Disparities in Health Care and Beyond

A couple of weeks ago, a relative of mine slipped and fell on their head. Naturally, this person went to the hospital to be checked by a doctor to insure no unforeseen internal injuries existed. This relative was released from the hospital the same day, and to the best of my knowledge, was told to get some rest and take an over-the-counter pain medication when needed. A couple of days later, my relative returned to the hospital in a comma and died shortly thereafter at the age of 52.

At question is the depth of the examination that was performed for someone who had jut fallen on their head and almost rendered unconscious. There is a growing knot in my stomach as we wait for the results of an autopsy and information as to what tests were administered to determine that my relative had no internal bleeding or other serious injuries requiring treatment beyond aspirin and rest.

This event caused me to remember an incident with one of my children.

A number of years ago, my young teenage son was riding home on his bike as it was turning dark. The lack of daylight caused him to misjudge where the curb started/ended. He slammed into the curb, which caused him to be tossed into the air, flip over and come down head first, hitting his head on the concrete curb. Upon his arrival home, I immediately took him to the emergency room to make certain that no internal injuries, i.e., concussion, internal bleeding, etc., existed.

Once in the emergency room, I explained his accident to the receiving nurse, filled out all the intake paperwork, including providing my health insurance information. A neurologist was called and he advised me that he was scheduling my son to have an x-ray and he would exam him to rule out any broken bones or fractures, internal bleeding, concussion, etc.

Abruptly, the exam and x-ray, which had not yet been performed or taken, were ruled out and the neurologist was told he was not needed by another doctor who stepped in and said he was taking over. The neurologist stayed around for a little while -- until he received another call. He stated his disagreement to the second doctor, saying that my son should at least be examined by him and he should go ahead with the x-ray since it was a fall to the head. The second doctor did not back down and the neurologist shook his head in obvious frustration and left.

The second doctor began insisting that my young teenage son was on drugs and how he knew "all about kids in the streets." He did not examine my son in any way, rather, he performed an interrogation. When my son repeatedly denied having taken any drugs or alcohol, this doctor insisted on speaking with my son alone. Concerned that my son would not be treated at all, I stepped just beyond the curtain out of sight but definitely not out of listening range. I was horrified as this doctor did his best to try and get my son to say he was on drugs or alcohol, which my son emphatically denied.

The doctor refused to implement the tests and exam that the neurologist wanted to do saying that the x-ray was too expensive to waste on someone who was probably just on drugs or got high on something. The doctor did, however, hand me a bill -- for full payment -- which was odd since our health insurance, which I had provided upon arrival, more than adequately covered any charges. I suspect he realized that his bill would never be authorized for payment. What would he charge for since no exam was performed? Young teenage African American male with his mother enters emergency room and occupy two chairs for 12 hours?

I looked at the bill and calmly advised the doctor that a "bill" is generally what is given in exchange for services rendered. His refusal of allowing anyone on his staff to administer medical services, coupled with his refusal of providing those services himself as a doctor to my son, thereby going against the Hippocratic oath he took when he became a licensed medical practitioner, nullified any request for payment. No service, no payment. I gently returned the bill to this doctor and quietly suggested he frame it before he saw a nickel from me or my insurance carrier as I exited the hospital. The neurologist returned as I was leaving and I advised him that I had placed a call into my pediatrician. He urged me to definitely follow up with another doctor, saying it is best to err on the side of caution when it comes to head injuries and seemed relieved that I was doing so.

I called my pediatrician and the following morning, which by that time was only hours away, my son received the necessary medical services to ensure his health and well being.

So what happened here? At the time, both my husband and I were working (I am retired) and we had pretty good health insurance coverage for our family through our employers (mine private, his government). So, insurance was not at issue. We enjoyed a good income, so money was not at issue. We were residents/home-owners of the community and citizens. So immigrant status or non-resident status was not at issue. We were at a hospital that boasts a long-time rating as among the top 100 in the country. So availability (not access, as I was clearly being denied access) to quality health care was not at issue.

Moreover, what if? What if a person seeks medical attention and actually is intoxicated? Are not hospitals supposed to treat that person or, at the very least, thoroughly examine the person to determine if injury of any kind exists or not before releasing that person; especially after valid, full insurance coverage has been provided?

Disparities in health care access and coverage have long been at issue on many levels all across this country. Racial and gender disparities are high up on the list and not just in health care.

Yesterday, Applied Research Center (Advancing Racial Justice Through Research, Advocacy and Journalism) released it's May 2009 report, "Race and Recession: How Inequity Rigged the Economy and How to Change the Rules." The report's opening statement reads:

While all Americans worry about economic insecurity during this crisis, its most damaging effects have been unevenly distributed. People of color are unemployed, hungry, homeless and without health care at alarming rates. Many have already fallen through the widening cracks in the social safety net, and countless more are about to go under. This dire and worsening situation amounts to a state of emergency. Examining the disparities reveals patterns that are not simply coincidental. Indeed, people of color face barriers to opportunity at every turn, and the impact is devastating, not just to them, but also to struggling white people. Ultimately, to ensure a stable and growing economy for all will require solutions that directly address these disparities.

The report goes on to outline six policies that should be implemented within the next year to combat these disparities as:

• Employee Free Choice Act
• Community Reinvestment Act Modernization
• Immigrant Legalization
• Green Jobs-Good Jobs
• Raise the Minimum Wage
• Pass Comprehensive Universal Health Care

To read more: Click here for executive summary. Click here for full report.