EQUALITY IN THE DOCTOR'S OFFICE: Lawyers Seek Remedies
for Racial Disparities in U.S. Health Care, 1 NO. 19 ABA Journal
E-Report 10 (May 17, 2002)
The racial issues most often addressed in the United States concern
jobs, housing and education. But equal access to medical care may be as
urgent as any other need.
"Gaps in health care have not changed in 30 years,' said Annette
Dula, a senior research associate at the University of Colorado in
Boulder. 'The infant mortality rate of African-Americans since 1970 has
grown to three times that of whites.
The overall percentage of black doctors in the United States has
increased only four-tenths of a percent, from 3.5 percent to 3.9
percent, since that time.''
Dula spoke at a conference, "Bioethics, Minorities and the Law:
Rights and Remedies," held to raise awareness and discuss legal
efforts to reverse the trends. The meeting in Tuskegee, Ala., in early
April was co-sponsored by the ABA's Tort and Insurance Practice Section,
the Tuskegee University National Center for Bioethics in Research and
Health Care, and the National Bar Association, whose membership is
primarily minority lawyers.
"We lawyers have the capacity to help find remedies for victims
through the law," said Mitchell Orpett, immediate-past chair of
TIPS. The conference "remind[ed] us that we have a unique
capability to remedy injustice and craft legal protections."
The source of the disparities in medical services is complex,
according to a March report from the Washington, D.C.-based Institute of
Medicine, "Unequal Treatment: Confronting Racial and Ethnic
Disparities in Health Care."
"Disparities are rooted in historic and contemporary
inequities," the report states, "and involve many participants
at several levels, including health systems, their administrative and
bureaucratic processes, utilization managers, health care professionals
The report asserts that racial and ethnic minorities tend to receive
a lower quality of health care than
nonminorities, even when controlling for access- related factors such as
insurance, status and income.
Marian Gray Secundy, the newly appointed director of the Tuskegee
bioethics center, said, "The entire history of health care in the
United States has been shamefully blighted by a long series of racial
And this history of inequities cannot be ignored, said Tuskegee
University President Benjamin F. Payton.
"Blacks have difficulty feeling a sense of confidence in medical
care," he said. "It grew out of our history of abuse. It is
documented here in Macon County."
Tuskegee is the site of the infamous Tuskegee experiment, a U.S.
government study in which hundreds of black men suffering from syphilis
were observed without receiving treatment or being informed that they
had the disease. No white men were included in the study, which began in
1932 and lasted 40 years.
In 1997, President Clinton issued an official apology to the
survivors of the program and awarded a $200,000 grant to create the
Tuskegee University bioethics center.
One unfortunate legacy of the experiment, Dula said, is that blacks
are reluctant to participate in contemporary medical research programs
due to a lingering distrust of the medical system.
And low participation in research, including clinical trials, can
impede the development of effective
drugs and treatments, said M. Gabriela Arcade, an associate professor at
the University of Louisville's Institute for Bioethics, Health Policy
"Barriers to participation need to be addressed," she said.
"We must carefully incorporate racial and ethnic variables" to
drug and treatment testing to produce results that will be applicable to
a wide range of people.
The Tort and Insurance Practice Section presented a $5,000 donation
for the Tuskegee Human and Civil Rights Multicultural Center to Fred
Gray Sr., the Tuskegee attorney who represented and won settlements for
subjects of the syphilis experiment and for their descendants.