economic Studies found that from 2003 to 2006 the combined cost of health disparities totaled $1.24 trillion in our country. This report also found that in the same time period, eliminating certain health disparities would have reduced direct health care  expenditures by $229.4 billion. These potential savings would be realized not only by improving the health of populations and communities that suffer from health disparities and barriers to health care and public health services, but by reducing the costs resulting from the disproportionate burden of disease faced by these populations. As a result, the final health reform legislation must, at a minimum, include:

  • Data Collection, Analyses, and Quality to ensure collection and reporting of data on race, ethnicity, gender, disability status, geographic location, socioeconomic status, primary language, sexual orientation, gender identity, and, especially for subpopulation groups, as well as the development of standards for measuring these factors to improve health status and quality in health care.
  • Health Care Quality Improvements, including the National Strategy for Quality Improvements in Health Care, Quality Measure Development, Community Health Needs Assessment, and Cultural and Linguistic Competence in health care and public health services by providing grants and demonstration projects to support research and community-based programs designed to reduce health disparities and barriers to health services through education and outreach, health promotion and disease prevention activities, and health literacy and services.
  • Health Workforce and Infrastructure Investment to strengthen the recruitment, retention, training, and continuing education of health professionals, and increase their diversity, distribution, cultural competence, and knowledge of treating the unique needs of populations impacted by health disparities.
  • Access to Language Services for Limited English Proficient Patients, including funding for these services under federal programs and new coverage programs, training of interpreters, and evaluation of and accountability for provision of these services.
  • Prevention and Wellness provisions, including the National Prevention and Health Promotion Strategy and Prevention and Public Health Fund.

We want to underscore that our support for these crucial health equity provisions in no way signals an endorsement for reducing affordability protections in order to reach a specific spending threshold. Nor should providing affordable coverage prevent us from making progress on reducing health disparities. These provisions are critical to efforts to help us succeed in closing the gaps in health status and health care.

Thank you for your ongoing leadership and support of issues impacting populations and communities that continue to suffer grave health and health care disparities. We would also like to thank you for your thoughtful consideration of this request and offer our assistance in addressing this critical issue. Please contact Daniel E. Dawes, J.D., at (202) 682-5110 or ddawes@apa.org, if you would like any additional information.

Sincerely,

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Saving Health Care in Queens

This post, about our ongoing efforts to encourage investment in health care in Southeast Queens, first appeared on the Equal Justice Works blog.

This is a guest post from Equal Justice Works Fellow Seth Cohen, an attorney at New York Lawyers for the Public Interest (NYLPI). Seth is a graduate of Brooklyn Law School and is sponsored by Johnson & Johnson and Patterson Belknap Webb & Tyler LLP.

When NYLPI helped organize the Southeast Queens United in Support of Healthcare (SQUISH) coalition back in 2006, they may not have realized how big a role they’d have to play in developing New York’s health policy.  Today, SQUISH is an independent community coalition that continues to give a voice to New Yorkers desperate for adequate medical care by raising awareness about issues that affect the delivery of services and advocating against the reduction and removal of critical health services.  As part of NYLPI, I help provide legal and technical support on health policy issues for the organization.

Recently, local health facilities have been coping with the strain of hospital closures, including St. John’s Hospital and Mary Immaculate Hospital, bringing the total number of Queens hospitals closed in the last year to three. In response, $30 million in grants has been awarded by the State to be split among 12 medical facilities in the borough – four in Southeast Queens.

SQUISH and many advocates say this is a great first step, but argue that this isn’t enough. I agree. It is vital for health care in Southeast Queens – which is racially and ethnically diverse as well as severely medically under-served – to be improved, and the Department of Health has signaled an interest in doing so. But the State government is still responsible for coordinating a plan for the future of health care delivery in Queens. One suggestion is that a task force of all stakeholders be convened – including community leaders – around health care concerns in the area.

Read more about the grant and health care issues facing Queens here: http://www.queenstribune.com/news/1254415740.html.


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State Cites St. Barnabas for Failure to Provide Language Services

This post, about our successful efforts to secure and enforce rights to language services for a client at St. Barnabas Hospital in the Bronx, originally appeared on the blog of the Committee of Interns & Residents, which is fighting for the right to unionize at St. Barnabas Hospital.

The NY State Department of Health recently issued a citation to St. Barnabas finding that the hospital has violated state laws mandating that non-English speaking patients receive translation services so that they can understand diagnoses, treatment plans, and other essential healthcare information.

According to the attorney who prepared the complaint, a Spanish-speaking patient admitted to St. Barnabas Hospital filed a complaint with the State after spending more than a week in the hospital without receiving translation services that would allow her to understand her diagnosis and medical documents she was asked to sign. Only after the patient’s attorney intervened did St. Barnabas provide a telephone-based translation service to the patient.

The Department of Health’s investigation finds the following violations of state law:

  • St. Barnabas failed to document the patient’s language preference.
  • St. Barnabas failed to document whether the patient was provided with a qualified translator.
  • After the patient was diagnosed with tuberculosis, St. Barnabas failed to document that the diagnoses and treatment plan were explained to the patient in a language she could understand.

In diverse communities like the Bronx, where it is estimated that more than 50% of families speak a  language other than English at home, timely access to effective translation services is essential to delivering quality healthcare.

Research compiled by the Agency for Healthcare Research and Quality finds that “Language barriers in the health care setting can lead to problems such as delay or denial of services, issues with medication management, and underutilization of preventive services.”  Local stories compiled by New York Lawyers for the Public Interest also illustrate the severe consequences of inadequate communication in healthcare settings.

Given these high stakes, let’s hope that this Bronx patient’s complaint has spurred St. Barnabas Hospital to make real improvements in the language services it provides to the communities it serves.

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