Boston hospital set to offer "preferential care based on race"

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In 2015 some of us wondered why Black and Latinx patients with heart failure—our hospital’s most common diagnosis—seemed more likely than white patients to end up on our general medicine service rather than on our cardiology service, where patients have better outcomes (along with a more comfortable experience, including private rooms and better amenities). Our effort to understand and correct this disparity has led us to rethink the nature of the fight for racial justice in medicine.

After analyzing ten years of hospital data, we concluded that the trend we observed was painfully robust: white patients at Brigham and Women’s Hospital—a prominent, predominantly white Harvard teaching hospital—were indeed more likely to be admitted to the cardiology service

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Redress is simultaneously the most substantial and the most unprecedented component of our Healing ARC. In general, institutional redress should involve not just a direct solution to monitor and end health inequities but to offer restitution for past and present injustices. Redress could take multiple forms, from cash transfers and discounted or free care to taxes on nonprofit hospitals that exclude patients of color and race-explicit protocol changes (such as preferentially admitting patients historically denied access to certain forms of medical care).

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Sensitive to these injustices, we have taken redress in our particular initiative to mean providing precisely what was denied for at least a decade: a preferential admission option for Black and Latinx heart failure patients to our specialty cardiology service.

The Healing ARC will include a flag in our electronic medical record and admissions system suggesting that providers admit Black and Latinx heart failure patients to cardiology, rather than rely on provider discretion or patient self-advocacy to determine whether they should go to cardiology or general medicine.

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Offering preferential care based on race or ethnicity may elicit legal challenges from our system of colorblind law. But given the ample current evidence that our health, judicial, and other systems already unfairly preference people who are white, we believe—following the ethical framework of Zack and others—that our approach is corrective and therefore mandated. We encourage other institutions to proceed confidently on behalf of equity and racial justice, with backing provided by recent White House executive orders.

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