Race, Health Care and the Law 
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Race Medicine and HealthCare in LA County

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Vernellia R. Randall
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 Robert A. Beltran, M.D., M.B.A.
Vice-Chair, Governing Board
California Latino Medical Association

reprinted from California Physician, California Medical Association On-line Magazine

Our country faces a War on Health Care and a major battleground is Los Angeles County. What happens here will foreshadow how our country faces the commitment to provide health care for all.

On June 26, 2002, Los Angeles County’s new health director, Dr. Thomas Garthwaite, released his strategies for systemwide reform " This is a thoughtful and comprehensive document, but it is flawed, perhaps because it was put together do quickly. Dr. Garthwaite took office just five months ago. And while, he and his staff have spent many long and sleepless nights crafting it, the plan causes grave concern for community advocates, health service researchers, and health policy experts. They find flaws in the methodology, in the process, as well as in its conclusions.

Some critics of the Garthwaite plan have said that he has used a "chainsaw" instead of scalpel to make cuts and consolidations, leaving many jagged edges. One of these jagged edges exposes sometimes hidden inequalities in how our nation dispenses health care. In 1999, Dr. Kevin Schulman, then of Georgetown University Medical Center, documented how racial and gender bias distorts clinical decision-making. This sent shock waves throughout the health system, reminding us of how pervasive discrimination is in health. One-year prior, then-President Clinton issued his Executive Order on "Eliminating Racial and Ethnic Disparities in Health."

Our own Los Angeles County Department of Health Services documented the same disparities two years ago in a report called, " The Health of Angelenos." This report showed disparities in health status, health risks, medical access, and other health determinants for our multiethnic population in Los Angeles County.

And there is more evidence from private foundations and federal agencies. The Institute of Medicine report on "Unequal Care", released in March, discusses strategies on how to eliminate ethnic and racial disparities in health. The work of the Commonwealth Fund concentrates on two major areas related to improving health insurance coverage and access, and improving the quality of health care services.

Many in the healthcare arena find it incongruous that Los Angeles County can propose a major redesign of its health care system, yet downplay strategies and programs to reduce bias in the delivery of medical care.

This is a major short fall in the proposed redesign and it must be corrected if the Garthwaite plan is to be credible, successful, and sustainable.

Furthermore, many stakeholders in our county healthcare system hope politics as usual will not prevail; that Garthwaite will rethink his plan and in doing so provide a more inclusive process that utilizes the resources and intellectual capital of our multiethnic physicians and their medical associations.

After all, it is this group of healthcare providers who have the cultural/ linguistic and relationship expertise to communicate with the impacted populations. They are the physicians, nurses, and other professionals whose task it will be to mitigate the pain and suffering that is inevitable when drastic change occurs.

Let there be no doubt. The scenario, which our Board of Supervisors has constructed, will cause the crippling and collapse of our countywide healthcare delivery system. The Hippocratic Oath has a primary tenet: "First do no harm." It should be embraced by the supervisors.

Surely, combining the county crisis with the existing nurse shortage, increased delays in emergency room care, physician group failures, and the instability of healthcare finances is a recipe for terminal failure. What can be done to avert this disaster and the consequences that follow?

Our only salvation is the full force and leverage of community participation and advocacy, which will allow for wiser and more inclusive input. This, in combination with more flexible, efficient use of state and federal monies, will avoid full system collapse.

Short of this, no medicine, no bureaucratic magic, no surgical procedure can restore life to an already ailing healthcare system so badly in need of coordination, integration, and collaboration of services and healthcare providers both public and private.

Related Pages:
Home ] Up ] Racist Health Care ] Using Civil Rights Law to Eliminate Health Disparities ] Racist laws which effect Hispanic Health Care ] Minorities Health Access ] Access to Health Care and Minorities ] Discrimination and Inaccessibility ] Why Race Matters? ] Discrimination and Quality ] Racial Profiling in Health Care ] Self-Perpetuating Mythology - the Degenerate Black Patient ] Health and Civil Rights: Unfinished Agenda ] Lawyers Seek Remedies for Health Care Disparities ] [ Race Medicine and HealthCare in LA County ]
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Home ] Organ Transplantation and Advanced Technoloty ] Racial Discrimination ] Legislating a Public Health Nightmare: the Anti-immigrant Provisions of the "Contract with America" Congress ] Culturally Competent Care ] Mental Health Care and Race ] Site of Medical Care: Do Racial And Ethnic Differences Persist? ]
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Contact Information:
Professor Vernellia R. Randall
Institute on Race, Health Care and the Law
The University of Dayton School of Law
300 College Park 
Dayton, OH 45469-2772
Email: randall@udayton.edu


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