AMA apologizes for past racism

By Liz F. Kay and David Kohn
http://www.baltimoresun.com

The nation’s chief medical association apologized yesterday for decades of past discrimination against African-American physicians, when it effectively denied membership to many black doctors – which many believe has left a legacy of separate and unequal care.

The American Medical Association released an article and commentary acknowledging discriminatory practices that, although ended decades ago, still affect medical care. For example, until 1968 it limited membership to doctors who were also members of a state-level affiliate – many of which were segregated. In response, black doctors formed their own associations, which the AMA refused to recognize.

“We applaud the AMA for coming forward with information that is not pretty,” said Dr. Nelson Adams, president of one of those groups, the National Medical Association, a mostly black medical group started over a century ago. “It represents a time to celebrate where we are.”

Others were less gentle. “I’m grateful for the apology. But the time for apologies is long since past,” said Dr. Levi Watkins, a cardiologist at Johns Hopkins Hospital, as well as associate dean of the medical school. Watkins, 62, who grew up in pre-civil rights era Montgomery, Ala., was the first black person to attend Vanderbilt Medical School. He has long been involved in civil rights.

He noted that many studies show that every year in this country, 120,000 extra deaths occur among African-Americans because of disparities in care between whites and blacks. Watkins said that institutional racism remains entrenched in health care. “Right now,” he said, “I would like apologetic action.”

Without membership in medical societies, black physicians were denied admitting privileges at hospitals, financial support such as loans to open practices, leases for office space and even medical malpractice insurance, said Dr. Matthew Wynia, director of the AMA’s Institute of Ethics. Continuing education was also difficult because black doctors couldn’t attend meetings to learn about new treatments and research.

“The legacy of this history is still with us today,” he said. The proportion of black doctors remains the same as it was in 1910 – about 2.5 percent, Wynia said.

The study, to be published next week in the Journal of the American Medical Association, grew out of the Commission to End Health Care Disparities, a work group co-chaired by the AMA and the NMA. One of the issues high on the list was mistrust of the medical association by African-American patients and even some doctors, Wynia said.

“If we wanted to do anything credible in the area of health disparities, we had to take responsibility for any role the association had to play in segregation in the medical profession,” he said.

The 4,000-word history does not delve into the motivation behind the actions but rather chronicles their impact, Wynia said. “We don’t know what drove the decisions, but we know what the decisions were and we know what the impact was, and we know the impact is still with us,” he said.

“This legacy has such profound effects today but it’s really not known, especially among white doctors,” Wynia said.

“If you don’t recognize this whole cultural backdrop to that relationship, you’re liable to become defensive and annoyed if someone doesn’t automatically trust you, and if you perceive African-American colleagues as having unjustified anger” about joining the medical society, Wynia said.

At the same time, the AMA does not reflect a unified medical voice because many African-American and progressive white doctors refuse to join as a result of its history.

Carnell Cooper, a trauma surgeon at the Maryland Shock Trauma Center, praised the AMA for making what he called a remarkable statement, given its magnitude and influence. He hoped this would lead to more support for increasing the number of African-Americans in medicine – a proportion that is declining in his speciality.

“It’s especially important, I think, as we try to work as a society to increase those numbers, it is important that the AMA show this sort of support for such efforts,” Cooper said.

The public apology adds the AMA to a growing list of institutions that have sought to make amends for discriminatory pasts. Maryland lawmakers, for example, passed in 2007 and the governor signed a resolution expressing “profound regret” for the state’s role in slavery

And President Bill Clinton expressed regret in 1997 for one of the most notorious chapters in racist medical care: a long-running research project based in Tuskegee, Ala., that monitored – but did not treat – hundreds of black men with syphilis.

The AMA history notes that it did not require state-level chapters to desegregate until 1968, after the Civil Rights Act of 1964 required hospitals to integrate to continue to receive federal Medicare and Medicaid reimbursement. By that time most state chapters had already admitted black members.

Dr. Wanda Ramsey was more optimistic about the impact of the apology. The Catonsville physician, 50, is vice president of the Monumental City Medical Association, a chapter of the National Medical Association for Baltimore founded in 1942.

“I think if they’re open and willing to work with us, especially with health care disparity being a big issue right now, I think a lot more can get done in terms of dealing with the health needs of the total population,” she said. “I’m anxious to see how they will continue to extend themselves to working with black physicians.”

Her father, Dr. Harold Ramsey, is a retired tumor surgeon who held leadership positions in the NMA. “I don’t have anything so negative to say about the AMA except about what they did not do,” the 80-year-old said, calling their problems ones of omission rather than commission.

Emerson C. Walden, a retired African-American doctor who lives in Columbia, worked for five decades in Baltimore as a surgeon. “It’s long overdue. It’s a step in the right direction,” he said of the AMA’s apology.

In the late 1940s, Walden was a resident at Provident Hospital – then the only hospital in Baltimore focused on caring for blacks. On Saturday nights, the 157-bed hospital often filled up, and Walden would call the doctor in charge at Johns Hopkins Hospital to see if there was room.

“He would call back,” Walden remembered, “and say, ‘I’m sorry, we don’t have a single colored bed in the house.'” Walden would continue calling other hospitals until he found enough “colored” beds.

A spokesman for Hopkins, which was founded on a mandate to provide care for all citizens regardless of race, acknowledged the practice. “Like most hospitals of that era, Johns Hopkins segregated patients by color, a practice that we deeply regret today,” said the spokesman, Gary Stephenson.

Walden also recalled that until the 1950s, he wasn’t allowed to join the AMA or MedChi, the Maryland state medical society. He said he could never understand how fellow medical professionals could accept segregation. “How could a doctor, trained to work on all kinds of people, still be bigoted?”

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