Gary Fowler
USA TODAY ran this story on the front page on April 22, 2020:
In late March 2020, Gary Fowler, 56, went to three Detroit emergency rooms looking for care. His father had COVID-19 and was in the hospital on a ventilator. Now Fowler had a fever and was feeling ill as well. He wanted a coronavirus test, and he needed help with his breathing.
Three times, he was turned away.
Fowler's son, Keith Gambrell, explained what happened in interviews with reporter Kristen Jordan Shamus of the Detroit Free Press, part of the USA TODAY Network.
At the first hospital, "He tells them, 'My father has the coronavirus. I would like to get a test because I am showing symptoms. I am coughing,' " Gambrell said. "He had a fever of 101. He had shortness of breath. He was showing all the signs.
"They tell him, 'Sir, more than likely the fever is from bronchitis.' And they tell him to go home. But they also give my dad a piece of paper saying to act like you have the virus."
Fowler was not tested for COVID-19.
He continued to seek medical care in the following days, Shamus wrote, going to another emergency room with a 100.7 degree fever and shortness of breath. There, Gambrell said, his father was told he'd get better care at a facility three miles away.
So they drove him the roughly three miles to the next ER, where Gambrell said his father explained: " 'My chest hurts. I can't breathe. I have a fever that has not broke. I've been taking Tylenol, I've been drinking stuff and it is not breaking. I think I have the virus because my father tested positive for it and I saw him ... the day he went to the hospital.'
"But it was the same thing. They tell him: 'You're fine. You have bronchitis. Go home. Drink water. Act like you have the virus.' " (Not only was Fowler denied testing, but Henry Ford said it has no record of him coming in.)
He followed instructions. He went home. He couldn't breathe well, so he slept upright in a blue recliner by his bed.
That's where he died on April 7.
"My dad passed at home, and no one tried to help him," Gambrell said. "He asked for help, and they sent him away. They turned him away."
(Nicole Carroll. “A story in USA TODAY sparked Oprah Winfrey's new documentary on – and battle against – racial bias in health care.” https://news.yahoo.com/story-usa-today-sparked-oprah-090114555.html?fr=yhssrp_catchall. USA TODAY. April 29, 2022.)
Before you dismiss this narrative as some kind of isolated medical care snafu – a tragedy that rarely occurs – please read on and consider the sizable research supporting the issue of disparities in healthcare, specifically racial bias and structural inequalities.
A National Embarrassment
Large and persisting racial differences in health is a national embarrassment. National data reveal that Black persons had an overall mortality rate that was 1.6 times higher than white persons in 1995 – identical to the black/white mortality ratio in 1950 (Williams, 1999).
(X.S. Ren, B. Amick, and D.R. Williams. 1999. “Racial/Ethnic Disparities in Health: The Interplay Between Discrimination and Socioeconomic Status.” Ethnicity and Disease, 9.)
(Priest, N., & Williams, D. R. 2018. “Racial Discrimination and Racial Disparities in Health.” In B. Major, J. F. Dovidio, & B. G. Link (Ed.), The Oxford Handbook of Stigma, Discrimination, and Health (pp. 163-182)
(Cunningham TJ, Croft JB, Liu Y, Lu H, Eke PI, Giles WH. Vital Signs: Racial Disparities in Age-Specific Mortality Among Blacks or African Americans — United States, 1999–2015. MMWR Morb Mortal Wkly Rep 2017; 66:444–456.)
Moreover, for multiple causes of death (heart disease, cancer, diabetes, and cirrhosis of the liver) the racial discrepancy was larger in 1995 than in 1950. These inequities fly in the face of cherished American principles given the public's commitment to principles of equal treatment in society.
Despite that in recent years, access to care has improved in the wake of the Affordable Care Act that reduced the number of uninsured Americans across all racial and ethnic groups, the racial health gap has remained, according to a series of studies published in the Journal of the American Medical Association (JAMA).
(Phil Fontanarosa, MD, Interim Editor in Chief of JAMA. “Theme Issue: Racial and Ethnic Disparities and Inequities in Medicine and Health Care.” Journal of the American Medical Association. August 17, 2021.)
A dismal picture of persistent health disparities in America was described in an issue devoted entirely to inequities in medicine. The wide-ranging issue included research on spending and patterns of care, comparative rates of gestational diabetes and the proportion of Black physicians at medical schools.
“The topics of racial and ethnic disparities and inequities in medicine and health care are of critical importance,” Dr. Phil B. Fontanarosa, interim editor in chief of JAMA, said in a statement. He noted that more than 850 articles on racial and ethnic disparities and inequities have been published in JAMA and associated journals in the past five years.
The new issue offers studies on disparities in the utilization of health care services and in overall health spending. Together, the findings paint a portrait of a nation still plagued by medical haves and have-nots whose ability to benefit from scientific advances varies by race and ethnicity, despite the fact that the A.C.A. greatly expanded insurance.
(Roni Caryn Rabin. “Racial Inequities Persist in Health Care Despite Expanded Insurance.” The New York Times. Aug. 17, 2021.)
“Assertions in both that disavowed the presence of structural racism in medicine and among physicians were wrong, misguided, and uninformed. An extensive evidence base strongly supports the presence of structural racism in medicine and its adverse influence on health."
– Articles on race, racism, and racial/ethnic disparities/inequities published in JAMA Network Journals during last 5 years. May 4, 2021.
Despite innovations like Medicare Advantage, Black, Hispanic, Native American or Asian-Pacific Islander — still have less access than white or multiracial individuals to a physician who is a regular source of care.
They are also less likely to have influenza and pneumonia vaccinations, and they have more limited access to specialists. Fewer health care providers and specialists are found in low-income and minority neighborhoods, which is a function of structural racism and a legacy of residential segregation.
Another study in the journal compared health care spending by race and ethnicity, finding that at $8,141 per year, spending for white individuals is higher than for Americans of other races and ethnicities, and the portion of it spent on outpatient care is higher than the average.
Health care spending for Black individuals is $7,361 per year, and a smaller proportion of the funds are spent on outpatient care. The amounts that go to pay for care of Black people in an emergency room and hospital are 12 percent and 19 percent higher, respectively, than the nationwide averages.
The difference also reflects patient behavior. It is also about people’s past experiences with the health care system and the quality of care they or their loved ones have received, which leads to hesitation or resistance to accessing health care early.
Other important considerations?
Social and economic factors also play a role, among them poverty and so-called food deserts and neighborhoods that expose residents to pollution and offer few opportunities for physical exercise and recreation.
Rates of gestational diabetes became more prevalent in pregnant women of all ages and across all races and ethnic groups from 2011 to 2019, with the highest rates reported in Asian Indian women.
Overall, Black women face a much higher risk of dying from pregnancy complications than white women, with maternal mortality rates of 41.7 per 100,000 live births for Black women, compared with 13.4 per 100,000 live births for white women.
Black infant mortality rates are also higher, with death rates of 10.62 per 1,000 live births for Black newborns, compared with 4.68 per 1,000 live births for white babies.
Black patients opt for more preventive care when their physician is Black, yet the proportion of faculty physicians at American medical schools who identified as Black or African American has only slightly increased over the past 30 years, from 2.6 percent of faculty in 1990 to 3.8 percent of faculty in 2020, still far less than their proportion of the general population.
The pandemic has highlighted longstanding inequities, taking a greater toll on Black and Hispanic communities. The health care system has a long history of racism. Hospitals only desegregated when they were threatened with the loss of federal funds from the Medicaid and Medicare programs, which were enacted in 1966.
(Roni Caryn Rabin. “Racial Inequities Persist in Health Care Despite Expanded Insurance.” The New York Times. Aug. 17, 2021.)
What I See
Like so many others, I too have made hasty generalizations that the poor get the best medical treatment for free. We all are very familiar with the high cost of healthcare, and, unwittingly, we sometimes choose to scapegoat those whom we believe either to be “using the system” or to be purposely devouring our tax money for frivolous treatments.
However, I encourage you to research the disparities yourself, and you can make your own conclusions based on facts. As for me, now I hang my head, and I am willing to admit my errors in judgment. No one in America should be denied first-class medical care, yet structural racism in medicine exists. The story of Gary Fowler is just one horrendous nightmare representative of a national shame. We must work to correct the disparities immediately.
Gary Fowler
Let's speak a little more about Gary Fowler. Fowler lived in Detroit’s 48235 ZIP code, a coronavirus hot zone with the highest infection rate per capita – 162 cases per 10,000 residents – and the highest number of confirmed cases of the virus at 724, USA TODAY reported.
Delays in diagnosis for those in the Black community and people of color raise other concerns. So are there also delays in testing? Are there delays in treatment? Are facilities sending people home when they really should be admitted to the hospital because they’re so at risk for deteriorating quickly? Race contributes to the potential inequities.
The Detroit Free Press reported:“The American Hospital Association sent a letter to the U.S. Department of Health and Human Services Secretary Alex Azar about the racial disparities in the federal COVID-19 response, highlighting a lack of available tests for African Americans, unequal medical treatment for those who have the disease and lack of public health information about coronavirus for communities of color.”
Note:
The troubles aren’t over for the Fowlers. On the day her husband died, Cheryl, 57, got sick, too. She started coughing and had a fever of 102 degrees.
When Cheryl’s cousin, state Rep. Karen Whitsett, who also had COVID-19, heard about the deaths of Gary and David Fowler, she contacted the family and put them in touch with the doctor who had treated her.
But even Whitsett said she’d had trouble getting tested.
“The part that bothers me the most through this whole entire process is that…if I hadn’t used my name, if it wasn’t for my name and my job title, I don’t think I would have gotten anywhere, either,” with testing and treatment, Whitsett, a Detroit Democrat who represents the 9th House District, told the Washington Post.
“We have people dying. And they’re in my community, and they’re in my district, which is my family,” Whitsett said. “People in my community are not my constituents. They are my family. And they’re dying. So I need politics to stop and I need lives to be saved.”
Whitsett has been in the news lately for praising President Donald Trump and crediting him with saving her life because he promoted the anti-malaria drug hydroxychloroquine as a potential treatment for coronavirus. She was given this drug in her treatment and went to the White House to meet Trump.
The doctor who prescribed hydroxychloroquine for Whitsett also issued prescriptions for Cheryl and the rest of the family.
“The part that bothers me the most through this whole entire process is that…if I hadn’t used my name, if it wasn’t for my name and my job title, I don’t think I would have gotten anywhere, either,” with testing and treatment, Whitsett, a Detroit Democrat who represents the 9th House District, told the Washington Post.
Still, Cheryl’s condition worsened and she also had to travel hospital-to-hospital before she was tested despite having a doctor’s note.
(Ann Brown. “Gary Fowler Was Denied COVID-19 Testing At 3 Detroit Hospitals. He Died At Home. Family Members Are Sick.” https://moguldom.com/273256/gary-fowler-was-denied-covid-19-testing-at-3-detroit-hospitals-he-died-at-home-family-members-are-sick/#:~:text=A%20Black%20man%20named%20Gary%20Fowler%20went%20to,having%20difficulty%20breathing.%20He%20was%20repeatedly%20denied%20care. April 22, 2021.)
Please, consider this happening to you or to your loved one. In dire straits, a sick human being goes to several proper facilities for life-saving care, and treatment is denied. Now, please think about the long history of structural racism and racial inequities in the system. Are you outraged? Are you willing to accept the inequity and the excuses like the following issued by Henry Ford Health System that claims “it does not deny treatment to anyone”?
A Henry Ford representative said to the papers:
"Some patients will meet criteria for admission at the time, while others may not,""In the case of COVID-19, we have a multistep triage process. As patients arrive to our emergency department, all are screened for COVID-19 symptoms. Those with mild or moderate symptoms who do not meet admission criteria at the time they present may be sent home with strict instructions to return immediately if symptoms worsen. Our thoughts and prayers are with the Fowlers and all families devastated by the effects of COVID-19."
Final Thought
Lastly consider once more that Gary Fowler was never even given a coronavirus test – even though he couldn't breathe and even though he'd been in close contact with his father, David Fowler, who had tested positive, and was hospitalized. And, I need to mention that Gary was a diabetic who was showing COVID-19 symptoms – he should have been considered a priority.
Black Americans have been disproportionately affected by the coronavirus and have lacked access to testing. Discrimination against patients of color limits their access to healthcare and the quality of their treatment. To root out structural inequalities in healthcare, we should look to the ways that implicit bias affects both interpersonal dynamics (such as those between a patient and a clinician) and organizational dynamics (such as dynamics within healthcare institutions).
Implicit bias is the tendency to unconsciously associate groups (for example, people of color) or category markers (for example, Blackness) and a negative evaluation (implicit prejudice). In a seminal report by the Institute of Medicine in 2003, “Unequal Treatment,” a team of physicians, behavioral scientists, public health experts, and other health professionals concluded that even when access-to-care barriers (such as income and insurance) were controlled for, racial and ethnic minorities received worse healthcare than white people received.
The problems continue. Nearly 20 years since the publication of “Unequal Treatment,” the study’s results have been replicated again and again, confirming that implicit bias by medical practitioners and within the healthcare system plays a role in negative health outcomes for people of color. Implicit bias tests show, for instance, that physicians are more likely to provide requested pain treatment for white patients compared with Black patients. Repeated studies show that American healthcare workers, even those who are avowedly anti-racist, demonstrate a significant implicit bias against patients of color and a preference for white patients, as reported by Scientific American.
(“Racial Discrimination in Healthcare: How Structural Racism Affects Healthcare.” https://www.stkate.edu/academics/healthcare-degrees/racism-in-healthcare. St. Catherine University. June 15, 2021.)
A New National Anthem
By Ada Limón
The truth is, I’ve never cared for the National
Anthem. If you think about it, it’s not a good
song. Too high for most of us with “the rockets
red glare” and then there are the bombs.
(Always, always, there is war and bombs.)
Once, I sang it at homecoming and threw
even the tenacious high school band off key.
But the song didn’t mean anything, just a call
to the field, something to get through before
the pummeling of youth. And what of the stanzas
we never sing, the third that mentions “no refuge
could save the hireling and the slave”? Perhaps,
the truth is, every song of this country
has an unsung third stanza, something brutal
snaking underneath us as we blindly sing
the high notes with a beer sloshing in the stands
hoping our team wins. Don’t get me wrong, I do
like the flag, how it undulates in the wind
like water, elemental, and best when it’s humbled,
brought to its knees, clung to by someone who
has lost everything, when it’s not a weapon,
when it flickers, when it folds up so perfectly
you can keep it until it’s needed, until you can
love it again, until the song in your mouth feels
like sustenance, a song where the notes are sung
by even the ageless woods, the short-grass plains,
the Red River Gorge, the fistful of land left
unpoisoned, that song that’s our birthright,
that’s sung in silence when it’s too hard to go on,
that sounds like someone’s rough fingers weaving
into another’s, that sounds like a match being lit
in an endless cave, the song that says my bones
are your bones, and your bones are my bones,
and isn’t that enough?
\(Ada Limón, "A New National Anthem" from The Carrying. Copyright © 2018 by Ada Limón. Reprinted by permission of Milkweed Editions.)
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