Seattle's Autonomous Zone Protesters Demand Race Based Health Care—Would it Work?

Protesters in Seattle's Capitol Hill Autonomous Zone, or CHAZ, put forth a list of 30 demands upon taking over the area, one of which is that hospitals hire black doctors and nurses to treat black patients, a move that would require health care facilities to walk a fine legal line.

Race-based health care, while having gained support, presents legal and practical challenges to implementation. Proponents say it's one way to start closing disparities in health care, but it could take years and require changes to the education system to fill the shortage of black doctors, and CHAZ's demand that black doctors be employed for the specific purposes of treating black patients isn't quite legally sound.

Protesters took over several blocks in Seattle, dubbing it first CHAZ, then CHOP for Capitol Hill Occupied Protest. It began in response to George Floyd's death but transformed into larger calls for societal reform and protesters are demanding that "the hospitals and care facilities of Seattle employ black doctors and nurses specifically to help care for patients." Kimani Paul-Emile, a professor at Fordham University's law school, told Newsweek health care facilities can't hire doctors of a certain race specifically to treat patients of a certain race, as that kind of segregation would pose serious legal problems.

However, patients are within their legal right to choose their doctor and physicians and researchers support increasing opportunities for black patients to see black doctors. It's not a new concept and data shows there's merit to racial concordance between doctors and patients. Black people are more likely than white people to die at an early age from chronic conditions such as heart disease, stroke and diabetes, in part, because they aren't being screened and treated, according to the Centers for Disease Control and Prevention.

A 2018 National Bureau of Economic Research random clinical trial in Oakland, California, found black patients who saw black doctors were more likely to pursue diabetes and cholesterol screenings than those who saw non-black doctors. Based on the Oakland study's findings, researchers estimated black doctors could reduce the black-white gap in cardiovascular-related deaths by about 19 percent.

Black people also receive vaccinations against pneumonia, HPV, hepatitis and the flu less often than white people, according to the Department of Health and Human Services Office of Minority Health. Patients in the Oakland study were 10 percentage points more likely to agree to get the flu shot if their doctor was black, findings showed.

When patients saw a photo of their doctor, the physician's race didn't change their decision to have a diabetes or cholesterol screening, Dr. Owen Garrick, CEO of Bridge Clinical Research and an author on the study, told Newsweek. The "big difference" emerged after doctors interacted with patients and researchers determined the way black doctors communicated with black patients was why they sought preventative care when others didn't.

black doctors black patients seattle demand autonomous
A signs reads "Capitol Hill Occupied Protest" in area that has been referred to by protesters by that name as well as "Capitol Hill Organized Protest, or CHOP, on Sunday in Seattle. One of the demands protesters have is that Seattle hire black doctors and nurses to care for black patients, a move that experts say would require walking a fine legal line. David Ryder/Getty

Part of the reason black doctors often communicate better with black patients, experts said, is because they're able to establish a level of trust that's been eroded over time. Experts often point to the 40-year-long Tuskegee Study, when black men were not given an identified treatment for syphilis so researchers could observe the infection's natural course.

Mistrust in the health care system goes beyond that one study, however, and personal stories of bad experiences have even been passed down from generation to generation, Dr. Damon Tweedy, an associate professor of psychiatry and behavioral sciences at Duke University School of Medicine, said. A doctor who understands that perspective could convey health needs to a patient who's approaching health care from a long-standing position of mistrust in a way another doctor couldn't.

"In the long run, the numbers don't line up where every patient is going to see a black doctor and we don't necessarily want that," Tweedy told Newsweek. "The problem is that the choice isn't there."

Patients have a right to informed consent and to refuse treatment, which includes treatment from a particular physician, according to Paul-Emile. But the demand requires facilities to balance the patient's best interest and the law, which she called a "legal black hole in some ways.

Treating a patient without informed consent opens the provider up to malpractice lawsuits. But, Paul-Emile's research, as published in the UCLA Law Review, New England Journal of Medicine and American Medical Association, found a facility consistently acquiescing to patients' requests and moving a doctor off cases because of their race could result in lawsuits alleging a hostile work environment, as providers have the right to a workplace free from discrimination.

Tweedy told Newsweek the default shouldn't be to switch a patient's doctor because of their race. As someone who had white patients tell him they didn't want him as a doctor because he's black, Tweedy said he would advise residents to try to get to the root of why the patient wants a new doctor.

There are instances when switching doctors is in the patient's best interest. Tweedy recalled an instance decades ago, when a black Vietnam veteran didn't want an Asian provider because of a bad experience he had during the war. Paul-Emile's research published in the New England Journal of Medicine found it could be ethically appropriate to switch doctors if a veteran with post-traumatic stress disorder refused treatments from a doctor who resembles a former enemy combatant.

The same could be true for an older black patient in the south or a Muslim patient seeking a physician who shares her religious or cultural background, Paul-Emile said.

Even when a new doctor is ethically warranted, the lack of diversity in the health care industry could make it an impossible request to fulfill if the facility doesn't have a doctor available who fits the racial or ethnic criteria. And increasing minority representation will require more than just implementing changes in who is being hired.

One of the "biggest challenges" to increasing the number of black doctors in the health care field is standardized testing, Dr. Ryan Huerto, a family medicine doctor and a health services researcher at the National Clinician Scholars Program, told Newsweek. Experts called into question the exams' ability to measure potential and criticized it for skewing the playing field against already disadvantaged students.

Colleges and universities are already getting rid of SAT and ACT requirements and not all medical schools require students to take the MCAT, exams Huerto said aren't indicative of a person's ability to become a good physician. Even in a world without standardized exams, the pool of first-generation, low income and minority students pursuing a career in the medical field would still be smaller because it's costly to apply and train to be a doctor.

But investing in increasing black doctors in the workforce could benefit institutions as a whole. By having a workforce that's indicative of the community it represents, Huerto said positive interactions between minority patients and minority doctors could help rebuild trust in the entire facility's ability to care for patients regardless of the doctor's race.

Moving forward, experts called for health care professionals to be open minded and willing to have uncomfortable conversations that can lead to better care for all patients. Huerto said he was "cautiously optimistic" that medical facilities will diversify their workforce and given that many institutions have the economic capabilities to do so, he said, "I know if the folks in power are committed to it, it can happen quickly."