Racism in healthcare implementation, management and operation. White medical professionals are doing harm in peoples’ homes WITHOUT ACCOUNTABILITY.
In 2017, after realizing I need to focus on learning the infrastructure that is systemically disenfranchising black folk from equitable healthcare…..I was sought after and recruited by Blue Cross-Blue Shield of Texas to be a Case Manager for their Texas STAR-KIDS managed care contract implementation.
The population served by this contract are pediatric members with SPECIAL NEEDS in urban, urban-adjacent and rural areas. Many of these children require medical attention beyond the typical pediatric clinic. They require targeted mental health support, frequent durable medical equipment assessments/upgrades, educational interventions, caregiver education, medication reconciliation, accessing pharmacies, evaluations for in-home assistance, on top of assessment concerning the improvement/stability/decline of illness. I was a part of a team of RNs, LVNs, LPCs, and LCSWs. I had the kids that pro-life campaigners forget about when making conflated promises of caring for all children after they breathe the same air. Physical, Intellectual, Mental Differently-Abled humans are no less human. But, I could not find a single pro-life advocate outside the homes of the members…..I went into this job from being a Volunteer Coordinator for the same volunteer organization that I went to that dumb ass DONA training in order to do what I had been doing……. I knew all too well the corporate environment. But, I was not about to let them pay me peanuts when I am beyond over-qualified. Tried that “but you’re not actually a nurse” shit on me before, and I always end up being a go to because I work twice as hard as everyone else…... No bih, gimme my coin. I possess the basic education and experience for the job, so I knew not to undervalue myself if i went back to corporate America.
The shit started the first damn month. The initial complaint being that the 90% white staff hated calling the language translation line for non-english speaking members. The manner of insults that these healthcare workers (prior occupants of our local NICU/PICU, Obstetric, Pediatric, Family Medicine, Home Health, Cosmetic Surgery hospitals and clinics) was not only audible, visual and palpable. I truly tried to rationalize it as the adjustment from the clinic to case management. By month four, I tried to excuse it as personality conflicts with members. By month seven, I knew I had to stop trying to excuse behavior because racists did not excuse themselves from their comments. In trying to ensure I minimized my interaction with said team members, I made sure to familiarize myself with our support staff. The various interpreters I worked with on-site expressed their un-comfortability and traumatic observations to me at length. Most of the racist and classist responses poured from the registered nurses on staff, but there were sporadic, yet impactful comments from a certain LCSW Manager. These people are the people that do not ask questions before calling Child Protective Services. These are the people that do not think of the time someone has to take out of their lives to meet with them. Homes, meals, yards, clothes, pets, relatives and any possible thing you can think of in your intimate space was open for evaluation. All of these things that make up our lives were under constant criticism based on race, socio-economic status, sexuality and diagnosis.
STRIKE ONE.
Over the course of the next six months, the staff would express not feeling safe in predominantly BLACK and LATINX areas of Travis and surrounding counties. Raving about Starbucks new locations where homes, parks and hand-reared businesses once thrived. Pulling up in these communities dripping with their wealth on wheels. Expressing they will never wear open toed shoes in “roach infested living rooms”. Expressing “how can they have the latest iPhone, but not have minutes to talk to me?” Expressing “They only want to get approved for an iPad so they can use it, it is not for the kid.” of “they are just trying to get approved for the kid’s SSI check.” But you don’t feel safe? This was bolstered by an actual ostracization of the only Black nurse manager due to calling for better care standards and employee conduct. Surveillance on the four darker skinned employees by the Director and Program Manager. Let me mention that of course the Black Nurse Manager was on locked and hitting their numbers (which were made up by a Program Director, trained in Speech Language Pathology that had been out of practice for years, and a Geriatric Home Health nurse who worked in support of the CCC for only maybe a year). Consistently and clearly, the Nurse Manager was Black Excellence. But the hierarchy was forceful and critical regardless, because black women have to be three times better at EVERYTHING.
Strike TWO.
I AM REALLY TRYING AT THIS POINT TO JUST GATHER INFO…..AND STAY SANE.
We had a quota of four Individual Service Plans (ISPs) and Screening and Assessment Instruments (SAIs) a week. This was compounded by actual case management. A bih was doing SIX to EIGHT A WEEK. I was as usual, the outlier. My life experience, education and basic ass compassion knew I needed to work around employed care takers’ schedules. So if that parent could only meet at 6 am before school/work, that is when we met. If they could only meet when they got off at 7pm, we met after 7….period. I was a salaried employee. I had flexibility, my caretakers and members rarely had that professional luxury. I had reliable transportation, internet services, did not live in a food desert, speak English. I had an personal obligation to do as much as I could (and a professional obligation per the company culture) in the time that ensured my caseload was being properly managed. This was beyond my pay, btw. Was not a 40hr work week on a slow week. Members that were deemed unreachable were back under adequate care, seeing their primary care providers, caretakers given resources to ensure their most basic needs were met. My high risk mental health kids were given targeted care plans, access to care providers that look like them, and affirmations that they can be whatever they want. Cause a heaux is RESOURCEFUL AF. I gave NICU families a lens into healthcare to ensure that they had access to all that they are entitled to at discharge (it never covers the reality of the next three to five years if you don’t have secondary insurance). People are not educated on the necessity for Medicaid despite your socio-economic status. A child in the NICU/PICU can bankrupt a family. I didn’t code-switch with my families, I spoke to them in the manner best for their comprehension. I let every single one of my kids know that I was them. And they too could go to college if they wanted to, travel the world, and be whomever they are destined to be.
WIN……IT IS WHAT I DO
As I presented solution after solution to the gripes of my team during team meetings, it became abundantly clear I was working with some racist as fuck white women. I really tried, every single meeting to present a accessible solution. A real team player. Shitty part is that the ringleaders were my bosses. I watched favoritism, teenage clique behavior press hard. But, bc this light-skinned privilege, these folks felt safe to talk and do all kinds of fuck shit in front of me. But, I am not dumb. I returned to the old lab and clinical saying “If you did not document it, it did not happen.” I turned my journal into my lab notebook, my SOAP note. And I began documenting the macro and micro-aggressions I saw in member’s profile notes, the slave/master narrative they pushed with the black project manager (lemme know when setting up a grown person’s workstation and iPad is the job of a PROJECT MANAGER), the micromanaging of the black and non-white employees’ time, then the end all be all……the numerous times the LCSW Manager for the Mental Health provision contract touched my hair. Then her mentioning to traveling to Africa upon the discussion of me going to Germany with my non-American, German partner. Consistently ear-hustling and interjecting in conversations between myself and another team member. Did I mention this was a middle aged, white woman who claimed to be a feminist??? Oh shit, I didn’t mention that? My boss and her best friend who was all of our bosses were proclaimed feminists and atheists…….and legit racists.
STRIKE THREE…….BUT, I BELIEVE IN DIVINE INTERVENTION.
And a felony assault charge did not make the books THAT DAY…...
That third time…..when she went in with her hands to my hair on an elevator….was the breaking point. I reported a bih. It is the only thing I could do. I was tempted to file a police report for harassment. But, I knew the process of making this known. I also knew that odds were stacked against me because “angry black woman” and “white tears” narratives would be in full force by management. Due to the reporting process and the nature of my supervisor’s relationship with Long Arms Linda the LCSW, I ended up being unreachable by my boss for three hours. Three hours of multiple meetings with HR from the Mental Health contractor concerning the LCSW rehashing her fuck shit over and over again. I gave that bitch one too many chances to touch me without repercussions. When I finally was able to meet with my boss remotely, I sat in an open conference room, in tears, exhausted explaining where I was and what I was doing. Her BFF/her boss (Geriatric Home Health Haggard) walked in, and laughed in my face as she heard me rehash what happened. I deuced out after that per my primary care provider and therapist’ recommendations that the job was a prime contributor in the deterioration of my physical and mental health.
Imagine if this had been a workplace with an ethnic majority, a black majority? You think Karen would still play Steve Irwin with Black People at work?
I was done. I filed an EEOC complaint with documentation. Two other folks also filed complaints. Results: NOTHING. Unless I had recordings or video, it was their words against mine. It is these same racist folks who are in hospitals not listening to racialized black and brown birthing folk. Not listening to our children. These people are literally blaming caretakers for not giving adequate care to their children with medications in a foreign language. Legit would not even ensure the member’s meds were in a language that the caretaker could read, y’all. Then blame the caretaker for frequent hospitalization…….like Western Medicine is as clear as kindergarten????? Like these caretakers are born with your whole degree in their minds, and your just helping them use it??? Like the discharge doctor or nurse sat them down and fully explained in their native language, at their comprehension level EXACTLY how to dose, dispense and dispose of medications? Y’all these people genuinely believe they were out here doing “God’s Work” (their words, not mine) and improving quality of life. And they can behave this way because of gatekeeping, lawyers, conformist kinfolk, control of people’s paycheck.
But, this was my last attempt at acceptance. There are so many other things that happened, but I chose to speak on these because of the lies being told about healthcare legislation, home health, case management, and who holds those positions. I have tried since my first paycheck in life to make sure that I am an operational asset. I can no longer say that knowing that silence is a part of that accolade. These people weaponized their knowledge, dehumanized families and limited compassion to peers. Those are 18 months I can never erase from my brain. I have now seen racism from the lab bench to the park bench. And those holding clinical licensures, using a tool for good to cause harm in every single setting they are allowed to do so. I will not be sharing arrival or departure stories of clients on this blog in regards to systemic racism without their words/experience/emotions being front and center. Their stories are not mine to share.
HEART Rituals, LLC could come of nothing. But, you will NOT catch me in another white-led and run business as an employee. NOPE….Must be a make it/break it matter for me to make that sacrifice again. I am not saying that there are not white/white-presenting people who make amazing bosses and colleagues. What I am saying is that due to the nature of intimacy, birth, death, health and life as it is lived, I cannot work for another human being that does not have the care and capacity for the humanity of racialized black and brown bodies. These same nurses were wined, warm and in comfort, displaying privilege on social media as their caseloads endure a pandemic, endured a winter storm and political isolation. Peak IG Influencer behavior on tax dollars in full display. People are allowed to enjoy the comforts of their efforts and earning. But when your job is to ensure accessibility, stability and empathy, and you choose to demean a person based on circumstance….you are a different kind of broken person. When you choose to demean a person when the society they live in does not work towards their success, you are a different kind of neglectful person. The nature of corporate America and indeed, healthcare is that we throw people away that “do not make the numbers look good”. And, these people engage this tender population in the same regards.
So, I am fully aware that folks may not want the weight of who I am at their transitions because of the magnitude shared even here. I work to educate my clients using science, spirit and a whole lot of substance due to personal experience. The reaches of my empathy go beyond the normal because the of breadth of life I have lived and seen transition. Racism is just a constant part of that breadth. Sadly, it truly does scientifically, spiritually and substantially impact every area of life before air even hits alveoli. So, in sharing these three small parts, maybe you can see the roots of purposeful compassion and righteous anger.
I was told not to long ago by an amazing soul, “Ras, you are not a vessel. You are a portal.”
You are welcome to open this door if you want to, but most definitely if you need to.