Racism in the ER: Black Kids Get Shortchanged
A new study shows huge differences in how people are treated.
By Sheryl Estrada
Black youth suffering from acute appendicitis who visit an emergency room in the U.S. will most likely remain in intense pain.
According to the study "Racial Disparities in Pain Management of Children With Appendicitis in Emergency Departments," published on Monday in the Journal of the American Medical Association's JAMA Pediatrics, racial differences do exist in the administration of analgesia or painkillers.
"There has been literature documenting racial disparities in the pain management of adults," lead author Dr. Monika K. Goyal of the Children's National Health System in Washington, D.C., told DiversityInc. "Our goal was to determine whether these racial disparities also existed in the care of children."
Goyal said she and her team specifically chose appendicitis because "it is well regarded as a painful surgical condition, and management of pain, specifically with opioids, is one of the mainstays of treatment."
Using data from the National Hospital Ambulatory Medical Care Survey from 2003 to 2010, the researchers analyzed data of almost one million patients age 21 or younger, including the variables of race, ethnicity, age, gender, insurance status, triage level and pain score.
Goyal and coauthors note that in the past there were persistent perceptions among clinicians that administering painkillers may mask symptoms, leading to diagnostic delays. However, several randomized trials have shown those concerns to be unfounded. And there are protocols to ensure children do not overdose or become dependent on the medication.
Yet only 56.8 percent of youth evaluated in emergency departments diagnosed with appendicitis received pain medication, and about 41.3 percent received at least one dose of an opioid, such as morphine and fentanyl.
Black patients in severe pain were 80 percent less likely than white patients to receive opioids for their pain. Approximately 21 percent of Black patients, compared to more than 40 percent of white patients, received opioids. Black patients with moderate pain were also less likely to receive any pain medication compared to white patients.
Goyal's team wrote that while clinicians may recognize pain equally across racial groups, they may be reacting to the pain differently by treating Black patients with painkillers, such as ibuprofen and acetaminophen, while treating white patients with opioids for similar pain.
"This analysis by pain strata suggests that there may be a higher threshold of pain score for administering analgesia to Black patients with appendicitis," the authors wrote.
Goyal said she was surprised the results of their research demonstrated such dramatic differences in opioid administration by race.
"We assess pain scores in the emergency department, meaning, we ask patients to rate the pain they are experiencing," Goyal told DiversityInc. "We should be responding to the pain scores the patients provide us."
The current study was not designed to understand why these disparities exist, so Goyal and her team are planning studies to further delve into the topic in order to "help inform the development of interventions to achieve health equity."
"I believe that the causes of such racial disparities are multifactorial," she explained, "which include both conscious and unconscious bias, institutional practices, parental preferences, and societal expectations."
Dr. Imani Jackson Rosario is a clinical instructor at Rutgers New Jersey Medical School in Newark, N.J., who served as director of the Urology Residency Program. She agreed with Goyal's perspective and said socioeconomic inequality and racial bias contribute to the disparity.
"Hospitals serving minority communities are often underfunded and understaffed," Rosario told DiversityInc. "They serve a low-income population of patients who are uninsured or underinsured, which affects the hospital's bottom line. These hospitals often operate under a deficit, which affects equipment purchasing and staffing, which ultimately affects quality of care."
In regards to racial bias, she said, "There is data that shows medical professionals, including and often specifically doctors, carry personal biases related to culture and race that influence the way they care for patients. This phenomenon is well documented and this most recent study is further evidence of the problem. There has been a concerted effort, though more effort is needed in my opinion, to address this problem at the level of medical student education."
The Institute of Medicine of the National Academy of Sciences has called for more studies looking at the role that the unconscious behavior of doctors plays in health care.
Goyal explained racial disparities in health care are also a societal issue.
"We are all accountable for these disparities," she said. "I hope that our work makes us acknowledge that these disparities exist and motivates us to all work towards creating a more equitable health care system."
She noted organizations participating in a movement in health care to eliminate disparities.
"The American Association of Medical Colleges has developed an initiative for health equity," Goyal said. "The National Institutes of Health have an Institute on Minority Health and Health Disparities, the Institute of Medicine also has an initiative to reduce health disparities and the Center for Disease Control and Prevention's Healthy People 2020 [agenda for improving the nation's health] includes achievement of health equity as one of its goals."
Zahiem Salahuddin was arrested and faced simple assault, reckless endangerment and possession of an "instrument of crime" charges just for using a toy.
Zahiem Salahuddin, a 13-year-old 8th grade student, was playing with his friends on the basketball court in Grays Ferry, Pa., this past summer. Salahuddin had a plastic toy gun that shot an orange plastic ball. A white boy was hit with the plastic ball. It was unclear which child shot the ball that hit the other child.
Salahuddin rode his bike home later, but was stopped by men in a black pickup truck who told him he shot at a Philadelphia police officer's son. Police in marked cars then arrived and Salahuddin was arrested, charged, and spent three days in jail.
For an orange plastic ball from a $3.50 toy, he faced simple assault, reckless endangerment and possession of an "instrument of crime."
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Instead of hiring a diversity and inclusion specialist to address diversity issues, they chose to hire mental health professionals and white-led university consultants.
After a report was released detailing racist incidents in the Haverford, Pa., school district and town, leadership in one of the most affluent regions in the country, with a predominantly white population, decided that diversity is not a priority.
"This is America 2018 right here. Racism and discrimination," Hamdia Ahmed said.
Shooter on trial might face life in prison, if convicted.
Jeffrey Zeigler, who is on trial for shooting at a lost Black teen in Rochester Hills, Mich., watched as his wife, Dana, broke down in tears in Oakland County Circuit Court on Tuesday, while testifying about the April 12 shooting, and watching a video of the incident.
Dana said she was frightened when she saw Brennan Walker, a 14-year-old Black teen, on her porch.
"What are you doing on my porch?" she recalled. "I saw a Black person standing at my door and I screamed at him, and I asked him what he was doing there."
Her report to police: "A Black male was trying to break into her house and her husband chased after him into the yard."
The video shows Zeigler aiming at the teen, despite the claims that he tripped and his gun fired.
Rochester Hills Michigan 6 months ago.
The surveillance footage was just released.
14 y/o Black Teen misses the bus to school & figures he knew the route well enough to walk the 4-mile route. He gets lost, stops to ask for directions, & nearly loses his life.
WHY WE KNEEL! pic.twitter.com/k3cnL3kO6u
— StanceGrounded (@_SJPeace_) October 11, 2018
Prosecutor Kelly Collins said that "being a bad shot does not negate one's intentions."
Walker, then age 14, had missed his bus to school that morning and came to the Zeigler's door for help. After his wife screamed, Zeigler fired a shotgun at the teen, but missed him.
Zeigler had referred to Walker, in an interview with a sheriff's deputy, as "that colored kid" at his front door. The defense initially claimed it was the interviewing officer who said "colored."
Zeigler also said he was "tired of being a victim."
His attorney, Rob Morad, has said that "race was not a factor in the shooting, but rather actions from passion instead of judgment," Morad told jurors. He said the couple had five previous break-ins and were on "high alert."
Walker's mother, Lisa Wright, who was also in tears in the courtroom watching the video of her son flee for his life, said that she believed the shooting was a hate crime and that she wanted to see the prosecution push this to the fullest extent.
In April, she said that she believed this was racially motivated. After watching a video near the time of the incident, she said: "You can hear the wife say, 'Why did these people choose my house?' Who are 'these people?' "
Walker testified that after he knocked on the front door, which is behind a screen door, Zeigler's wife accused him of trying to break in.
"I was scared," he testified. "I was trying to tell them that I was trying to get to high school, but they weren't listening."
Zeigler was arrested and released on $50,000 bond and ordered to wear a tracking device. He was charged with assault with intent to murder, which could lead to life in prison, Oakland County District Attorney Jessica R. Cooper said, along with use of a firearm in a felony.
Zeigler also has a conviction for firing a handgun at another motorist during a dispute in 2004.
Reader Question: Watching the video, would you say Zeigler is innocent or guilty of intent to murder?
A young girl had to tell the officer during questioning, "He's an after-school teacher and he's babysitting us."
A white woman in Georgia called the police on a Black man, Corey Lewis, as he babysat a 10-year-old white girl, and 6-year-old white boy. Their parents, who live in East Cobb, arranged for Lewis to babysit the kids weeks ago.
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"Do not assume you are properly registered to vote," warns activist Shaun King.
"Do not assume you are properly registered to vote," warned Shaun King repeatedly. His wife went to vote with her registration card in her hand, and they said she couldn't vote. King said some of the reasons that people are being turned away are nefarious.
Fifteen states close registration today, including Arizona, Arkansas, Florida, Georgia, Indiana, Kentucky, Louisiana, Michigan, Mississippi, New Mexico, Nevada, Ohio, Pennsylvania, Tennessee, and Texas. States that do not have online registration: Arkansas, Michigan, Mississippi, and Texas.
A list of every state's deadline and links to each state's voting requirements was published by the New York Times.
Tarrick Walker created a movement that's spreading outside of his community. You can join, too.
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Kiah Morris said the racism she endured for years was taking a toll on her husband's health. She chose her family over politics.
Kiah Morris is a former state representative in Vermont — a nearly all-white state. Morris recently stepped down because she had endured years of racially motivated harassment and threats — even local teens targeting her home.