January 22, 2019
There is nothing “borderline” about administering lower-quality medical care to black patients than to white patients: It is clear-cut discrimination.
Yet, a recent study out of Oregon suggests that emergency medical responders—EMTs and paramedics—are 40% less likely to administer pain medications to minority patients than to white patients, Men’s Health magazine reports.
Outright discrimination by paramedics is rare, the researchers say—and is out-and-out illegal. In many of these cases, they believe, unconscious bias may be at work.
Jamie Kennel, head of Emergency Medical Services programs at Oregon Health and Science University and the Oregon Institute of Technology, led the research, which was presented in December at the Institute for Healthcare Improvement Scientific Symposium in Orlando, Florida.
The study looked at 104,000 medical charts of ambulance patients from 2015 to 2017. It found that minority patients were less likely to receive morphine and other pain medication compared with white patients—regardless of socioeconomic factors, such as health insurance status.
To illustrate the problem, the report tells the story of Leslie Gregory—now the founder and director of right2health.org—who was, just a few years ago, one of a very few black female emergency medical technicians working in Lenawee County, Michigan. She said the study’s findings ring true based on her experience.
She remembers one particular call that illustrates the problem: The patient was down and in pain. As the EMTs arrived at the scene, Gregory could see the patient was black. And that’s when one of her colleagues groaned.
“I think it was something like: ‘Oh, my God. Here we go again,’” Gregory said. She worried —then, as now—that because the patient was black, her colleague assumed he was acting out to get pain medication.
“I am absolutely sure this was unconscious,” added Gregory, who now lives and works in Portland, Oregon, where she founded her nonprofit organization. “At the time, I remember, it increased my stress as we rode up on this person. Because I thought, ‘Now am I going to have to fight my colleague for more pain medication, should that arise?’”
Gregory says that she created Right to Health, “out of frustration that our nation had made so little progress in addressing the hate and ignorance related to ethnic disparities and America’s problems with its history and founding principles of inequity.”
Indeed, research has found African-Americans more likely to be deeply distrustful of the medical community, perhaps with good reason. Such distrust is understandable and goes back generations, said Gregory.
“How can a person of color not disrespect a system that is constantly studying and talking about these disparities, but does nothing to fix it?” she asked.
Gregory wrote an open letter to the Centers for Disease Control and Prevention in 2015, asking the agency to declare racism a threat to public health.
Past declarations of crisis—such as those focusing attention on problems such as smoking or HIV—have had significant results, Gregory noted.
But the CDC told Gregory, in its emailed response, that while it supports government policies to combat racial discrimination and acknowledges the role of racism in health disparities, “racism and racial discrimination in health is a societal issue as well as a public health one, and one that requires a broad-based societal strategy to effectively dismantle racism and its negative impacts in the United States.”
And study author Kennel believes that, along with this non-answer, the issue may continue to build because ambulance companies are reluctant to release data on patient care.
“We were prepared to maybe not look that great,” said Robert McDonald, the operations manager at American Medical Response in Portland, Oregon. AMR is one of the nation’s largest ambulance organizations, and it shared its data from more than 100,000 charts with Kennel.
Some people chalk up the disparities that Kennel found to differences in demography and health insurance status, but he notes that the study controlled for those variables.
So now that AMR knows about disparities in its care, what can the company do?
Research contact: @OHSUNews