Friday, February 23, 2018

Hospitals balance a patient's request with a fair workplace

ST. PETERSBURG — Syrenthia Dysart entered the hospital room to perform what she thought would be a routine assessment.

Her elderly patient did not fidget, fuss or speak as Dysart checked her breathing, fluids and pulse. While Dysart held her fingers on the woman's wrist, the charge nurse came in and told Dysart to leave.

Dysart didn't understand.

"Because you're black," she recalled the nurse saying.

Dysart was unaware that the woman's family had told staff she once had been mugged by a black man. Feeling it might make the woman uneasy, the family asked that no black staff attend to her. The request made its way up the chain of command, and according to Dysart and a lawsuit she has filed in the U.S. District Court in Tampa, the request resulted in a "hospitalwide directive" — meaning everyone from doctors to janitors were made aware.

This type of request has been called one of medicine's "open secrets," and hospitals often acquiesce.

Until recently, the subject hasn't attracted much attention because hospitals often deal with the requests surreptitiously, rescheduling physicians and nurses without explanation.

But some recent studies and lawsuits have brought light to the practice and have raised the question: What does a hospital do when a patient demands that a doctor or nurse of a particular ethnicity not treat them?

Many in the medical field say hospitals are not the setting to educate patients in social justice, and that caring for the patient is first priority.

But hospital employees who have sued over the issue say it violates their right to a discrimination-free workplace.

A hospital in Michigan recently settled out of court with a nurse placed in a situation similar to Dysart's. A man in the neonatal unit asked that no black staff touch his wife or handle his baby. To emphasize the demand, he rolled up his sleeve to reveal a swastika tattoo.

Tonya Battle, a nurse who has worked there for 25 years and was involved with the lawsuit, remembers the note posted to the wife's medical information clipboard: "No African American nurses to care for baby, per dad's request."

"I felt like I was thrown under the bus by the hospital," Battle told the Tampa Bay Times. "Like I was dispensable and I didn't matter."

Both Battle and Dysart spoke with human resources afterward. And both received similar responses: The hospital had a duty to care for the patient and to respect their rights.

The two responded similarly: What about my rights?

While physicians must treat patients of all races equally, the patients they treat have rights, not obligations.

A patient has the right to refuse medical care, the right to informed consent, and is backed by their right to seek criminal charges or sue if they are touched against their will.

So when Dysart entered the elderly woman's hospital room, she had the right to refuse care for whatever reason — Dysart's hairdo that day or the color of her skin.

Palms of Pasadena Hospital in St. Petersburg chose to honor the family's request, according to Dysart and the lawsuit, and, therefore, created a discriminatory work environment. But, ostensibly, the facility had another choice.

If a patient is putting an undue burden on the hospital, staff can tell him or her that they're unable to accommodate the request, said Jay Wolfson, professor of health law at the University of South Florida.

In this scenario, the hospital can arrange to transfer the patient, providing he or she is well enough to travel.

The problem then becomes the hospital is passing the buck, Wolfson said. What if the next hospital also refuses the request? And the next?

"At what point do you stop trying to educate the patient?" Wolfson asked.

These requests have become common, according to a study conducted in part by Dr. Aasim Padela, an assistant professor and researcher at the University of Chicago. Padela surveyed 127 doctors from across the country and found that 20 percent had encountered race- or religion- related demands from patients.

One reason this might be occurring more, Padela said, is because the hospital-patient relationship has changed. Half a century ago, doctors consulted less with patients, and patients had little choice in their treatment. Today, the relationship is moving more toward a patient-centered consumer model, Padela said, where the public views doctors more like "mechanics repairing people" and it's reasonable to make such demands.

In fact, several studies have found that accommodating a patient's racial preference is beneficial.

One 2003 study published in the Annals of Internal Medicine shows that when a patient and physician are of the same race, on average the visits were more than two minutes longer and the patient was more satisfied with the care.

"Do we segregate hospitals? I think that's ridiculous," Padela said.

But he said hospitals should reflect the community they serve.

"You have this social responsibility as an institution to provide the best care," Padela said. "And concordance does improve patient satisfaction."

Yet some worry accommodating the requests sends the wrong message.

"Yeah, it might be a good thing," said Vernellia Randall, emeritus professor of law at the University of Dayton. "But better than not having racism in our society?"

Before she was a professor and lawyer, Randall worked as a nurse for 30 years. Like Dysart and Battle, Randall says she experienced racism in the hospital.

"Yeah, I will move on and I will do my job, but do you think that it doesn't eat at me having to see that note?" Randall said, referring to Battle's case in Michigan. "That's like a big sign on the bathroom saying white people only, or colored people only. It's not stress- or injury-free to be in that environment."

Like the hospital Battle worked for, Palms of Pasadena has a policy that is generic and ambiguous.

The hospital is owned by HCA, the largest for-profit in the nation. It owns 42 hospitals in Florida and nearly a dozen in the Tampa Bay area (though it did not own Palms at the time Dysart alleges the incident occurred).

Its code of conduct states: " … we recognize and affirm the unique and intrinsic worth of each individual … we respect the diverse backgrounds and cultures of our patients and our employees."

Because of such vague language, staff can be left to decide on a case-by-case basis whether to transfer the patient; hide the request as best as possible and schedule accordingly; or potentially alienate part of its staff.

The hospital did not respond to a request for a comment about the lawsuit.

Battle's suit against the Hurley Medical Center resulted in a $200,000 settlement, a formal apology and training so that "employees are prepared to appropriately handle situations like this," according to a statement from the CEO, Melany Gavulic.

But the hospital would not define how it trained employees to handle such requests, or how it would handle them in the future.

Dysart, 33, who still works for Palms of Pasadena, hopes for a more definitive change.

Times researcher Natalie Watson contributed to this report.

Weston Phippen can be reached at (727) 893-8321 or [email protected]

Editor's note: An earlier version of this story was not clear that Palms of Pasadena was not owned by HCA Healthcare at the time a nurse alleges a family's racial bias prevented her from treating a patient.

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