Monday, June 15, 2020

New Mexico Hospital Had A Secret, Racist Policy That Separated Native American Babies From Their Mothers

Ignorant people often say that various marginalized groups should "get over" the injustices that were done to their ancestors many generations ago.

"Injustices" is, of course, an extremely weak word to describe things like genocide and the myriad dehumanizing aspects of slavery.

The first African slaves were brought to the British colonies in August 1619 (although slavery had existed on what is now known as the continental United States since 1526). In December 1865, the Thirteenth Amendment made slavery illegal in the United States. That's 246 years of "official" slavery. We are not even remotely close to being 246 years removed from the end of slavery. That will happen in the year 2111.

Despite Donald Trump's desire to lead the Confederacy in a re-boot of the Civil War this summer, the War Between the States seems like something from the distant past. But Dave Chappelle, in "8:46", says his great-grandfather (William David Chappelle) was born as a slave. This history is still fresh. Racism based on skin colour remains rampant, in housing, employment, bank loans, the court system, and law enforcement.

Nearly one-quarter of all Native Americans in the US live on reservations (22%), almost all in substandard conditions. On some reservations, as many as 85% of the people are unemployed. Native Americans have the highest poverty rate at 27%, the rate of child abuse is twice as high as the national average, the infant death rate is 60% higher than for white babies, and the life expectancy is 5.5 years less than any other "race". Native women are 2.5 times more likely to be sexually assaulted than any other group. Suicide is the leading cause of death for girls between the ages of 10-14, and the second-leading cause of death for all Native Americans between the ages of 10-34.

And racist shit like this is still going on, in 2020:
A prominent womens hospital [in Albuquerque, New Mexico] has separated some Native American women from their newly born babies, the result of a practice designed to stop the spread of COVID-19 that clinicians and health care ethicists described as racial profiling.

Lovelace Women's Hospital in Albuquerque implemented a secretive policy in recent months to conduct special coronavirus screenings for pregnant women, based on whether they appeared to be Native American, even if they had no symptoms or were otherwise at low risk for the disease, according to clinicians.

The hospital screens all arriving patients for COVID-19 with temperature checks and asks them whether they've been in contact with people who have the illness. But for soon-to-be moms who appeared to be Native American, there was an additional step, according to clinicians interviewed on the condition they not be named.

Hospital staff would compare the expectant mother's ZIP code against a list of Indian reservation ZIP codes maintained by the hospital, known informally as the "Pueblos List," a reference to New Mexico's Pueblo Indian tribes. If the pregnant woman's ZIP code matched one on the list, she was designated as a "person under investigation" for COVID-19, the clinicians said.

Lovelace does not use rapid COVID-19 tests, and babies were sometimes born before asymptomatic Native American mothers' test results came back from the lab, a process that can take up to three days. As a result, the hospital separated Native American newborns from their asymptomatic mothers in at least a half-dozen cases, one clinician said.

Such separations deprive infants of close, immediate contact with their mothers that doctors recommend. ...

The Navajo Nation and several Pueblo tribes in New Mexico have recorded some of the highest per capita rates of COVID-19 infection in the nation. In response to the pandemic, the state has designated several counties as hot spots, including some that are home to tribes with large numbers of cases. But 10 of the ZIP codes on the Lovelace Pueblos List reviewed by New Mexico In Depth and ProPublica do not fall within those hot spot counties, nor do all tribes within those ZIP codes have a high rate of infection.

A Lovelace spokeswoman acknowledged screening patients by geography, but she would not confirm or deny the existence of a policy based on ZIP codes as described by staff. Lovelace, whose owner is Nashville, Tennessee-based Ardent Health Services, is Albuquerque's largest privately owned hospital system.

"Part of our screening process includes identifying and testing patients who reside in high-risk areas such as nursing homes and regional hot spots of COVID-19 cases as recommended" by the Centers for Disease Control and Prevention, Lovelace spokeswoman Whitney Marquez wrote in a May 21 email.

But CDC guidelines for evaluating COVID-19 risk among pregnant patients do not mention geography or ZIP code of residence. The guidelines instead state that only pregnant patients with COVID-19 symptoms or recent high-risk contacts with COVID-19 patients should be treated as suspected cases.

"Regardless of pending test results, pregnant individuals who are asymptomatic at the time of admission and have no history of high-risk contact should not be considered to be suspected cases," the CDC guidelines note.

In a follow-up email, Marquez said Lovelace's residential geography screening applied to all patients: "Any patient admitted to the hospital for any reason from a designated hot spot region is tested for COVID-19 as a PUI (person under investigation), per CDC guidance."

Marquez's claim was disputed by several clinicians who work in the hospital. Only ZIP codes with significant populations of Native Americans appeared on the list. Patients who did not appear to be Native American were not subject to further screening based on the ZIP code list, they said. ...

"This isn't about where you live or if you live in a hot spot — it's about whether someone thinks you look Native," a clinician explained. "The only people for whom we've been told to check ZIP codes are patients who appear to be Native."

Health care ethicists said the practice described by the clinicians raises troubling questions about bias, trust and informed patient consent.

Saskia Popescu, a senior infection prevention epidemiologist at George Mason University in Fairfax, Virginia, said such policy decisions wouldn't make sense from an infection control or epidemiology perspective, and they could create or exacerbate trust issues toward health care among Native American patients. ...

Popescu said she understood why the hospital might place someone under investigation if they came from high-risk settings like nursing homes, but she questioned how a case could be made for doing so based on a home ZIP code. ...

A copy of the Lovelace list reviewed by New Mexico In Depth and ProPublica contains names of tribes next to each of 22 associated ZIP codes. Native Americans have a much higher COVID-19 rate overall than other populations in New Mexico, but most of the tribes on the list have a low prevalence of the illness. For instance, the ZIP code for Cochiti Pueblo had recorded zero cases as of Tuesday; the ZIP code for Picuris Pueblo had just one. An additional eight ZIP codes had 7 or fewer cases. ...

"Hospitals have the latitude to decide on who to test, but no testing decisions should be made arbitrarily solely on the basis of race or ethnicity," State Epidemiologist Michael Landen wrote in an email Thursday. ...

Usually, Lovelace officials announce new policies by emailing links to staff. But that was not done in this case. Instead, supervisors read the policy aloud at the beginning of each shift, clinicians said.

The verbal readings didn't mention that Native American mothers had to provide informed consent to be tested or separated from their newborn, a clinician said. ...

"I don't believe that patients were given an opportunity to decline testing or separation from their babies," that clinician said. "This is a violation of informed consent, which is a foundation of modern health care." ...

Several Lovelace clinicians voiced concern about newborn separations and delayed breastfeeding, which can reduce the odds of successful breastfeeding later on, denying health benefits to mothers and their babies. For babies, breastfeeding can benefit immune system and brain development. Mothers who breastfeed have lower risks of breast cancer. ...

For some health care ethicists, the policy described by the Lovelace clinicians recalled the federal government's long, troubling history of separating Native American infants from their mothers. For others, it appeared uncomfortably similar to the disparate treatments of minorities in previous epidemics. ...

1 comment:

laura k said...

Good post. I love to see not-Trump posts.