In July of 2018, Crystal Galloway was found by her mother unresponsive and lying on the bathroom floor of their Tampa, FL home. Ms. Galloway’s lips were swollen and she was drooling, which her mother assumed was indicative of an injury from a slip and fall. Her mother, Nicole Black, called paramedics, who responded to the residence, but failed to assess Ms. Galloway by measuring her vital signs -- a routine medical intervention to assess a patient’s status -- or transporting her to the hospital. Eventually, Ms. Black transported her daughter to the hospital where it was determined that Ms. Galloway suffered a stroke; she slipped into a coma and died five days later. The details of what transpired differ depending on who tells it; Ms. Black reports that she and her daughter were racially profiled and refused services because the paramedics were more preoccupied with the family’s ability to afford medical transport than the welfare of her daughter. The paramedics report that Ms. Galloway refused services and they cannot compel people to accept services. After a two month investigation by Hillsborough County Officials, Ms. Black’s account of racial discrimination could not be corroborated; however, one paramedic was fired, two were suspended and one demoted for failing to do their job appropriately. It was determined that the paramedics failed to take Ms. Galloway’s vitals and there was no evidence that Ms. Galloway refused the medical care that may have saved her life. The most compelling part of the investigation details released, is a statement made by Mike Morris, the terminated paramedic and lieutenant on the scene. According to ABC News, Mr. Morris stated that he would do the same thing over again and that he doesn't need to check the vitals of patients because he can gauge them just by looking. He admittedly used profiling over effective medical intervention like taking vital signs and patient history.
Crystal Galloways was a 30 year old black woman who had given birth via Cesarean section a week before her death. According to the Centers for Disease Control and Prevention (CDC), pregnancy puts women at a higher risk for stroke and pregnancy-related strokes are on the rise in the United States. So, it is reasonable to assume that had less profiling and more medical protocol been followed in the assessment of Crystal Calloway the outcome on that day may have been considerably different. Unfortunately, racialized profiling is a common tool used in medical practice.
In fact, racialized profiling in medicine is a major contributor to the harrowing disparities in maternal mortality rates in the United States. The U.S. has become a dangerous place for women to give birth, but particularly hazardous for specific groups of minority women. Black and Indigenous women in the U.S. are, respectively, three and two times more likely to die from a pregnancy-related incident than non-Hispanic White women (CDC, 2011-2016). The US maternal health crisis is gaining a plethora of attention domestically and internationally particularly because the U.S. is the only developed country where the maternal mortality rate is rising. For over 10 years, it has been known that two-thirds of the pregnancy-related deaths are preventable through improved quality of medical care and there has been success in reduction of deaths when initiatives have been targeted, but yet the racial disparity persists and is growing (Berg and Harper, et al. 2005; Main and Cape et al., 2017). Health organizations across the U.S. are aware of the issue of racism in maternal healthcare. There has been a rise in the implementation of implicit bias training for health care staff and a focus on Health Equity at state and national conferences repeating the statistics shared here and other statistics that paint the same picture. Racism is killing Black and Indigenous mothers in the United States.
Admittedly, this issue is not an easy one to address, but there are organizations that have taken steps to create tools to improve medical care through equitable means. One of these organizations is the Council on Patient Safety in Women’s Health Care, which is an alliance of national medical organizations that include the American College of Obstetrics and Gynecology (ACOG), the Society for Maternal-Fetal Medicine (SMFM) and the Association of Women’s Health and Obstetric and Neonatal Nursing (AWHONN). The Council’s mission is to “ continually improve patient safety in women’s health care through multidisciplinary collaboration that drives cultural change” and they do this work by creating and promoting safety bundles focused on preventable issues that commonly contribute to maternal mortality and severe morbidity related to pregnancy and birth. The Council created the Alliance for Innovation on Maternal Health (AIM), which is a “national data-driven maternal safety and quality improvement initiative based on proven implementation approaches to improving maternal safety and outcomes in the U.S.” as quoted from their website. The AIM program supports state teams and health systems to eliminate preventable maternal mortality and severe morbidity through innovative obstetric and non-obstetric strategies. The AIM program is marketed to states and health systems by promising access to Patient Safety Bundles and Tools, connection to a network of teams doing the same work and some level of technical assistance. One safety bundle specifically addresses racialized inequities: Reduction of Peripartum Racial/Ethnic Disparities. This bundle includes a readiness protocol, education and training for all staff, feedback loops, measurements and accountability through quality improvement techniques. An actual tool with specific, manageable action steps that health care providers can implement to address racial disparities with technical assistance from AIM. With the focus of the health care -- both Public Health and clinical health-- on advancing health equity to solve this persistent issue, the reasonable thought process is that all if not most of the AIM projects will focus on this Patient Safety Bundle to reduce racial disparities, right?
There are currently 20 AIM State teams prioritizing implementation of safety bundles across the United States and none of these states focus on implementing the Peripartum Racial/Ethnic Disparities Patient Safety Bundle (note as of August 2020 that the Council website no longer shares what AIM states are working on). It is unfathomable that a tool and an avenue to implementation is available and yet it is not being utilized by any state team or health system involved in this project. What is the disconnect? How can racism and implicit bias be recognized as major contributors to persistent racial disparities in maternal mortality, yet this tool is not adopted as an initiative to rectify this outcome? This blog is not meant to be a call out to state systems, but rather a call to further examine the fear of identifying racism as a problem in our institutions. We must get past the fragility of being called a racist in order to save women and babies from dying due to racism.
This has been one of those writings that I have picked up and put down over time. Because life of course. The 2nd anniversary of Crystal Galloway’s death has come and gone, more Black women, both known and unknown, continue to be taken too soon by a racist medical system, we are in the midst of an unprecedented infectious pandemic that of course is killing Black folk at astronomical rates compared to other groups. We are in the midst of an uprising due to rampant police brutality, the mistreatment and dehumanizing of Black people and the white supremacy that has gone unchecked for centuries. The masses are finally recognizing and naming the pandemic as old as the United States itself, racism. I am hopeful that America is on the brink of a change; ideally I am hopeful that this means radicalized change for advancement, but in many realms this means digging heels into “tradition,” “civility,” and all the other dog whistle language that means keep the status- quo of an America swaddled patriarchal, white supremacy.
As the way of a solution-based intellectual, I come with recommendations of actions healthcare facilities committed to change can take now to benefit Black mothers and babies:
Make attending anti-racist and implicit bias training a requirement for all personnel at every level. All front desk staff, office managers, nursing assistants, nurses, physician assistants, doctors and administrators. Everyone. Make it a requirement by including it in performance evaluations.
Make the training on racism in medicine and implicit/explicit bias an ongoing training topic, with required continuing education credits annually.
Do an organizational assessment on internal and external policies and practices; assess how anti-racist and Reproductive Justice centered your organization is. (Yes, shameless plug for the work RJ2 does)
Create a zero-tolerance policy on racism in your organization. There cannot be any middle ground here. If you are truly about being an anti-racist organization then you need to treat racism like the weapon it is.
Use the tools available to you. In this article, the under utilization of the Peripartum Racial/Ethnic Disparities Patient Safety Bundle was highlighted. This is unacceptable. The resources available are only as good as how they are implemented.
This blogentry is in remembrance of Crystal Galloway. We will not forget your name.
Sources:
https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/maternal_mortality_a/state/ALL (Great resource with links to other papers)
C. Berg and M. Harper et al.(2005)Preventability of Pregnancy- Related Deaths: Results of a State-wide review.
Main and Cape (2017) Reduction of severe maternal morbidity from hemorrhage using a state perinatal quality collaborative https://www.ajog.org/article/S0002-
9378(17)30124-2/fulltext