HV Triad 2: --

Inequity in Care- and how unconscious bias can influence patient outcomes

Years ago I did a home visit for a middle school student who cared for her grandmother. When I arrived, she was also caring for her cousin who was 2 years old. Her cousin was missing his hands and feet. At some point, the mother arrived and shared the story of how her son lost his limbs. She shared he was sick, and she went to several er’s and was turned away and accused of abusing her son as his limbs were black and blue. Eventually her son was received at a hospital, and was eventually diagnosed treated for an infection, eventually resulting in the loss of limbs. I always wondered if this mother was taken seriously at the 1st hospital, and her son received the appropriate treatment in a timely manor, would he still have his hands and feet. This experience demonstrated to me people may have a difference experience when seeking medical care based on unconscious biases people have.

Racial Inequity in the workforce.

When the pandemic hit, many more black employees in our workforce had to continue working at our group homes whereas most white employees were able to work from home. This resulted in a much higher rate of black employees contracting the virus versus white employees. Due to their circumstances and lack of access to educational opportunities, black employees hold most of the lowest paid positions at our company, while mostly white employees hold management or senior management positions.

Surprised by the Black Student Union

When I was in college, a friend and I were the co-organizers for a celebration to welcome our new college President. Me, my friend and the incoming President were White, and most of the coordinating committee were also White. The prior President was Black, and there was disappointment among some students that the new President was also not Black and hadn’t been overly supportive of racial and equity issues.. I thought I was relatively close to friends in the Black Student Union (BSU), as I had marched with them against Apartheid and other issues. But, on the day of the celebration, at the beginning of the event, about 20 BSU members entered the room with picket signs and loudly noted their disappointment with the new President. I was shocked and appalled, and felt betrayed by my “friends.” Years later, i came to understand that I had the advantage to host this celebration, and did not consider the needs of Black and other students. This event gave the BSU a space to have themselves heard, and they made the news the next day- not the positive story I had anticipated.

Access During Pandemic

During the pandemic, there continues to be a gap in access between “the Coast” and “the Glades”. When the began to offer COVID-19 testing at the Ballpark and Delray, it was almost 4-6 weeks later until testing was available in the Glades. Now with the vaccines, the same thing is happening again with Glades not being given “access” because we don’t have a Publix in our community.

WANTED: New Thinking and Leaders Willing to Lead

The storming of the Capitol Building is a story of the deep inequities, of racism and white supremacy. For some, this is blatant and obvious. For others, there is no comprehension of these connections. Is it based on the eye of the beholder? A group of white professionals were talking about being done with perfunctory diversity trainings and workshops. They were saying we (the US) need something stronger. Not driven by HR departments or 2-hours mandated in a school district setting. The entire framing of our systems needs to change in order to make real progress. I agree. Until people are pushed out of their comfort zones personally and accept a degree of personal reflection on these matters, our work will be surface level and meaningful, community and societal level change, won’t be realized.

Lessons from the classroom

I would like to share an example that involves children to note that inequity often begins early on.

Many families in our own communities struggle everyday with virtual school, because they lack access to reliable internet connections, computer equipment, technical skills, adequate space or privacy in the home or simply having someone available to guide them through it. Other families do not have these limitations, and therefore their children are more likely to succeed. In some instances, children who are struggling may unfairly be labeled as difficult, disinterested or lazy. The playing field is simply not level.

At such a young age, these children are already experiencing the harsh reality of inequity.

Stolen Dreams and Opportunities

When I was in college I wanted to study abroad. I completed my application and submitted all of the necessary papers. However, my advisor did not support my interest and he actually did not provide any information for me to review. My advisor told me that was not a good fit for me and that it was too much for me to handle with my course work. I had to do my own research for opportunities such as exchange student and scholarships. I did not know the process or where to begin, it was really discouraging at 18 years old. My roommate had the same advisor and not only did he encourage her, she was provided informational packets and then shared her excitement with me. Well, guess who announced that she was selected to study abroad the following semester with all expenses paid. My college roommate! The information that she received was not available for everyone and it was totally unfair. Inequity on so many levels. I had a higher GPA than she did, I expressed my interest and she did not but, was chosen! Information was not shared with everyone and the selection was bias! Application process was never shared!

Struggling With Access to Care

I am a 51 yo African American woman who is well-educated, gainfully employed, and fully insured. I live with a chronic condition, systemic lupus erythematosus (lupus) which causes severe joint pain and a host of other challenges. At different times, I have gone to the ER…typically after consultation with or at the direction of my rheumatologist. I have come to loathe these experiences because I have often been questioned to the point of interrogation BEFORE my pain is addressed (if it is addressed). Sometimes it is only after lab work reports high markers of inflammation that my account is ‘confirmed.’ Other times, I have been dismissed until my physician has been consulted or intervenes on my behalf. At the same time I know there are people who receive more attention for hang nails. It’s maddening. Though I have access to health care, I cannot access health care.

Challenges of SSI Disability Benefits

For those individuals seeking SSI-Disability Benefits, individuals who can afford to hire an attorney to advocate and complete forms, and work within the system are two times more likely to be approved for benefits on the first “go around” that those who don’t and definitely increase the approval rating when reapplying after initial denial. However, those who are really in need of guidance, often have lower incomes (if any) and cannot afford or have the ability or access to easily obtain legal counsel. Once approved for benefits, the waiting period for health care access and services through Medicare does not begin until 2 years after approval — a time when many need it most. “People who will become eligible for SSDI benefits are significantly more likely to be uninsured than other workers—an average of 22 percent over the three years prior to SSDI entry, compared with 16 percent in the general population” with the likelihood “living in a family whose income is below the federal poverty level being twice as high among people receiving SSDI benefits as among those who have not yet become disabled” The cost of coverage through COBRA is “cost-prohibitive” for many of these individuals.

Many individuals and families absolutely give up even trying to obtain these benefits even though they are entitled to receive the funds and critical health care services.

No Cocktails For You

My son’s father passed away due to complications from COVID….he was exposed (on his job at the water utilities department) while working in very close quarters with a contractor who had tested positive for the disease. There is no hospital in the rural county where he lives, but he was transported by ambulance to the closest facility about 30 minutes away with obvious signs of apoxia, O2 levels well below the 94% that most acknowledge as a threshold for concern. He spent about 6 hours in the ER before he was moved into a room…on a regular floor (where the nurse to patient ratio is much lower). He was ultimately moved to ICU, intubated, and…there is actually no “and,” there’s a “BUT.” But, he died.

My son’s dad fought, my son fought for him….finally getting eyes on his case after a personal friend of his called the CEO of one of the largest health systems in the country. That gentleman reached out to the CEO of the hospital where his dad was a patient. Several specialists were consulted. All of this after 8p on August 25th. They all said they wish they’d consulted on the case sooner…it was too late. We know that because he passed away the next morning on August 26th.