Hospital apologizes for complying with racial request

The incident may have violated employees' rights, and an ethicist says that it also has implications for patient safety.

By Andis Robeznieks, amednews staff. Oct. 27, 2003.

A nationally recognized Philadelphia-area hospital received some national attention it didn't want, including charges that it violated the Civil Rights Act of 1964 when it complied with the request of a patient's husband that only white hospital staff members care for his pregnant wife.

Officials of Abington Memorial Hospital in Abington, Pa., have issued a public apology, apologized individually to the employees involved, formed a diversity task force to develop plans to avoid future incidents and are holding employee forums on revising the hospital's nondiscrimination policy.

Links
See related content

Don Clark, EdD, president of the Willow Grove branch of the National Assn. for the Advancement of Colored People, said a sign was placed outside the patient's room indicating that her husband did not want black employees to enter. Dr. Clark said he was told by hospital officials that this sign was eventually replaced by one instructing all staff members to report to the nursing station before going in.

"If it was an African-American employee, they were told not to enter the room," he said.

The incident occurred the week of Sept. 7-13. Citing privacy laws, the hospital would not reveal much more except to say the patient was there "for several days." In a letter to the community, Richard L. Jones Jr., Abington Memorial's president and CEO, apologized for the incident and explained how the request for no contact with minority employees came to be honored.

"A maternity patient's family member made requests of the hospital that were racially discriminatory," Jones wrote. "In a misguided effort to protect African-American employees from a potential conflict with this family, maternity staff informed them of the volatile situation and suggested that they not interact with this patient. While these actions were made with the best intentions, it was perceived that the hospital was acquiescing to the family's wishes."

Jones then stated the hospital policy that "employees will be assigned to patient services without regard to the race, creed, color, national origin or religion of either the patient or employee."

Michael Goldrich, MD, a Highland Park, N.J.-based otolaryngologist who chairs the AMA's Council on Ethical and Judicial Affairs, noted that a new AMA policy states that a patient acting in a prejudicial manner toward physicians or other health care professionals may constitute sufficient justification for arranging transfer of care. While it appeared the hospital was accommodating a patient choice, Dr. Goldrich said it was actually accommodating "a statement of prejudice."

"I think we have an obligation to protect our society from these hurtful types of activities," he said, adding that it points to a need for more training so the staff knows in advance how to act appropriately when an inappropriate request is made.

A matter of patient safety

Both Dr. Clark and Arthur Caplan, PhD, chair of the department of medical ethics at the University of Pennsylvania, Philadelphia, acknowledged that people often choose a primary care physician on the basis of race, ethnicity or gender, but the right to those choices does not extend into a hospital. Dr. Caplan added that nondiscrimination is not necessarily the main issue.

"The driving principle for me is patient safety and welfare," Dr. Caplan said, adding that safety is achieved by routinization, standardization and teamwork, and the team often consists of people of all backgrounds.

"They should have said to the husband: 'The best care for your wife comes from our team, and our team has all kinds of folks,' " Dr. Caplan said. "It's not because you have to accept a mixed health care team by law; it's because it's what's best for your wife, pal, and your baby, and that's what I'm interested in."

Abington Memorial is well-known for its commitment to safety, recently receiving an American Hospital Assn. award and a John M. Eisenberg Patient Safety Award. The awards recognized the hospital's "blame-free" culture of safety. There was concern that this would be used to shield the employees responsible for the incident from facing disciplinary action.

Dr. Clark said this would be unacceptable and, if it had occurred, the NAACP might have pursued more serious actions for violations of the Civil Rights Act, which states that using race as a criterion for work assignments is illegal. "Our interest is not tearing down the institution but to eliminate any racist elements in the institution's culture," he said, and although the hospital can't tell him who was disciplined and how, Dr. Clark said he believes it did what was necessary. "Healing needs to take place, and consequences need to be applied."

Beth Ann Neill, Abington Memorial's director of public relations and marketing, confirmed that employees would not be shielded from discipline. "Although we do have a blame-free environment, that does not mean that hospital employees will not be held accountable for their actions," she said. "Our staff must act in accordance with hospital policy."

ADDITIONAL INFORMATION:

Weblink

Abington Memorial Hospital open letter to the community, in pdf (www.amh.org/frontpage/amhopenltr.pdf)

"Disrespect and Derogatory Conduct in the Patient-Physician Relationship," AMA Council on Ethical and Judicial Affairs, Report 8-A-03 (www.ama-assn.org/ama1/pub/upload/mm/369/ceja_report_8a03.doc)