You can't make this sheet up!
The Fight Against DEI Programs Shifts to Medical Care
Complaint against Cleveland Clinic challenges stroke prevention and men’s health programs aimed at Black and Latino patients
By Theo Francis and Melanie Evans, WSJ
Aug. 14, 2024 3:38 pm ET
Black men and women are at least two times as likely as white Americans to die from strokes. Hospitals around the country have long sought to bring those numbers down.
Now, the Cleveland Clinic, a prestigious hospital system, is being accused of illegally discriminating on the basis of race for operating a program to prevent and treat strokes and other conditions among minority patients.
The allegation pushes the fight against race-based programs into untested legal territory, arguing that healthcare providers can’t use racial and ethnic demographics to target treatment, preventive care or patient education.
Activist groups have challenged private- and public-sector diversity efforts in education, employment and contracting, often using civil rights laws originally drafted to protect minority populations. These efforts gained new prominence with last summer’s Supreme Court decision barring the use of race in college admissions and are reshaping institutional practices.
“Race discrimination is a defining feature” of the programs at the Cleveland Clinic, a nonprofit with hospitals in Ohio and Florida, two activist groups allege in a complaint filed Wednesday with the civil-rights office of the federal Department of Health and Human Services.
By tailoring education and treatment initiatives for Black and Latino patients, including medical referrals and post-stroke care, the hospital system is violating the Affordable Care Act and a provision of the Civil Rights Act of 1964 that prohibits discrimination by recipients of federal funds, the complaint says.
“Cleveland Clinic is not permitted to sort individuals and coordinate benefits on the basis of race according to whatever rationale it believes is appropriate however well-intentioned its misguided notions may be,” the complaint says.
The Cleveland Clinic treats patients regardless of race, ethnicity or other characteristics as part of its mission to provide medical care and education and to conduct research, said the hospital system’s spokeswoman Andrea Pacetti.
Cleveland Clinic programs to treat and prevent stroke in Black and Latino patients violate the Affordable Care Act and the Civil Rights Act of 1964, two activist groups assert. Photo: Dustin Franz for The Wall Street Journal
The groups accusing Cleveland Clinic of discrimination have sued over other kinds of initiatives. Wisconsin Institute for Law and Liberty settled with Comcast over a program to assist minority-owned small businesses and has sued government agencies over similar programs. Virginia-based Do No Harm—a membership group for medical professionals and others opposing diversity, equity and inclusion initiatives—has sued a university women’s organization and a major drugmaker over minority fellowships.
“There’s definitely a concerted effort to attack DEI in healthcare and medicine, but I haven’t seen it done before over the way the actual provision of medical care is done,” said David Glasgow, executive director of New York University School of Law’s Meltzer Center for Diversity, Inclusion and Belonging.
So far, such cases are unusual, legal experts say. New York successfully defended a directive that healthcare providers take race and ethnicity into account when distributing Covid treatments, after being sued in 2022.
Health disparities
The Cleveland Clinic’s programs are among many initiatives to target longstanding health disparities between Black and Latino patients and white patients, with limited success. Studies and surveys show persistent gaps in treatment quality, and higher death rates, for Black and Latino patients with diabetes. Black, Native Hawaiian and Pacific Islander, and American Indian and Alaska Native women are more likely to die as a result of pregnancy.
The groups behind the complaint say other factors could explain what look like racial disparities, and institutions shouldn’t fall back on race to identify patients needing attention.
Research shows environmental and other factors, such as health insurance and income, affect health and play a role in health disparities, but can’t fully account for the differences in medical outcomes. That finding leaves other potential contributors, researchers say, including psychosocial stress, bias and poor communication by hospital and medical staff in the face of language and cultural differences.
“The most likely explanation is that it is the combination of all of these things,” said Mitchell Elkind, a Columbia University professor of neurology and epidemiology and chief clinical science officer at the American Heart Association.
Medical research has sharpened a focus on economic, social and environmental factors that contribute to health, such as air pollution where patients live and whether they have access to healthy food.
The AHA last year overhauled its heart-disease screening tool for patients, removing race as a factor, in part to address concerns it might perpetuate harmful stereotypes. The tool now uses a patient’s age, some health measures and ZIP Code. Location shows whether patients live in neighborhoods with high poverty and unemployment. Elkind said research shows the new tool is precise and accurate. The AHA announced in February it would further study its new tool’s results.
Medical screenings
The Cleveland Clinic launched its minority men’s health center about two decades ago, after an influential report to Congress by the National Academies of Sciences, Engineering and Medicine found Black patients were less likely to get recommended medical care than white patients, with disparities tied to higher death rates.
The minority men’s center offers medical screening, specialist referrals and public education for conditions that disproportionately affect Black and Latino patients, such as diabetes, according to the Cleveland Clinic’s website.
The Cleveland Clinic says its minority stroke program, started in 2019, includes four doctors and aims to tailor its treatment and prevention services to Black and Latino patients, according to its website.
The HHS Office for Civil Rights evaluates complaints and may investigate. It can impose penalties, including in some cases fines and loss of federal funding. Hospitals rely heavily on payment from publicly financed health insurers Medicare and Medicaid. Hospitals can appeal the office’s determinations in administrative proceedings and ultimately in federal district court.
Do no harm
In its complaint and a letter addressed to the chief executive and board of Cleveland Clinic, Wisconsin Institute says the practices it considers discriminatory have affected unidentified members of Do No Harm “who are not members of racial or ethnic minorities.”
An institute attorney said multiple Do No Harm members have been affected, declining to be more specific. The group, which doesn’t levy dues, said it has more than 10,000 members and declined to identify significant financial supporters.
Stanley Goldfarb, Do No Harm’s chairman and a retired physician and University of Pennsylvania kidney-disease researcher, said the group recognizes disparities in health risks and medical outcomes among minority patients, but believes programs like Cleveland Clinic’s are harmful.
“It undermines trust, it suggests there’s two kinds of healthcare being delivered—there’s healthcare being delivered to minorities, and there’s healthcare being delivered to white people,” Goldfarb said. “Our mission is to get rid of discriminatory practice in medicine.”
Distinguishing prevention or other medical services by race is illegal even when care is identical and no one is excluded, said Cara Tolliver, an associate counsel at Wisconsin Institute.
“The whole premise of it is based on the notion that if you are of a certain race, you must be at higher risk,” Tolliver said.
Telling medical institutions that they can’t help minority populations address significant medical risks could prove to be a tough sell, said Jason Schwartz, a Gibson Dunn & Crutcher law partner who represents a venture fund accused of discrimination for making grants to Black female entrepreneurs.
“The rule is not that you have to help everyone or no one, whether it’s a charitable endeavor or a public health priority,” Schwartz said. “That would shut down an awful lot of good works.”
Comentarios