Health Care in a Context of Civil Rights (1981) / Chapter Skim
Currently Skimming:
APPENDIX E: Case Study: Cook v. Ochsner
APPENDIX E: Case Study: Cook v. Ochsner
Pages 174-184
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 174... ...
Ochsner Foundation Hospital et al., was filed in 1970 by black residents of metropolitan New Orleans who alleged that New Orleans hospitals were engaged in racial discriminatory practices in violation of Title VI and were not providing a "community service" or "uncompensated services" in violation of their obligations as recipients of Hill-Burton funding. In May 1971, DREW was added as a party defendant under the allegation that DREW had failed to provide for an enforcement program under Title VI and Hill-Burton and had allowed the defendant hospitals to operate in violation of their Title VI and Hill-Burton obligations.
|
From page 175... ...
OCR also faced the difficulty of formulating for the first time the form and amount of data that they would require to assess compliance by a hospital with the Title VI assurance and of determining in measurable terms their interpretation of what constituted compliance with Title VI. Relying heavily on the concepts of compliance that had been developed in reviews of educational institutions, the data request that was finally devised asked primarily for two kinds of data: data on the racial composition and privileges of staff physicians and data on total inpatient and emergency room admissions broken down by race, method of payment, and source of referral.
|
From page 176... ...
After the passage of the Civil Rights Act, the hospital board of trustees enacted a policy prohibiting white physicians from admitting only black patients to the hospital; following the enactment of this policy and the initial assessment of Title VI compliance incident to initial Medicare certification, most of the white physicians dropped their Flint-Goodridge privileges. As of 1978 there was only one white physician practicing at Flint-Goodridge; most of the white physicians who dropped their privileges also stopped treating black patients.
|
From page 177... ...
With the exception of one black representative on the lay advisory board of Mercy Hospital, there have been no known black representatives on any of the hospitals' boards of trustees or lay advisory boards. On July 19, 1977, DHEW notified these three hospitals that it had finished its investigation and that each hospital had been found to be out of compliance with Title VI.
|
From page 178... ...
7,867 1,004 13.6 1978 10,660 1,965 18.4 Southern Baptist Hospital Total Number Total Number Percent Black Year Patients Black Patients Patients 1968 2 1969 25 1970 90 1974 20,591 571 2.8 1975 20,673 729 3.5 1976 20,229 955 4.2 1977 20,680 1,206 5.8 1978 20,731 1,534 7.4 Note: Included are data collected in 1978 while the negotiations and subsequent hearings were taking place.
|
From page 179... ...
Mercy Hospital, while denying non-compliance with Title VI, did enter into negotiations and offered to (1) have formal and informal discussions with its medical staff to encourage the staff to admit their black Medicare and Medicaid patients into Mercy Hospital; (2)
|
From page 180... ...
Southern Baptist Hospital also denied violation of Title VI but agreed to negotiations and eventually to take the following measures: (1) send a letter of inquiry to all hospital staff physicians asking them if they would accept referrals from community health clinics; (2)
|
From page 181... ...
This conclusion was reached, "because of the remoteness from direct patient contact, and, in the case of Hotel Dieu and Mercy, the requirement of religious order membership for qualification." Based on these general conclusions regarding DHEW's compliance requests, the ALJ looked at each of the respondents to determine if they were out of compliance with Title VI. He found that, given the racial composition of its patient population, Hotel Dieu was no longer "racially identifiable." However, the hospital was required to take appropriate steps in order to increase utilization by blacks.
|
From page 182... ...
First, the ALJ adopted a limited interpretation of the scope of Title VI. There was little question but that the New Orleans hospitals had practiced racial discrimination in the past and that there continued to be disparities in the services provided to whites and minorities.
|
From page 183... ...
But paired with the ALJ's narrow view of the incidental obligations of a medical staff physician, this interpretation would virtually quash any effort to enforce Title VI in health facilities unless facilities make discrimination a matter of institutional policy. It must be noted that the interpretation of the ALJ does not conform to the interpretation of virtually all modern courts of the hospital-physician relationship, at least in the context of medical staff privilege decisions, malpractice liability, or even the Hill-Burton "charity care" obligations.
|
From page 184... ...
184 It also serves as a model, for better or worse, of OCR's technical and administrative capabilities. The manner in which OCR formulated and conducted its data-collection effort and developed the remedial practices that become the focus of the negotiations demonstrate the administrative "state of the art" as OCR enters this "new era" of civil rights enforcement.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.