These California bills would train nurses, judges and police to spot their own biases

California saw a decrease in the number of women who died giving birth in 2013, as the maternal mortality rate rose across the country, state officials said. But black pregnant women across the state are still three to four times more likely to die of complications in childbirth than white women.

State health researchers say the large disparity is likely not attributed to social factors, such as patients’ education level or socioeconomic background. Instead, they highlight evidence of racism and prejudice implicit in the medical community: A survey of medical students and white residents released in 2016 by the University of Virginia found that about half of those who participated believed in myths about biological racial differences, notably that black patients tolerate more pain and have thicker skin.

“It was not in 1816, dear colleagues. That was in 2016, ”said Senator Holly Mitchell (D-Los Angeles) during a recent Senate Health Committee hearing. “Black women are in grave danger because when they say they are in pain… some providers don’t believe it and don’t have the cultural skills to respond appropriately. “

Two state lawmakers hope to tackle the issue this year with proposals that would require training for nurses, doctors and other healthcare professionals on how to spot implicit bias in the workplace. The legislation is part of a larger campaign to tackle subconscious perceptions and stereotypes that contribute to discrimination and disparities in treatment in medicine and other industries, and may play a role in cases where life and death are at stake.

Mitchell’s Senate Bill 464, which authorized its first Senate committee vote this month, would create a training program to help perinatal care providers identify and correct their biases. It would task the state’s public health department with collecting better data on maternal mortality rates and would require hospitals to provide patients with more information on how to file discrimination complaints.

As part of a package of bills from State MP Sydney Kamlager-Dove (D-Los Angeles) due to hold her first committee hearings this week, doctors, physician assistants and nurses are expected to complete eight hours of Implicit Bias training and testing within two years of receiving it. their licenses and every two years thereafter. Similar training would be put in place for police officers and court officials, in particular judges, bailiffs, court clerks and litigators.

The high death rate of black pregnant women in California and across the country also captured the attention of Congress and the 2020 presidential campaign, as Democrats presented plans to expand access to health care. for pregnant women and to combat the stigma that affects the way black patients are treated. .

Although the state’s legislation has not been publicly opposed, Kamlager-Dove said she has faced some setback in private meetings with lawmakers and potential funders.

“Nobody likes being told what to do and nobody thinks they are racist, so the question I often hear is, ‘Why do we need this? “She said.” The point is not to have punitive legislation. It is to help people recognize that they have [implicit biases] and help reduce them.

University researchers have found that all people have implicit biases, or subconscious perceptions, both positive and negative, that can influence behavior. Studies suggest that such internal belief systems have had an effect in a variety of industries: women were more likely to survive a heart attack seen by female doctors. Prosecutors are more likely to charge black suspects than white suspects in similar cases. And many orchestras now have candidates auditioned behind blind screens for prevent gender bias from affecting their decisions; some go so far as to organize trials in carpeted rooms to muffle the noise of a candidate’s heels.

The discrimination and implicit prejudice against African American women in medical wards dates back to the early days of gynecology, when the “modern father” of the estate James Marion Sims, conducted tests without anesthesia on slave black women in the 1800s to develop the first surgical interventions for women’s reproductive health.

In recent years, as US health officials saw the increased maternal mortality rate, California health authorities have invested funds in research, improved health care, and developed tools to better assess the needs of women. The states the maternal mortality rate has fallen by 55% between 2006 and 2013, according to an analysis from the California Birth Equity Collaborative, a pilot program founded by state health officials and the Stanford University School of Medicine.

The maternal mortality rate for white women in the state is now 4.7 deaths per 100,000 live births, compared to 3.1 for Hispanic women and 4.1 for Asian and Pacific Islander women, according to a 2018 study by the United Health Foundation and the American Public Health Assn. But the death rate for black pregnant women is 17.4.

Disparities persist even when accounting for socio-economic factors, state and local health researchers said. In Los Angeles County, pregnant African American women with a bachelor’s degree or above had worst birth outcomes, including deaths or babies born prematurely or with less weight, than white women who did not complete high school, according to county health officials.

When testifying in support of Mitchell’s proposal, health advocate Janette Robinson-Flint told members of the state’s Senate health committee this month: “Black women have been left behind.

“Four hundred years ago the Good Ship Jesus brought enslaved Africans to the shores of Jamestown, Virginia, and since then black women have been systematically dehumanized,” said Robinson-Flint, who co-founded Black Women for Wellness, an herb -roots organization that offers programs for pregnant women.

She said she and other policy advocates have gathered a number of cases that show how black women continue to face verbal abuse, discrimination and racism from doctors, nurses. and medical assistants.

19-year-old was refused ultrasounds in two emergency rooms because she was told that “if she was old enough to get pregnant, she was old enough to have this baby naturally,” said Robinson -Flint.

Kira Johnson, who spoke four languages, lived in China and ran several businesses, died after giving birth to her second son, Langston, from complications from a routine Caesarean section. Doctors found three liters of blood in his abdomen, according to a wrongful death trial filed against Cedars-Sinai Medical Center.

“After 10 hours of watching Kira suffer needlessly excruciating pain, after 10 hours of begging and begging them for help, the medical staff at Cedars-Sinai finally took action,” her husband Charles said. Johnson IV, to federal lawmakers at a conference in the United States. Chamber hearing in September.

Training alone is not enough to target implicit bias and should not distract from ongoing efforts to target more overt forms of racism and prejudice, said Kelly Capatosto, senior research associate at the Kirwan Institute for the Study of Race and Ethnicity at Ohio State University. Still, she and other experts called California’s legislative proposals “a step in the right direction.”

“California is at the forefront in examining the legal ramifications around implicit bias,” she said. “A lot of states haven’t done much to recognize the problem. “

In the criminal justice system, attention to the need for bias training has arisen from the rise of the Black Lives Matter movement and the evolution of social media, which has sparked greater recognition of the use disparate force by law enforcement against blacks, Latinos and other people. of color, said Demarris Evans, deputy public defender for San Francisco and chair of the office’s racial justice committee.

Evans, who has worked with San Francisco police officers to combat prejudice for the past two years, wrote a letter on behalf of the committee in support of the Kamlager-Dove bill requiring training for all police officers , calling it a “good start”. “

“It should be incorporated throughout their work,” she said. “There should be training and references to the biases implicit in regular meetings and debriefings, not one thing that you are involved in every two years.”

California Supreme Court Chief Justice Tani Cantil-Sakauye also expressed support for training judges on implicit bias. In her State of the Judiciary address last month, she said the Executive Director of the Judicial Council, Martin Hoshino, had already made unconscious bias training mandatory for all court administrative employees.

“He recognizes science, like me, that the formation of unconscious stereotypes can affect attitudes, actions and beliefs in any encounter where we meet someone different from ourselves,” she said.

She asked Hoshino to review the statewide judicial education curriculum to ensure that training is available to all judges. And she said she was planning on taking the first class.

More stories from Jazmine Ulloa »

[email protected]

To follow @jazmineulloa on Twitter.

Bernard P. Love