Systemic health care and legal issues have persisted for centuries, but have garnered increased recognition within the past year. Navigating today’s environment requires flexibility and innovation, as well as adapting existing laws in new ways.
The Boston University School of Law held a series of virtual conversations titled “Legal Innovations in Response to Public Health Crises” Friday as part of its 2021 American Journal of Law and Medicine Symposium.
The event consisted of three panels throughout the day on Zoom, featuring multiple experts from the legal and public health fields.
Experts from around the country presented their research on health care inequality, challenges within the law and public health policy.
Miriam Weismann, professor of business law and tax at Florida International University, was a panelist and keynote speaker — in a presentation titled “Not the Same America For All: The Discriminatory Impact of COVID-19” — at the event.
When asked about the inspiration for her research on social determinants of health, Weismann said in an interview the keynote for the event centered around equity.
“The theme of the keynote is that America is not the same for all,” she said. “We have unequal access to health care, we have discriminatory impacts on minorities … We need to change the way we think about health care delivery.”
During the day’s third panel, Weismann presented on “Ruthless Utilitarianism” and how COVID-19 protocols reveal discrimination. In developing her topic, Weismann said in an interview she recalled a memory from working as academic director of FIU’s Healthcare MBA program with one of the local hospitals.
“I said to the CEO of the hospital, ‘What are your triage protocols? What are your crisis standards that you are using in the event that you have to ration care?’” she said. “And he hesitated.”
Weismann said the hospital’s unwillingness to discuss rationing care revealed how damaging it is to be without universal triage protocol — a common standard used by hospitals to ration care and prioritize patients who are most at-risk.
“That’s when I decided to take a look at how we could possibly be in a pandemic and not have a triage protocol in place so that everybody was following the same rules,” she said.
She added that this issue was not exclusive to Florida — 13 states do not have triage protocols for rationing health care, making any situation necessitating rationing care “arbitrary.”
She said some objective metrics, such as a Sequential Organ Failure Assessment, are used to assess medical conditions and determine which patients have a greater chance of survival and will therefore receive the limited health care supplies.
Through research, Weismann and her colleagues found triage protocol guidelines could result in discrimination against Black Americans and other minority groups.
Cheryl Holder, interim associate dean for diversity, equity, inclusivity and community initiatives and associate professor in FIU’s Herbert Wertheim College of Medicine, said there are flaws to this SOFA scoring.
“The problem with the scoring is that some of the parts of the scoring is based on research that ended up not really having sufficient number of [Black people] in the study and also determination of what is Black,” Holder said in an interview. “Can you then extrapolate that across the nation, which is what this score does?”
Holder said the instruction to self-quarantine and call personal doctors is based on the idea that everyone has stable access to health care, which is not a reality for some.
“That’s the huge assumption, that everybody has a doctor,” she said. “Where I am in Florida, we did not expand Medicaid, about 25 percent of the core population do not have doctors. So who are they to call?”
But the experts are optimistic COVID-19-related problems of the present will help institutions make better decisions in the future, Holder said.
“We’re hoping that this pushes people to understand that we have to change the health care system that we currently have,” Holder said in an interview. “We have to have equity in health care, or else it impacts everybody at some point again. And if we don’t control this pandemic, our economy will continue to suffer.”
She pointed to vaccine rollout as an example of someone else’s health affecting another’s.
“Our systems support wealthier people, so they have ready access to vaccines,” Holder said. “That vaccine may not be effective because we’ve continued to leave a large group of folks vulnerable to the infection, which will then increase the risk of mutant strains.”
BU professor of Law Emerita Frances Miller, who moderated a panel, said in an interview interdisciplinary strategies are key in solving systemic health care issues.
“The cures for these problems are not necessarily medical,” Miller said. “The more you learn, the more data points you have to be able to make the connections.”
Sara Hickey, a second-year BU law student, said minority groups are less likely to go to doctors due to their distrust of the health care system, caused in part by their lack of representation.
“I’m really happy to see that this symposium was focused on those disparities because I think the pandemic has heightened the disparities that are always there and have always been there,” she said in an interview. “Looking at it through this lens will hopefully lead to more awareness in non-pandemic times as well.”