'The system was complicit in her demise': Dr. Susan Moore's death spotlights racism in health care

Shari Rudavsky
Indianapolis Star

When the back pain from his sciatica became too excruciating to bear, Tony Gillespie called an ambulance. Two years later, it’s not that intense pain that Gillespie remembers but the treatment he said he received as a Black man.

The emergency room staff gave him a modicum of morphine that barely touched the pain. As he writhed in agony, the nurses refused to increase the dose, implying he might be an addict, he said.  If they gave him more and he drove home he could be arrested, they said. He thought that was absurd because he had arrived in an ambulance. When a physician arrived, the doctor apologized profusely, Gillespie said, and admitted him to the hospital, where he was given medication for the pain.

The sting of that experience has not faded. If anything, it has only more greatly reminded him of the importance of his job.

Gillespie is the vice president of the Indiana Minority Health Coalition — a career devoted to advocating for better health care for minorities.

Still, and despite the urging of his mother, Gillespie decided not to file a complaint.

“I think I didn’t because, I didn’t want to go through having to prove my pain again," Gillespie said. "It was painful and embarrassing and demeaning as well.”

Taking a stand:What 3 Indianapolis-based hospital systems will do to fight racism as public health crisis

That memory came flooding back last month when Gillespie learned about Dr. Susan Moore, a physician who posted a video on Facebook after receiving what she described as racist treatment at Indiana University Health North, where she went to be treated for COVID-19. Three weeks after posting the video, Moore died at a different hospital.

After her death, Moore’s story made national news, putting IU Health in an uncomfortable spotlight. IU Health has convened both an internal and external review committee to investigate the situation.

Moore's experience was no anomaly but the latest episode in the disparate ways Black patients may be treated, which can lead to poorer health outcomes, Black physicians, advocates, lawmakers and experts in health disparities said in conversations with IndyStar in recent weeks. From Black doctors reporting they were offered food at prenatal visits as though they were welfare mothers to the fictitious trope that Black people have higher pain tolerance, they said racism contributes in myriad ways to health disparities.

Dr. Susan Moore:What we know about the Black doctor’s claims of racism at Carmel hospital

And, they said, those disparities are rife. Black infants die at more than twice the rate of white babies, according to the Centers for Disease Control and Prevention. The maternal mortality for Black women is more than twice the rate for white women.

Black adults are 60% more likely to be diagnosed with diabetes than white adults and twice as likely to die from the disease, according to the federal Office on Minority Health. A recent study found that while Black patients are more likely to develop kidney failure than white patients, they’re less likely to receive an organ transplant.

COVID-19 has put increased scrutiny on the disparity of care. A wily disease that can range from mild to deadly, COVID-19 infections are 1.4 times more likely to occur in Black people, according to CDC data. Black COVID-19 patients are 3.7 times more likely to be hospitalized for treatment and 2.8 times more likely to die.

Racial disparities in care receive renewed attention 

Moore's death occurred against this backdrop, speaking volumes to those who have worked to narrow health disparities.

In an emailed statement, Dr. Jerome Adams, who served as former President Trump's surgeon general, said he was "deeply saddened" by her death.

"The COVID-19 pandemic has disproportionately ravaged communities of color and highlighted the existing disparities that have plagued our country for centuries," said Adams, who also is a former Indiana State Health Commissioner.  "Dr. Moore’s death is a sobering reminder of the continued work that needs to be done in our health care system to ensure that everyone receives compassionate, scientific, and ethical care.”

Dr. Jerome Adams

Several non-biological factors can contribute to these discrepancies, experts say. Black people are more likely to hold essential or frontline worker jobs, live in crowded housing, and have less access to healthy food and medical care.

While these disparities are not new, the current intensity of attention to them is. George Floyd’s death in police custody last May, a tragedy captured on video, sparked national protests and increasing awareness of the myriad ways the vines of racism entwine through our everyday lives.

In June, the city of Indianapolis passed a resolution declaring racism a public health crisis and promised to develop policies that would promote racial equity. Four months later, the leaders of Eskenazi Health, Community Health Network and Indiana University Health issued a similar statement decrying racism as a public health crisis. The three health care executives have pledged to take a series of steps to improve equity in their workplaces and the care they deliver.

The most subtle micro-aggressions

Moore's death might never have made national headlines if not for Dr. Carmen Brown, an American obstetrician-gynecologist now living in Australia.

Brown and Moore belonged to a Facebook group of about 3,000 Black women doctors, a medium in which Moore detailed her battle with COVID-19. When another doctor posted that Moore had passed away, Brown felt like she had lost someone she knew.

Moore was a doctor who knew how to advocate for her needs. If this could happen to her, what did that mean for those without such advantages, Brown thought. 

“I don’t think any of us were really shocked. I think we were broken," Brown told IndyStar. "It broke you because it didn’t protect her at all — her being a physician, her being educated.”

Brown fired off a searing series of tweets about the Moore case, concluding that while COVID-19 was the cause of death, “the system was complicit in her demise.” Soon #DrSusanMoore became a hashtag. 

The video Moore made from her hospital bed, an oxygen cannula attached to her nose, her voice raspy but certain, helped catapult the story to national prominence. Just as cell phone videos have captured police killings and other criminal justice inequities, Moore’s video showed racism can happen to anyone, said Dr. Woody Myers, Indiana’s first Black state health commissioner and the 2020 Democratic gubernatorial candidate.

“She eloquently described treatment that is far too commonplace in our health care system…. " Myers said. "Nothing she said was really surprising but she gave a face, a name, her voice and her own credibility as a physician to something that occurs virtually every day. It was the most subtle microaggressions that were also the big part of it. It wasn’t just one decision. It was the whole attitude.”  

Dr. Woody Myers.

After media reports of Moore's death, IU Health convened an internal and then an external review committee to look into her treatment as well as more general patient care and protocols. IU Health officials expect conclusions soon from the external review committee, which includes four Black, one Latino and one white member.

Last week the Greater Indianapolis branch of the NAACP and the Indianapolis Recorder held a public forum to which they invited to speak Eskenazi CEO Dr. Lisa Harris, Community CEO and President Bryan Mills, and IU Health CEO and President Dennis Murphy. All three had signed the racism as a public health crisis pledge.

More than 4,000 people watched the virtual forum on Zoom and on Facebook, said co-moderator Joseph Tucker Edmonds, a member of the NAACP’s education committee and IUPUI assistant professor of religious studies and Africana studies.

Joseph Tucker Edmonds.

Tucker Edmonds said that Moore's death was preventable and reflects how racism and white supremacy routinely occur.

“Dr. Moore is just another example of the ways in which racism as a public health crisis impacts every area of the Black community’s life," he said, "from its most celebrated citizens to those on the margins.” 

Indiana University Health CEO and President Dennis Murphy said racist behavior would not be tolerated at his institution. He added that some instances may be complex and everyone is entitled to a full evaluation of the surrounding circumstances. 

Race trumps class

Moore was not the first tragic example of how race can trump social class for even the wealthiest and most educated. Serena Williams and Beyoncé both weathered potentially fatal childbirth complications, their fame and fortune unable to protect them, said Rashawn Ray, a fellow at the Brookings Institution. 

Add the stressors of a pandemic into the mix and the already-present gaps are only likely to widen, he said. Crises lead people to rely less on training and more on gut responses, which can result in biases bubbling to the fore.

“When institutions like health care are under pressure, instead of becoming more equitable, often times they become more inequitable,” said Ray, who also is a University of Maryland sociology professor. “When crises occur, the people who are most marginalized are the ones who receive fewer resources, less time, less medication, less testing. And Susan Moore’s situation highlights that.”

The panel reviewing Moore's case should not look at her experience as an isolated incident but take a broader look at racial, class, and gender differences in the care patients receive, Ray said. The hospital should begin to collect data that allows it to assess whether any gaps in outcomes are improving over time.

Another key part to the puzzle lies in increasing the number of physicians and nurses who look like those they serve. Black doctors comprise about 4% of the profession, while Black people make up about 13% of the population.

There’s no guarantee that Black physicians will treat Black patients better than white ones do but employing Black professionals, Ray said, shifts workplace dynamics.

“Having diverse representation interrupts the interpersonal way that bias pays out,” he said. “If there is a Black physician or Black nurse on a floor, all of a sudden people are going to be more conscious about the decisions that they’re making around Black people’s bodies.”

All three hospital systems at the NAACP/Recorder forum pledged to start collecting such data and posting it on their websites.

More than data is needed to combat the presence of racism in health care, experts say. Cultural competency and implicit bias training can open providers’ eyes to ways they may be inadvertently contributing to the problem, many interviewed for this story agree.

In addition to teaching cultural competence to those already in the health professions, health care needs to do a better job of ensuring that those who hold these positions have the compassion one needs to care for others of all backgrounds, many who talked to IndyStar agree.

Attitudes tolerated a few decades ago are no longer acceptable and hospital leaders need to be proactive when they identify an employee who does not understand that. Looking to the future, Myers, the former state health commissioner, said medical schools should ensure those they admit embrace diversity, just as they look to applicants’ academic prowess.

“There is a reason that the United States Air Force wants to make sure you have 20/20 vision before they allow you to fly an airplane,” Myers said. “There are a number of criteria you can check before you give people this enormous responsibility of taking care of other people.”

A step in the right direction

Advocates in Indiana have been working to find ways to improve the situation here. 

Last spring, the Indiana Black Legislative Caucus convened a task force to look into health disparities in light of the COVID-19 statistics. The task force issued a report that contained multiple recommendations, among them mandating cultural awareness training for health care professionals. 

This recommendation has now become legislation, House Bill 1333, which would require health care professionals to undergo at least two hours of such training a year. The bill would also require the state health data center to add race, primary language, and disability status to the statistics it maintains.

“When you think about the biases that we have buried inside, whether they have been learned indirectly or directly, it’s going to take a while to unteach these biases,” said Rep. Robin Shackleford, D-Indianapolis. “This training is just a step in the right direction.”

Shackleford recalls sitting by her elderly father’s bedside in the hospital and asking repeatedly to speak with a doctor, going so far as to write on the board in his room that the family wanted an update. Only when the doctor saw her holding papers with the official insignia of her elected state office did she receive the information she sought, she said.

For her colleague, Sen. Vanessa Summers, D-Indianapolis, last summer’s task force represents just a start. Hearing Gillespie’s story about his ER visit for sciatica pain spurred her to sponsor House Bill 1390, which would establish another task force to develop solutions for combating racism as a public health crisis. 

While local hospital leaders have said they’re planning to change, Summers said such a task force might help guarantee that they do.

“That is the issue, how do I know that you have done that?” she asked. “So let’s come before us, tell us what your plan is and let us help you with things we see from the outside that you may not see that you may need to change.”

COVID-19 exposes racial disparities 

COVID-19 may offer the perfect backdrop against which to see such change, because it has once more exposed the deep roots of the disparities, many who talked to IndyStar believe.

For nearly three decades the Indiana Minority Health Coalition​​​​​, the only one of its kind in the nation, has been working around the state to improve health and mortality statistics for minorities.

The pandemic has posed numerous new opportunities for the coalition, from ensuring the state had sufficient Spanish speakers among its contact tracing staff to helping identify COVID-19 testing sites accessible to minority populations.

State statistics show that fewer than 4% of people in Indiana who have been vaccinated to date are Black, even though they comprise almost 10% of the state’s population.

The coalition is hosting a series of webinars aimed at different populations to encourage viewers to be vaccinated, said Gillespie, the group's vice president. The first one featured Marion County Health Department Director Dr. Virginia Caine; Dr. Lindsay Weaver, chief medical officer of the Indiana Department of Health; and Dr. Adams, at the time the nation’s surgeon general. 

Currently collaborating with more than 20 partners, the coalition would like to serve in a meaningful way as an advisor to the state’s hospitals, Gillespie said. For instance, the Coalition is partnering on a program in South Bend that matches some Black and other women of color with doulas, trained professionals who support women in childbirth and whose presence in the delivery room has been shown to lead to better birthing outcomes.

Major change, however, may be a long time coming, some say, because so much needs to be done to correct centuries of imbalance. The Indianapolis resolution on racism as a public health crisis takes a broad brush, addressing food access and criminal justice.

Such sweeping approaches are necessary to improve the situation and will take time, Brown said, likening it to a big gaping wound onto which people slap a bandage when a surgeon is needed.

“You’re trying to put little Band-Aids on those huge problems,” Brown said. “The work has yet to be done and quite honestly the ripple effect from Susan’s passing will not be felt immediately. This once again will take years of work to change systems.”

Contact IndyStar reporter Shari Rudavsky at shari.rudavsky@indystar.com. Follow her on Facebook and on Twitter: @srudavsky.