Equity Is More Than Words

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Above image: Graphic Created by Isabella Heffernan.

For Dr. Susan Moore, An Open Letter to IU Health CEO Dennis Murphy.

Dear Mr. Murphy and the IU Health Executive Team,

On behalf of Physician Women SOAR, an antiracist physician group, we wish to respond to the Indiana University Health (IU Health) statement regarding the medical treatment provided to the late Dr. Susan Moore, a Black physician who was admitted to IU Health in early December for COVID-19.

Twelve hours after she was discharged from IU Health, Dr. Moore was readmitted to another hospital in respiratory failure, where she was quickly transferred to the ICU. Dr. Moore remained in critical condition for over two more weeks and died on December 20th. While admitted to IU Health, Dr. Moore was treated so poorly that she turned to social media to both document her experience and to seek help from her fellow physician network. She stated that she was ignored, accused of drug-seeking behavior, and forced to advocate for herself, all while her lungs showed signs of significant pathology and her oxygen levels required close observation.

In response to public outcry over Dr. Moore’s video log of her treatment at IU Health and her subsequent death, IU Health CEO Dennis Murphy released a statement on December 24, 2020, entitled Directly addressing the issue of racial equity in our facilities. Despite its title, Mr. Murphy’s statement ultimately reinforces racial biases rather than challenges them. He fails to name racism as a problem within medicine, dehumanizes Dr. Moore, and dismisses her concerns.

https://iuhealth.org/for-media/press-releases/directly-addressing-the-issue-of-racial-equity-in-our-facilities

In honor of Dr. Moore’s memory, and with the hope of protecting other patients from similar needless suffering, we have deconstructed IU Health’s statement in order to illuminate the insidious and veiled defenses that will continue to block the development of a healthcare system with true equity.

<p”>Though Mr. Murphy opens with lip service to Dr. Moore’s traumatic experience at his institution, IU Health, he immediately pivots away from her, choosing instead to center and humanize the experiences of the IU Health healthcare team members who mistreated her. In her video, Dr. Moore recounts begging her physician to take her symptoms seriously, only undergoing a CT scan after speaking with a patient advocate — a CT scan that showed bilateral lung pathology, and signs of infection. Mr. Murphy describes her doctors as harried physicians “trying to manage the care of a complex patient in the midst of a pandemic crisis.” Referring to Dr. Moore as a “complex patient” not only contradicts the IU Health team’s desire to withhold pain medication, to withhold COVID-19 therapies, and to discharge Dr. Moore, but also deflects blame for her outcome from the IU Health team to Dr. Moore, for having such a “complex” condition. Blaming the victim is a stereotypic mechanism for the erasure of racism that seeks to distract readers from the core issue. The “several human perspectives” mentioned in this statement leave out Dr. Moore, the very human who brought this story to light.

In the video, Dr. Moore describes indifference from her nurses, who left her alone, short of breath, and in severe pain for hours. Mr. Murphy excuses this behavior by surmising that the IU Health nurses were unable to provide adequate and compassionate care while being “intimidated by a knowledgeable patient.” Mr. Murphy’s statement purposely ignores Dr. Moore’s own medical expertise and seeks to cast her in the racist “angry Black woman” stereotype. By failing to speak accurately about Dr. Moore as a physician-patient, the IU Health statement itself follows a typical racist rationalization with misogynoir undertones.

Equally notable is that Mr. Murphy’s statement relies on euphemistic language and fails to acknowledge the racism that Dr. Moore called out in her video and that was mentioned by every news outlet reporting her tragic story. The words “race” and “racism” are not mentioned (except to tout Mr. Murphy’s professed dedication to racial justice), and instead are replaced by euphemisms such as patients of color, diversity, inclusion, and treatment bias. In light of this, Mr. Murphy’s pledge to “transform our organization to be more diverse, equitable and anti-discriminatory” rings hollow. Indeed, Mr. Murphy artificially dissects and separates the review of the “technical” and “humanistic” aspects of Dr. Moore’s care. A true equity lens would account for the inseparable nature of these aspects of care, not just in the care of Black patients, but all patients.

When faced with a “sentinel moment to accelerate” their work, systems and leaders who truly take up the mantle of racial equity do not shift responsibility to the individual harmed or society at large, even in the context of a pandemic. They ask, “How could racism be operating here?” and explore, “Why was a Black woman and physician with valid concerns not heard and understood?”

We are writing to educate and inform healthcare professionals and administrators alike that healthcare broadly, and medicine specifically, does not inherently promote or value equity. Our systems were designed to be inequitable, and decoupling of egalitarianism from behaviors is unfortunately the norm. Equity in healthcare is not a given, but is something that must be worked towards on a daily basis.

Equity is both a process and an outcome. Equity is a measure by which we align our egalitarian values with our attitudes and behaviors. Equity necessarily demands that we stretch beyond ingrained and outdated notions of high quality healthcare, which contribute to persistent inequities rooted in disparate access, quality, and outcomes. True equity does not merely ask whether the people within a health system are well-intentioned, but instead whether the policies, practices, and institutional norms promote healthcare justice. We invite IU Health to strongly consider an apology for their wrongdoings in the care provided and their performative and inadequate response to Dr. Moore’s passing.

The starting points for equity in healthcare at IU Health, especially when they are reactionary to the tragic loss of a life, must include the following:

  1. Truth-telling and transparency: We demand that Dennis Murphy respond publicly to the points outlined here as he has pledged to “promote racial justice and resist discrimination of any kind” for the last several years at IU Health. In addition, this statement must include an accurate accounting of equity and lack of equity in the IU Health system and its blueprint to improve equity going forward. IU Health should make transparent their internal and external assessments on equity in health care and provide a 6-month and 2-year plan to address all identified gaps.
  2. Expertise: We demand that the outside board reviewing Dr. Moore’s care at IU Health includes Black female physicians with expertise in equity, justice, patient safety, and quality improvement.
  3. Accountability: We demand a detailed strategic plan for public consumption that outlines the assessment interventions. These assessment interventions should be inclusive of health care provider training as well as training of administrative and bureaucratic staff, and should include digital technologies such as telemedicine and patient portals. Metrics for success in these initiatives should be clear and updated regularly. We also call on the other organizations who signed the Indy Racial Equity Pledge to fulfill their stated commitment to hold each other accountable for creating change for Black Americans and moving toward a racially equitable community. We ask that you stand with us, and with the community, in demanding that IU Health fulfills the above-stated actions. We urge you to not only hold IU Health accountable for the systematic racial inequities that resulted in the tragic loss of an incredible physician, mother, daughter, sister, friend, and member of the Indiana community — but to also look deeply within your own organizations to identify and root out the same inequities, as they will inevitably be found.

Dr. Susan Moore was a much-loved member of our physician community. We, her fellow physicians, will not allow her to be dehumanized and reduced to racist and sexist stereotypes. We knew and remember Susan as a proud member of Delta Sigma Theta Sorority Incorporated. She was a caretaker for her two elderly parents, whom she adored and often turned to for wisdom before their health failed. Her social media posts reflect her love of community, medicine, family, and humor. Susan was, perhaps most importantly, a proud single mother to her son, whose accomplishments she proudly celebrated with her social networks.

As a group of over 2000 physicians nationwide, we urge IU Health to commit to taking true antiracist action within its organizational system inclusive of its culture. IU Health is a major healthcare system serving more than 1.7 million people, nearly 20% of whom are Black. IU Health owes it to the community it serves to recognize that though IU Health may value racial justice, without adequate intention and direction, their actions will continue to perpetuate racial injustices.

Signed,

Jessica Isom, MD MPH & Mary Seideman, MD PhD, Physician Women SOAR Editorial Board

Loucresie Rupert MD & Kadijah Ray MD, Co-founders, Physician Women SOAR

Founders Drs. Loucresie Rupert and Kadijah Ray started Physician Women SOAR (Support, Organize, Advocate and Reclaim) in 2017 to create a truly intersectional space to elevate marginalized voices. Physician Women SOAR members are dedicated to anti-racism work in order to learn how to better serve their communities. Through social justice efforts, the organization has donated over 600K to various political and social causes.