Tagged Race and Health

“Todo lo que quieres es que te crean”: el prejuicio inconciente en la atención de salud

A mediados de marzo, Karla Monterroso voló a su casa en Alameda, California, después de una excursión al Parque Nacional Zion de Utah. Cuatro días después, comenzó a tener una tos seca y fuerte. Sentía los pulmones pegajosos.

La fiebre durante esas semanas por momentos subía tanto (100,4, 101,2, 101,7, 102,3) que, en la peor de las noches, tenía que estar bajo una ducha de agua helada, para intentar bajarla.

“Esa noche había escrito en un diario cartas a todas las personas cercanas, lo que quería que supieran si me moría”, recordó.

Al mes, surgieron nuevos síntomas: dolores de cabeza y calambres punzantes en las piernas y el abdomen que le hicieron pensar que podía estar en riesgo de tener coágulos de sangre y accidentes cerebrovasculares, complicaciones que habían informado otros pacientes con COVID-19 en sus 30 años.

Aún así, no estaba segura de si debía ir al hospital.

“Como mujeres de color, te cuestionan mucho tus emociones y la realidad de tu estado físico. Te dicen que exageras”, dijo Monterroso, quien es latina. “Así que tenía ese extraño sentimiento de ‘no quiero usar los recursos para nada’”.

Fueron necesarios cuatro amigos para convencerla de que tenia que llamar al 911.

Lo que pasó en la sala de emergencias del Hospital Alameda confirmó sus peores temores.

Monterroso dijo que durante casi toda su visita, los proveedores de salud ignoraron sus síntomas y preocupaciones. ¿La presión arterial está baja? Esa es una lectura falsa. ¿Sus niveles cíclicos de oxígeno? La máquina está mal. ¿Los dolores punzantes en la pierna? Probablemente solo sea un quiste.

“El médico entró y dijo: ‘No creo que esté pasando mucho aquí. Creo que podemos enviarte a casa’”, recordó Monterroso.

Su experiencia, razona, son parte de por qué las personas de color se ven afectadas de manera desproporcionada por el coronavirus. No es simplemente porque es más probable que tengan trabajos de primera línea que los exponen más, y las condiciones subyacentes que empeoran COVID-19.

“Eso es parte de ello, pero la otra parte es la falta de valor que la gente le da a nuestras vidas”, escribió Monterroso en Twitter detallando su experiencia.

Investigaciones muestran cómo el prejuicio inconsciente de los médicos afecta la atención que reciben las personas. Los pacientes latinos (que pueden ser de cualquier raza) y los afroamericanos suelen ser menos propensos a recibir analgésicos o a ser referidos para atención avanzada que los pacientes blancos no hispanos con las mismas quejas o síntomas. Y es más probable que las mujeres mueran en el parto por causas prevenibles.

Ese día de mayo, en el hospital, Monterroso se sentía mareada y tenía problemas para comunicarse, por lo que estaban con ella en el teléfono para ayudarla una amiga y la prima de su amiga, que es enfermera especializada en cardiología. Las dos mujeres comenzaron a hacer preguntas: ¿Qué pasa con la frecuencia cardíaca acelerada de Karla? ¿Sus bajos niveles de oxígeno? ¿Por qué sus labios están azules?

El médico salió de la habitación. Se negó a atender a Monterroso mientras sus amigas estaban al teléfono, dijo, y cuando regresó, de lo único que quería hablar era del tono de Monterroso y el tono de sus amigos.

“La implicación era que éramos insubordinadas”, dijo Monterroso.

Monterroso le dijo al médico que no quería hablar sobre su tono. Quería hablar sobre su atención médica. Estaba preocupada por posibles coágulos de sangre en su pierna y pidió una tomografía computada.

“Bueno, ya sabes, la tomografía computarizada es radiación justo al lado del tejido mamario. ¿Quieres tener cáncer de mama?”, Monterroso recuerda que le dijo el médico. “Solo me siento cómodo ordenándote esa prueba si dices que no tienes problema en tener cáncer de seno”.

Monterroso pensó para sí misma: “Trágatelo, Karla. Necesitas estar bien”. Entonces le dijo al médico: “Estoy bien con el cáncer de mama”.

Nunca ordenó la prueba.

Monterroso pidió otro médico, un abogado del hospital. Le dijeron que no. Comenzó a preocuparse por su seguridad. Quería irse. Sus amigos estaban llamando a todos los profesionales médicos que conocían para confirmar que no estaba siendo bien atendida. Vinieron a recogerla y la llevaron a la Universidad de California-San Francisco. El equipo le hizo un electrocardiograma, una radiografía de tórax y una tomografía computada.

“Una de las enfermeras entró y dijo: ‘Me enteré de tu terrible experiencia. Solo quiero que sepas que te creo. Y no te vamos a dejar ir hasta que sepamos que estás segura”, dijo Monterroso. “Comencé a llorar. Porque eso es todo lo que quieres: que te crean. Es realmente difícil que te cuestionen de esa manera”.

Alameda Health System, que opera el Hospital Alameda, se negó a comentar sobre los detalles del caso de Monterroso, pero dijo en un comunicado que está “profundamente comprometido con la equidad en el acceso a la atención médica” y que “brinda atención culturalmente sensible para todos”. ” Después que Monterroso presentó una queja ante el hospital, la gerencia la invitó a hablar con su personal y residentes, pero se negó.

Monterroso cree que su experiencia es un ejemplo de por qué a las personas de color les va tan mal con la pandemia.

“Porque cuando vamos a buscar atención, si nos defendemos, podemos ser tratados como insubordinados”, dijo. “Y si no nos defendemos, podemos ser tratados como invisibles”.

Sesgo inconsciente en la atención médica

Los expertos dicen que esto sucede de forma rutinaria y sin importar las intenciones o la raza del médico. Por ejemplo, el médico de Monterroso no era blanco.

Investigaciones muestran que todos los médicos, todos los seres humanos, tienen prejuicios de los que no son conscientes, explicó el doctor René Salazar, decano asistente de diversidad en la Escuela de Medicina de la Universidad de Texas-Austin.

“¿Interrogo a un hombre blanco con traje que llega luciendo como un profesional cuando pide analgésicos de la misma manera que a un hombre negro?”, se preguntó Salazar, señalando uno de sus posibles sesgos.

El prejuicio inconsciente suele aparecer en entornos de alto estrés, como las salas de emergencia, donde los médicos se encuentran bajo una tremenda presión y tienen que tomar decisiones rápidas y de gran importancia. Si se agrega una pandemia mortal, en la que la ciencia cambia día a día, las cosas pueden complicarse.

“Hay tanta incertidumbre”, dijo. “Cuando existe esta incertidumbre, siempre hay un nivel de oportunidad para que el sesgo se abra paso y tenga un impacto”.

A vehicle parked in Oakland, California, during the first weeks of the 2020 Black Lives Matter demonstrations.(April Dembosky)

Salazar solía enseñar en UCSF, donde ayudó a desarrollar una formación sobre prejuicios inconscientes para estudiantes de medicina y farmacia. Aunque docenas de escuelas de medicina están retomando la capacitación, dijo, no se realiza con tanta frecuencia en los hospitales. Incluso cuando se aborda un encuentro negativo como el de Monterroso, la intervención suele ser débil.

“¿Cómo le digo a mi médico, ‘Bueno, el paciente cree que eres racista’?”, apuntó Salazar. “Es una conversación difícil: debo tener cuidado, no quiero decir la palabra sobre la raza porque voy a presionar algunos botones complejos. Así que comienza a complicarse mucho”.

Un enfoque basado en datos

El doctor Ronald Copeland dijo que recuerda que los médicos también se resistían a estas conversaciones cuando eran estudiantes. Las sugerencias para talleres sobre sensibilidad cultural o prejuicios inconscientes recibían una reacción violenta.

“Era visto casi como un castigo. Es como, ‘Usted es un mal médico, por lo que su castigo es que tiene que ir a capacitarse’, explicó Copeland, quien es jefe de equidad, inclusión y diversidad en el sistema de salud de Kaiser Permanente. (KHN es un programa editorialmente independiente de KFF, que no está afiliado a Kaiser Permanente).

Ahora, el enfoque de Kaiser Permanente se basa en datos de encuestas a pacientes que preguntan si la persona se sintió respetada, si la comunicación fue buena y si quedó satisfecha con la experiencia.

Luego se desglosan estos datos por demografía, para ver si un médico puede obtener buenas calificaciones en respeto y empatía de los pacientes blancos no hispanos, pero no de los pacientes de raza negra.

“Si ves un patrón que evoluciona alrededor de un grupo determinado y es un patrón persistente, entonces eso te dice que hay algo que proviene de una cultura, de una etnia, de un género, algo que el grupo tiene en común, que no estás abordando, dijo Copeland. “Entonces comienza el verdadero trabajo”.

Cuando a los médicos se les presentan los datos de sus pacientes y la ciencia sobre el sesgo inconsciente, es menos probable que se resistan o nieguen, agregó. En su sistema de salud, han reformulado el objetivo de la capacitación en torno a brindar una atención de mejor calidad y obtener mejores resultados para los pacientes, por lo que los médicos quieren hacerlo.

“La gente no se inmuta”, dijo. “Están ansiosos por aprender más al respecto, especialmente sobre cómo mitigarlo”.

Todavía se siente mal

Han pasado casi seis meses desde que Monterroso se enfermó por primera vez y todavía no se siente bien.

Su frecuencia cardíaca sigue aumentando y los médicos le dijeron que podría necesitar una cirugía de vesícula para tratar los cálculos biliares que desarrolló como resultado de la deshidratación relacionada con COVID. Recientemente decidió dejar el Área de la Bahía y mudarse a Los Ángeles para poder estar más cerca de su familia durante su larga recuperación.

Rechazó la invitación del Hospital Alameda para hablar con su personal sobre su experiencias porque concluyó que no era su responsabilidad arreglar el sistema. Pero sí quiere que el sistema de salud más amplio asuma la responsabilidad del sesgo sistémico en hospitales y clínicas.

Reconoce que el Hospital Alameda es público y no tiene el tipo de recursos que tienen Kaiser Permanente y UCSF. Una auditoría reciente advirtió que el Sistema de Salud de Alameda estaba al borde de la insolvencia. Pero Monterroso es la directora ejecutiva de Code2040, una organización sin fines de lucro sobre equidad racial en el sector tecnológico e incluso para ella, dijo, se necesitó un ejército de apoyo para que la escucharan.

“El 90% de las personas que van a pasar por ese hospital no van a tener los recursos que yo tengo para enfrentarlos”, dijo. “Y si no digo lo que está sucediendo, entonces personas con muchos menos recursos van tener esta experiencia y se van a morir”.

Esta historia es parte de una asociación que incluye a KQED, NPR y KHN.

Related Topics

California Noticias En Español Public Health Race and Health States

‘All You Want Is to Be Believed’: The Impacts of Unconscious Bias in Health Care

In mid-March, Karla Monterroso flew home to Alameda, California, after a hiking trip in Utah’s Zion National Park. Four days later, she began to develop a bad, dry cough. Her lungs felt sticky.

The fevers that persisted for the next nine weeks grew so high — 100.4, 101.2, 101.7, 102.3 — that, on the worst night, she was in the shower on all fours, ice-cold water running down her back, willing her temperature to go down.

“That night I had written down in a journal, letters to everyone I’m close to, the things I wanted them to know in case I died,” she remembered.

Then, in the second month, came a new batch of symptoms: headaches and shooting pains in her legs and abdomen that made her worry she could be at risk for the blood clots and strokes that other COVID-19 patients in their 30s had reported.

Still, she wasn’t sure if she should go to the hospital.

“As women of color, you get questioned a lot about your emotions and the truth of your physical state. You get called an exaggerator a lot throughout the course of your life,” said Monterroso, who is Latina. “So there was this weird, ‘I don’t want to go and use resources for nothing’ feeling.”

It took four friends to convince her she needed to call 911.

But what happened in the emergency room at Alameda Hospital only confirmed her worst fears.

At nearly every turn during her emergency room visit, Monterroso said, providers dismissed her symptoms and concerns. Her low blood pressure? That’s a false reading. Her cycling oxygen levels? The machine’s wrong. The shooting pains in her leg? Probably just a cyst.

“The doctor came in and said, ‘I don’t think that much is happening here. I think we can send you home,’” Monterroso recalled.

Her experiences, she reasons,  are part of why people of color are disproportionately affected by the coronavirus. It is not merely because they’re more likely to have front-line jobs that expose them to it and the underlying conditions that make COVID-19 worse.

“That is certainly part of it, but the other part is the lack of value people see in our lives,” Monterroso wrote in a Twitter thread detailing her experience.

Research shows how doctors’ unconscious bias affects the care people receive, with Latino and Black patients being less likely to receive pain medications or get referred for advanced care than white patients with the same complaints or symptoms, and more likely to die in childbirth from preventable complications.

In the hospital that day in May, Monterroso was feeling woozy and having trouble communicating, so she had a friend and her friend’s cousin, a cardiac nurse, on the phone to help. They started asking questions: What about Karla’s accelerated heart rate? Her low oxygen levels? Why are her lips blue?

The doctor walked out of the room. He refused to care for Monterroso while her friends were on the phone, she said, and when he came back, the only thing he wanted to talk about was Monterroso’s tone and her friends’ tone.

“The implication was that we were insubordinate,” Monterroso said.

She told the doctor she didn’t want to talk about her tone. She wanted to talk about her health care. She was worried about possible blood clots in her leg and she asked for a CT scan.

“Well, you know, the CT scan is radiation right next to your breast tissue. Do you want to get breast cancer?” Monterroso recalled the doctor saying to her. “I only feel comfortable giving you that test if you say that you’re fine getting breast cancer.”

Monterroso thought to herself, “Swallow it up, Karla. You need to be well.” And so she said to the doctor: “I’m fine getting breast cancer.”

He never ordered the test.

A vehicle parked in Oakland, California, during the first weeks of the 2020 Black Lives Matter demonstrations.(April Dembosky)

Monterroso asked for a different doctor, for a hospital advocate. No and no, she was told. She began to worry about her safety. She wanted to get out of there. Her friends, all calling every medical professional they knew to confirm that this treatment was not right, came to pick her up and drove her to the University of California-San Francisco. The team there gave her an EKG, a chest X-ray and a CT scan.

“One of the nurses came in and she was like, ‘I heard about your ordeal. I just want you to know that I believe you. And we are not going to let you go until we know that you are safe to go,’” Monterroso said. “And I started bawling. Because that’s all you want is to be believed. You spend so much of the process not believing yourself, and then to not be believed when you go in? It’s really hard to be questioned in that way.”

Alameda Health System, which operates Alameda Hospital, declined to comment on the specifics of Monterroso’s case, but said in a statement that it is “deeply committed to equity in access to health care” and “providing culturally-sensitive care for all we serve.” After Monterroso filed a grievance with the hospital, management invited her to come talk to their staff and residents, but she declined.

She believes her experience is an example of why people of color are faring so badly in the pandemic.

“Because when we go and seek care, if we are advocating for ourselves, we can be treated as insubordinate,” she said. “And if we are not advocating for ourselves, we can be treated as invisible.”

Unconscious Bias in Health Care

Experts say this happens routinely, and regardless of a doctor’s intentions or race. Monterroso’s doctor was not white, for example.

Research shows that every doctor, every human being, has biases they’re not aware of, said Dr. René Salazar, assistant dean for diversity at the University of Texas-Austin medical school.

“Do I question a white man in a suit who’s coming in looking like he’s a professional when he asks for pain meds versus a Black man?” Salazar said, noting one of his own possible biases.

Unconscious bias most often surfaces in high-stress environments, like emergency rooms — where doctors are under tremendous pressure and have to make quick, high-stakes decisions. Add in a deadly pandemic, in which the science is changing by the day, and things can spiral.

“There’s just so much uncertainty,” he said. “When there is this uncertainty, there always is a level of opportunity for bias to make its way in and have an impact.”

Salazar used to teach at UCSF, where he helped develop unconscious-bias training for medical and pharmacy students. Although dozens of medical schools are picking up the training, he said, it’s not as commonly performed in hospitals. Even when a negative patient encounter like Monterroso’s is addressed, the intervention is usually weak.

“How do I tell my clinician, ‘Well, the patient thinks you’re racist?’” Salazar said. “It’s a hard conversation: ‘I gotta be careful, I don’t want to say the race word because I’m going to push some buttons here.’ So it just starts to become really complicated.”

A Data-Based Approach

Dr. Ronald Copeland said he remembers doctors also resisting these conversations in the early days of his training. Suggestions for workshops in cultural sensitivity or unconscious bias were met with a backlash.

“It was viewed almost from a punishment standpoint. ‘Doc, your patients of this persuasion don’t like you and you’ve got to do something about it.’ It’s like, ‘You’re a bad doctor, and so your punishment is you have to go get training,” said Copeland, who is chief of equity, inclusion and diversity at the Kaiser Permanente health system. (KHN is an editorially independent program of KFF, which is not affiliated with Kaiser Permanente.)

Now, KP’s approach is rooted in data from patient surveys that ask if a person felt respected, if the communication was good and if they were satisfied with the experience.

KP then breaks this data down by demographics, to see if a doctor may get good scores on respect and empathy from white patients, but not Black patients.

“If you see a pattern evolving around a certain group and it’s a persistent pattern, then that tells you there’s something that from a cultural, from an ethnicity, from a gender, something that group has in common, that you’re not addressing,” Copeland said. “Then the real work starts.”

When doctors are presented with the data from their patients and the science on unconscious bias, they’re less likely to resist it or deny it, Copeland said. At his health system, they’ve reframed the goal of training around delivering better quality care and getting better patient outcomes, so doctors want to do it.

“Folks don’t flinch about it,” he said. “They’re eager to learn more about it, particularly about how you mitigate it.”

Still Unwell

It’s been nearly six months since Monterroso first got sick, and she’s still not feeling well.

Her heart rate continues to spike and doctors told her she may need gallbladder surgery to address the gallstones she developed as a result of COVID-related dehydration. She decided recently to leave the Bay Area and move to Los Angeles so she could be closer to her family for the long recovery.

She declined Alameda Hospital’s invitation to speak to their staff about her experience, concluding it wasn’t her responsibility to fix the system. But she wants the broader health care system to take responsibility for the bias perpetuated in hospitals and clinics.

She acknowledges that Alameda Hospital is public, and it doesn’t have the kind of resources that KP and UCSF do. A recent audit warned that the Alameda Health System was on the brink of insolvency. But Monterroso is the CEO of Code2040, a racial equity nonprofit in the tech sector and even for her, she said, it took an army of support for her to be heard.

“Ninety percent of the people that are going to come through that hospital are not going to have what I have to fight that,” she said. “And if I don’t say what’s happening, then people with much less resources are going to come into this experience, and they’re going to die.”

This story is part of a partnership that includes KQED, NPR and KHN.

Related Topics

California Public Health Race and Health States

COVID en LA: prevención en los trabajos ha salvado vidas de latinos, dicen oficiales

Funcionarios del condado de Los Angeles atribuyen la dramática disminución de casos y muertes por COVID-19 entre afroamericanos y latinos, en los últimos dos meses, a la agresiva aplicación de las normas de salud en los lugares de trabajo y a la apertura de líneas para denunciar si no se cumplen.

Ahora, los funcionarios buscan consolidar esos logros creando comités de empleados capacitados para detectar transgresiones en la prevención de COVID-19, y corregirlas o reportarlas, sin temor al despido o al castigo.

Cal/OSHA, la autoridad estatal de seguridad y salud en el trabajo, está abrumada con quejas y denuncias sobre el incumplimiento de las normas anti-COVID; y los supervisores de salud del condado —había 346 hasta el 9 de octubre— no pueden vigilar los más de 240,000 negocios de Los Angeles, según activistas.

Los comités ayudarían a evitar que Los Angeles retroceda en su esfuerzo por mitigar los casos y las disparidades raciales en el otoño, ya que es probable que más empresas vuelvan a la actividad, señaló Tia Koonse, investigadora del UCLA Labor Center y coautora de la evaluación sobre la propuesta para formar comités de empleados.

Se espera que la Junta de Supervisores del condado de Los Angeles apruebe una ordenanza este mes para que los negocios permitan que los empleados formen los comités, lo cual solucionaría los problemas de incumplimiento e informaría al departamento de salud cuando sea necesario.

Los críticos, incluyendo muchos líderes empresariales, dicen que la medida creará más burocracia en el peor momento posible para la economía. Pero grupos laborales y algunas empresas aseguran que es crucial para combatir la pandemia.

A trabajadores de diferentes partes del país se los despidió o castigó por quejarse de violaciones de seguridad relacionadas con COVID, y las leyes que los protegen no son consistentes.

“Los trabajadores tienen derecho a estar en un espacio seguro y no deben sufrir represalias” por señalar prácticas deficientes, dijo Barbara Ferrer, directora del Departamento de Salud Pública del condado de Los Angeles. Los trabajadores con bajos salarios han estado “en enorme desventaja” al tener que trabajar fuera de casa en contacto con otras personas, a menudo sin  protección suficiente, añadió Ferrer.

Durante el aumento de los casos de COVID que siguieron a las reuniones familiares del fin de semana de Memorial Day y a la apertura de negocios, los latinos (que pueden ser ser cualquier raza) en Los Angeles tenían una tasa de mortalidad cuatro veces mayor que la de los blancos no hispanos, mientras que las personas de raza negra tenían el doble de probabilidades que los blancos no hispanos de morir por la enfermedad.

Dos meses después, las tasas de mortalidad entre personas de raza negra y latinos habían disminuido a casi la mitad y se estaban acercando a la tasa de los blancos no hispanos, según los datos ajustados por edad del departamento de salud del condado.

Mientras que a finales de julio el número de latinos que daban positivo por COVID era cuatro veces mayor que el de blancos no hispanos, a mediados de septiembre los índices de casos de latinos eran sólo un 64% más altos. La tasa de positividad entre las personas de raza negra era un 60% más alta que la de los blancos a finales de julio, pero la disparidad había disminuido a mediados de septiembre.

Los expertos no saben si una política concreta es la responsable de esta disminución de muertes. Además, las tasas estatales y de los condados han disminuido para toda la población en las últimas semanas. Pero Ferrer atribuyó el progreso a que su departamento se centra en el cumplimiento de las directrices de salud en el lugar de trabajo, que incluyen reglas sobre el distanciamiento físico, proveer cubrebocas para los trabajadores y también exigir a los clientes que las usen.

“Para los que no cumplan con las directrices, en este momento podemos emitir citaciones, o hay casos en los que simplemente cerramos el lugar porque la transgresión es mayor”, explicó.

Las agudas disparidades raciales, que caracterizaron a la pandemia desde el principio, están ahora bajo mayor escrutinio ya que California se ha convertido en el primer estado que ha hecho de la “equidad en salud” un factor a la hora de permitir una reapertura ampliada.

Es posible que los condados grandes no avancen hacia la reapertura total hasta que sus vecindarios más desfavorecidos, y no sólo el condado en su conjunto, cumplan o estén por debajo de los niveles de enfermedad previstos. Los criterios obligan a los gobiernos locales a invertir más en pruebas, rastreo de contactos y educación en los barrios pobres con altos niveles de la enfermedad.

El enfoque de Ferrer en el lugar de trabajo se cristalizó durante una intervención en Los Angeles Apparel, una fábrica de ropa que se había puesto a fabricar máscaras faciales durante la pandemia. A pesar del inventario de máscaras, un brote en la fábrica resultó en al menos 300 casos, y cuatro muertes.

El departamento de salud intervino después de una denuncia de los centros de salud comunitarios que se vieron desbordados por los trabajadores enfermos de Los Angeles Apparel. El departamento cerró la fábrica el 27 de junio. Esa acción resaltó la necesidad de unir al gobierno y a los sindicatos para luchar contra la pandemia, indicó Jim Mangia, CEO de St. John’s Well Child & Family Center, una cadena de centros de salud comunitarios en el sur de L.A.

“En el St. John’s, casi todos nuestros pacientes son trabajadores pobres”, explicó Mangia. “Se contagiaban en el trabajo y lo llevaban a sus familias, y creo que intervenir en el lugar de trabajo es lo que realmente marcó la diferencia”.

Al principio de la pandemia, Ferrer también había establecido una línea de denuncia anónima para los empleados que quisieran reportar incuplimientos en el lugar de trabajo. Recibe unas 2,000 llamadas a la semana, según Ferrer. Hasta el 10 de octubre, el sitio web del departamento nombra 132 lugares de trabajo que han tenido tres o más casos confirmados de COVID-19, con un total de 2,191 positivos. Otra tabla, con fecha 7 de octubre, enumera 124 citaciones, la mayoría a gimnasios y lugares de culto, por no cumplir con una directriz de un oficial de salud.

“Afortunadamente, no somos como Cal/OSHA, en el sentido de que no nos lleva meses completar una investigación”, comentó Ferrer. “Somos capaces de movernos más rápidamente siguiendo las órdenes del oficial de salud para asegurarnos de que estamos protegiendo a los trabajadores”.

Los comités de salud pública son la siguiente fase del plan de Ferrer para mantener a los trabajadores seguros. El plan surgió de la respuesta de Overhill Farms, una factoría de alimentos congelados en Vernon, California, después de un brote de más de 20 casos y una muerte. La fábrica y su agencia de trabajo temporal fueron penalizadas con más de $200,000 en multas propuestas por Cal/OSHA en septiembre, pero antes de que llegaran las multas, la dirección de la fábrica reaccionó celebrando reuniones con los trabajadores para mejorar la seguridad.

“Encontraron que los trabajadores les ayudaron a bajar la tasa de infección y ayudaron a resolver los problemas”, dijo Roxana Tynan, directora ejecutiva de la Alianza de Los Angeles para una Nueva Economía, una organización de defensa de los trabajadores.

Si bien no es exactamente un caso que ensalce la generosidad corporativa, el cambio en Overhill Farms agregó credibilidad a los beneficios de los comités de trabajadores, señaló Koonse de UCLA.

Ninguna empresa tendría que gastar más del 0,44% de su nómina en los comités de salud, según Koonse.

Aún así, la idea ha sido recibida con división de opiniones por parte de las empresas. En una declaración del 24 de agosto, la CEO Tracy Hernández de la Federación de Negocios del Condado de Los Angeles escribió que la propuesta agregaría “programas onerosos y enrevesados que dificultarán, aún más, la capacidad de un empleador para cumplir con las demandas, recuperarse y servir adecuadamente a sus empleados y clientes”.

Pero Jim Amen, presidente de la cadena de supermercados Super A Foods, dijo que los negocios deberían dar la bienvenida a los comités, como una forma de mantener abiertas las líneas de comunicación. Tales prácticas han mantenido los índices de infección bajos en las tiendas, incluso sin un mandato, expresó Amen.

“En lo que respecta a Super A, nuestros empleados están muy involucrados en todo lo que hacemos”, añadió Amen.

Las organizaciones laborales ven a los comités como una forma crucial para que los trabajadores planteen sus preocupaciones sin temor a represalias.

“En industrias de bajos salarios, como la de la confección, el hecho de que los trabajadores se unan hace que los despidan”, dijo Marissa Nuncio, directora del Centro de Trabajadores de la Confección, una organización sin fines de lucro que sirve principalmente a inmigrantes de México y América Central.

Aunque las disparidades se están reduciendo en el condado de Los Angeles, algunas empresas siguen siendo inseguras y los posibles denunciantes no confían en que sus informes a la línea de denuncias del condado se lleven a cabo, añadió Nuncio.

“Seguimos recibiendo llamadas de miembros de nuestra organización que están enfermos, tienen COVID y están hospitalizados”, señaló Nuncio. “Y el lugar más obvio para que se hayan infectado es en su lugar de trabajo, porque no se están tomando precauciones”.

La reportera de datos Hannah Recht colaboró con esta historia.

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COVID Crackdowns at Work Have Saved Black and Latino Lives, LA Officials Say

Los Angeles County officials attribute a dramatic decline in COVID-19 death and case rates among Blacks and Latinos over the past two months to aggressive workplace health enforcement and the opening of tip lines to report violations.

Now, officials intend to cement those gains by creating workplace councils among employees trained to look for COVID-19 prevention violations and correct or report them — without fear of being fired or punished.

Cal/OSHA, the state’s workplace safety and health authority, is overwhelmed with complaints and tips about COVID-19 violations, and the county’s health investigators — there were officially 346 of them as of last Friday — can’t possibly keep tabs on all of Los Angeles’ more than 240,000 businesses, labor advocates say.

The councils could help keep Los Angeles from backsliding on its progress in mitigating cases and racial disparities in the fall as more businesses are likely to reopen, said Tia Koonse, a researcher with the UCLA Labor Center and co-author of an assessment of the workplace council proposal. The L.A. County Board of Supervisors is expected to approve an ordinance this month requiring businesses to permit employees to form the councils, which would troubleshoot compliance issues and report to the health department when necessary.

Critics, including many business leaders, say the measure will create more red tape at the worst possible time for the economy. But labor groups and some businesses say it is crucial to fighting the pandemic. Workers around the country have been sacked or reprimanded for complaining about COVID-related safety violations, and laws protecting them are spotty.

“Workers have a right to be in a safe space and shouldn’t face any retaliation” for noting poor practices, said Barbara Ferrer, director of the L.A. County Public Health Department. Low-wage workers have been “tremendously disadvantaged” by having to work outside the home in contact with other people, often without sufficient protection, she said.

During the upsurge of COVID cases that followed Memorial Day weekend family gatherings and business openings, Latinos in Los Angeles were dying at a rate more than four times higher than that of whites, while Blacks were twice as likely as whites to die of the disease. Two months later, death rates among Blacks and Latinos had fallen by more than half and were approaching the rate for whites, according to age-adjusted data from the county health department.

While four times as many Latinos as whites were reported COVID-positive in late July, the Latino case rates were only 64% higher by mid-September. The positivity rate among Blacks was 60% higher than that of whites in late July, but the disparity had waned by mid-September.

Experts can’t be certain that any one policy is responsible for the decline in deaths among Blacks and Latinos in Los Angeles — and state and county rates have declined for the entire population in recent weeks. But Ferrer attributed the progress to her department’s focus on workplace enforcement of health orders, which include rules about physical distancing, providing face coverings for workers and requiring face coverings for customers.

“If you’re in violation, at this point we can either issue citations, or there are cases where we just close the place down because the violations are egregious,” she said.

The sharp racial disparities that characterized the pandemic from the beginning are under even more scrutiny now that California has become the first state to make “health equity” a factor in its decisions to allow expanded reopening.

Large counties may not advance toward full reopening until their most disadvantaged neighborhoods, and not just the county as a whole, meet or are lower than the targeted levels of disease. The criteria prod local governments to invest more in testing, contact tracing and education in poor neighborhoods with high levels of the disease.

Ferrer’s focus on workplaces crystallized during a crackdown on Los Angeles Apparel, a clothing factory that had pivoted to face mask manufacturing during the pandemic. Despite the ready inventory of masks, an outbreak at the factory resulted in at least 300 cases — and four deaths.

The health department, acting on a tip from community health centers flooded with sick Los Angeles Apparel workers, shut down the factory on June 27. That action highlighted the need to bring the government and labor unions together to fight the pandemic, said Jim Mangia, CEO of St. John’s Well Child & Family Center, a chain of community health centers in South L.A.

“At St. John’s, almost all of our patients are the working poor,” Mangia said. “They were getting infected at work and bringing it home to their families, and I think intervening at the workplace is what really made all the difference.”

Early in the pandemic, Ferrer had also set up an anonymous complaint line for employees who want to report workplace violations. It gets about 2,000 calls a week, she said. As of Oct. 10, the department’s website lists 132 workplaces that have had three or more confirmed COVID-19 cases, with a total of 2,191 positives. Another table dated Oct. 7 lists 124 citations — mostly to gyms and places of worship — for failing to comply with a health officer order.

“Fortunately, we’re not like Cal/OSHA, in the sense that it doesn’t take us months to complete an investigation,” Ferrer said. “We’re able to move more swiftly under the health officer orders to actually make sure that we’re protecting workers.”

Public health councils are the next phase in Ferrer’s plan to keep workers safe. The plan stemmed from the response of Overhill Farms, a frozen-food factory in Vernon, California, after an outbreak of more than 20 cases and one death. The factory and its temporary job agency were hit with more than $200,000 in proposed penalties from Cal/OSHA in September, but before the fines landed, the factory leadership was already responding by beginning to hold meetings with workers to improve safety there.

“They found that the workers helped them bring down infection rates and helped solve problems,” said Roxana Tynan, executive director of the Los Angeles Alliance for a New Economy, a worker advocacy organization.

While it’s not exactly a feel-good story about corporate beneficence, the turnaround at Overhill Farms added credence to the benefits of workplace councils, said Koonse of UCLA.

No company would have to spend more than 0.44% of its payroll cost on the health councils, she estimated.

Still, the idea has gotten a mixed reception from businesses. In an Aug. 24 statement, CEO Tracy Hernandez of the L.A. County Business Federation wrote that the proposal would add “burdensome and convoluted programs that will further hinder an employer’s ability to meet demands, get back on their feet, and adequately serve their employees and customers.”

But Jim Amen, president of the eight-store Super A Foods grocery chain, said businesses should welcome the councils as a way to keep lines of communication open. Such practices have kept infection rates low at his stores, even without a mandate, Amen said.

“All I know is, for Super A, our employees are heavily involved in everything we do,” Amen said.

Labor groups see the councils as a crucial way for workers to raise concerns without fear of retaliation.

“In low-wage industries like the garment industry, workers coming together gets them fired,” said Marissa Nuncio, director of the Garment Worker Center, a nonprofit that mainly serves immigrants from Mexico and Central America.

While disparities are narrowing in L.A. County, some shops are still unsafe and potential whistleblowers aren’t confident their reports to the county’s tip line are being acted on, she said.

“We continue to get calls from our members who are sick, have COVID and are hospitalized,” Nuncio said. “And the most obvious location for them to have been infected is in their workplace, because so many precautions are not being taken.”

KHN data reporter Hannah Recht contributed to this article.

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Black Doctors Work to Make Coronavirus Testing More Equitable

When the coronavirus arrived in Philadelphia in March, Dr. Ala Stanford hunkered down at home with her husband and kids. A pediatric surgeon with a private practice, she has staff privileges at a few suburban Philadelphia hospitals. For weeks, most of her usual procedures and patient visits were canceled. So she found herself, like a lot of people, spending the days in her pajamas, glued to the TV.

And then, at the beginning of April, she started seeing media reports indicating that Black people were contracting the coronavirus and dying from COVID-19 at greater rates than other demographic groups.

“It just hit me like, what is going on?” said Stanford.

At the same time, she started hearing from Black friends who couldn’t get tested because they didn’t have a doctor’s referral or didn’t meet the testing criteria. In April, there were shortages of coronavirus tests in numerous locations across the country, but Stanford decided to call around to the hospitals where she works to learn more about why people were being turned away.

One explanation she heard was that a doctor had to sign on to be the “physician of record” for anyone seeking a test. In a siloed health system, it could be complicated to sort out the logistics of who would communicate test results to patients. And, in an effort to protect health care workers from being exposed to the virus, some test sites wouldn’t let people without cars simply walk up to the test site.

Stanford knew African Americans were less likely to have primary care physicians than white Americans, and more likely to rely on public transportation. She just couldn’t square all that with the disproportionate infection rates for Black people she was seeing on the news.

“All these reasons in my mind were barriers and excuses,” she said. “And, in essence, I decided in that moment we were going to test the city of Philadelphia.”

Stanford visits a Black Doctors Consortium testing site in Darby, Pennsylvania, on Sept. 9. Stanford has largely self-funded the testing initiative.(Nina Feldman/WHYY)

Black Philadelphians contract the coronavirus at a rate nearly twice that of their white counterparts. They also are more likely to have severe cases of the virus: African Americans make up 44% of Philadelphians but 55% of those hospitalized for COVID-19.

Black Philadelphians are more likely to work jobs that can’t be performed at home, putting them at a greater risk of exposure. In the city’s jails, sanitation and transportation departments, workers are predominantly Black, and as the pandemic progressed they contracted COVID-19 at high rates.

The increased severity of illness among African Americans may also be due in part to underlying health conditions more prevalent among Black people, but Stanford maintains that unequal access to health care is the greatest driver of the disparity.

“When an elderly funeral home director in West Philly tries to get tested and you turn him away because he doesn’t have a prescription, that has nothing to do with his hypertension, that has everything to do with your implicit bias,” she said, referring to an incident she encountered.

Before April was over, Stanford sprang into action. Her mom rented a minivan to serve as a mobile clinic, while Stanford started recruiting volunteers among the doctors, nurses and medical students in her network. She got testing kits from the diagnostic and testing company LabCorp, where she had an account through her private practice. Fueled by Stanford’s personal savings and donations collected through a GoFundMe campaign, the minivan posted up in church parking lots and open tents on busy street corners in Philadelphia.

It wasn’t long before she was facing her own logistical barriers. LabCorp asked her how she wanted to handle uninsured patients whose tests it processed.

“I said, for every person that does not have insurance, you’re gonna bill me, and I’m gonna figure out how to pay for it later,” said Stanford. “But I can’t have someone die for a test that costs $200.”

Philadelphians live-streamed themselves on social media while they got tested, and word spread. By May, it wasn’t unusual for the Black Doctors COVID-19 Consortium to test more than 350 people a day. Stanford brought the group under the umbrella of a nonprofit she already operated that offers tutoring and mentorship to youth in under-resourced schools.

Tavier Thomas found out about the group on Facebook in April. He works at a T-Mobile store, and his co-worker had tested positive. Not long after, he started feeling a bit short of breath.

“I probably touch 100 phones a day,” said Thomas, 23. “So I wanted to get tested, and I wanted to make sure the people testing me were Black.”

Many Black Americans seek out Black providers because they’ve experienced cultural indifference or mistreatment in the health system. Thomas’ preference is rooted in history, he said, pointing to times when white doctors and medical researchers have exploited Black patients. In the 19th century American South, for example, white surgeon J. Marion Sims performed experimental gynecological treatments without anesthesia on enslaved Black women. Perhaps the most notorious example began in the 1930s, when the United States government enrolled Black men with syphilis in a study at Tuskegee Institute, to see what would happen when the disease went untreated for years. The patients did not consent to the terms of the study and were not offered treatment, even when an effective one became widely available.

“They just watched them die of the disease,” said Thomas, of the Tuskegee experiments.

“So, to be truthful, when, like, new diseases drop? I’m a little weird about the mainstream testing me, or sticking anything in me.”

Brothers Tavier Thomas (left) and McKenzie Johnson were tested for the coronavirus at a Black Doctors COVID-19 Consortium testing site. Tavier, who studies history, says he feels more comfortable getting treatment from Black medical providers because of past abuses of Black people by white doctors and medical researchers in the U.S.(Nina Feldman/WHYY)

In April, Thomas tested positive for the coronavirus but recovered quickly. He returned recently to be tested again by Stanford’s group, even though the testing site that day was in a church parking lot in Darby, Pennsylvania, a solid 30-minute drive from where he lives.

Thomas said the second test was just for safety, because he lives with his grandfather and doesn’t want to risk infecting him. He also brought along his brother, McKenzie Johnson. Johnson lives in neighboring Delaware but said it was hard to get tested there without an appointment, and without health insurance. It was his first time being swabbed.

“It’s not as bad as I thought it was gonna be,” he joked afterward. “You cry a little bit — they search in your soul a little bit — but, naw, it’s fine.”

Each time it offers tests, the consortium sets up what amounts to an outdoor mini-hospital, complete with office supplies, printers and shredders. When they do antibody tests, they need to power their centrifuges. Those costs, plus the lab processing fee of $225 per test and compensation for 15-30 staff members, amounts to roughly $25,000 per day, by Stanford’s estimate.

“Sometimes you get reimbursed and sometimes you don’t,” she said. “It’s not an inexpensive operation at all.”

After its first few months, the consortium came to the attention of Philadelphia city leaders, who gave the group about $1 million in funding. The group also attracted funding from foundations and individuals. The regional transportation authority hired the group to test its front-line transit workers weekly.

To date, the Black Doctors COVID-19 Consortium has tested more than 10,000 people — and Stanford is the “doctor on record” for each of them. She appreciates the financial support from the local government agencies but still worries that the city, and Philadelphia’s well-resourced hospital systems, aren’t being proactive enough on their own. In July, wait times for results from national commercial labs like LabCorp sometimes stretched past two weeks. The delays rendered the work of the consortium’s testing sites essentially worthless, unless a person agreed to isolate completely while awaiting the results. Meanwhile, at the major Philadelphia-area hospitals, doctors could get results within hours, using their in-house processing labs. Stanford called on the local health systems to share their testing technology with the surrounding community, but she said she was told it was logistically impossible.

“Unfortunately, the value put on some of our poorest areas is not demonstrated,” Stanford said. “It’s not shown that those folks matter enough. That’s my opinion. They matter to me. That’s what keeps me going.”

Now, Stanford is working with Philadelphia’s health commissioner, trying to create a rotating schedule wherein each of the city’s health systems would offer free testing one day per week, from 9 a.m. to 9 p.m.

The medical infrastructure she has set up, Stanford said, and its popularity in the Black community, makes her group a likely candidate to help distribute a coronavirus vaccine when one becomes available. Representatives from the U.S. Department of Health and Human Services visited one of her consortium’s testing sites, to evaluate the potential for the group to pivot to vaccinations.

Overall, Stanford said she is happy to help out during the planning phases to make sure the most vulnerable Philadelphians can access the vaccine. However, she is distrustful of the federal oversight involved in vetting an eventual coronavirus vaccine. She said there are still too many unanswered questions about the process, and too many other instances of the Trump administration putting political pressure on the Centers for Disease Control and Prevention and the Food and Drug Administration, for her to commit now to doing actual vaccinations in Philadelphia’s neighborhoods.

“When the time comes, we’ll be ready,” she said. “But it’s not today.”

This story is part of a partnership that includes WHYY, NPR and KHN.

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