At Seattle Children, a father’s request that staff use a needle-free injection device on their child, as ordered by the doctor, ended in safety to remove him from the room instead of the narcotic cream.
“As a black man, the security guard, accompanied by my very sick child, was powerless, ashamed, and saw me as a criminal in the eyes of other families,” he said, citing an internal report. Hospital Diversity և Health Equality Center.
The report found that from 2008 to 2011, Seattle Children’s black patients were more than twice as likely to make safety calls as white patients. This was done almost a decade ago, proposing immediate action.
The same discrepancy exists today. Seattle Children are calling for the safety of black patients at twice the rate of white patients since the end of 2014, according to the Breaking National Hospital Inpatient and Observatory. The data included calls from patients’ families և visitors only if the child was involved.
Hospital managers said they were aware of any inconsistencies in the use of Code Purple, with staff calling for a safety or mental health professional when they felt there was safe or threatening behavior. They made some changes to the process at the end of last year.
“Our ultimate goal at Seattle Children is to eliminate Code Purple inconsistencies altogether,” said hospital spokesman En Morgan. “Systemic-institutional racism is present in our healthcare system. We are not inviolable, but we must become an anti-racist organization worthy of our patients, families and workforce.”
But some former and current employees have questioned why no action was taken earlier, as the discrepancy has long been known. Hospital management has had a turnover in recent years, and current executives say they are unaware of an earlier analysis that six current and former employees told The Breaking National that they remember.
Dr. Ben Danielson, a longtime director of the Odessa Brown Hospital, said hospital managers had been told of the discrepancy in the past but had not taken any action. He resigned last year, citing institutional racism within Seattle Children, including calls for Code Purple.
“It is abusive if leaders are unaware of the report,” Danielson said. “Or a bad experience that they knew for eight or ten years that only in September a decision was made to act.”
The Seattle Children’s Hospital, which serves the largest district of any children’s hospital in the country, has been reckoned with following Danielson’s resignation. After his concerns became public, first at Crosscut late last year, the hospital system was hit with calls for action. It hired former US Attorney General Eric Holder to conduct an investigation that is expected to be completed by the end of June.
“Do not wait”
Seattle Children’s staff has called an average of 700 Code Purples annually since 2015 for situations ranging from staff attacking a patient to a suffering parent.
According to the hospital, the Code Purple response usually consists of one or two security guards, a psychiatrist, a behavioral health nurse, or a social worker.
Seattle Children staff have historically been encouraged to use the code, according to an interview with longtime security director Jim im Sawyer, who gave the industry publication 2019.
“We tell our nurses to call it as soon as possible at the first sign of a possible exacerbation. “When you intervene early, you can usually defuse the situation. Everyone goes home victorious,” Sawyer said. Code Purple refers to perception, early intervention, de-escalation, and safe physical restraint, but the focus and point of emphasis is simply “do not wait.”
Mira Gregorian, Senior Vice President, Chief People’s Officer, and Bonnie Frieslich, Deputy Director of Patient Care, Chief Nurse, said the process was intended to be helpful to patients’s staff. But they realize that this is not the case for all patients.
SS patients had the highest rate of Code Purples as they received 15% of calls but accounted for only 6% of hospital stays from October 2014 to 2021. March:
White patients were slightly more prevalent in the data during this period compared to their large proportion of hospital stays. But when looking at patients on security calls, the percentage of white patients who received the Code Purple call equals their share of the patient population, while the inconsistency for black patients remains.
Studies have found similar inconsistencies in other hospitals. For example, an eight-year study of data from Midwestern Hospital found that black patients and their visitors were more than twice as likely as white patients’s visitors to receive security expectation requirements.
The Seattle Children Working Group reviewed Code Purple data և made recommendations to eliminate inequality in 2019.
The hospital made some of those changes in December. Leadership, Safety և Nursing staff now receive weekly data updates. The hospital is expanding its diversity, equity և inclusion training է to provide de-escalation training for front-line staff, which it hopes will reduce the number called Code Purples.
The hospital also demanded that the staff member who called the code, the head of the unit, be present for an answer and then find out. Otherwise, the hospital said it had not made any significant changes to the response process.
Dr. Carmen Black, a psychiatry assistant at Yale School of Medicine, said there should be guarantees to determine if Code Purple is appropriate at this time or if a visit to the patient’s attorney will help.
“It is very important to confirm that our front-line providers find themselves in extremely difficult situations when patients experience behavioral anxiety,” Black said. “But the customer does not even need security until we have analyzed what is happening.”
Child Leadership և Some staff praised the security staff.
“They do not carry weapons, they are a very diverse team, we have a very different model for security,” said Morgan. “They are cooperating, they are de-escalation experts, they are trying to establish relations where other employees cannot.”
However, he said he did not understand why other hospital staff would not be able to perform those roles.
“No matter what others may say, black-and-brown communities have every historical, present-day contextual right to be concerned about police or security involvement in their care,” Black said in an email.
It is clear that some colored families have had negative experiences with Seattle Children.
Abigail Echo-Hawk, director of the Indian Institute of Urban Health, wrote that security guards “aggressively demanded” her 12-year leave after visiting for hours.
Sakara Remu, chief strategist at the Washington Black Lives Matter Alliance, wrote on her personal website that security was located outside her son’s hospital room when he sought medical attention. Remmun wrote that the social worker said that showing her emotions on the night her 2-year-old child received her first chemotherapy treatment made nurses feel insecure.
Analysis of the past
The inconsistency of calls has not improved since an earlier report showed that black patients accounted for 7% of patients, but 16% of Code Purple calls a decade ago.
In fact, many of its offerings, including Code Purples information, control team building, and diversity and de-escalation training, have only recently gained traction.
The hospital was unable to find a note in the report, which the former employee passed to The Times, to ask at first whether it was legal. The hospital later said authorities were not aware of the earlier review of the inequality, but did not dispute that it was possible.
Six current և former employees, most of whom spoke on condition of anonymity, said they had seen or discussed the data and the discrepancy in 2012 or 2013.
Cynthia Roth, who worked at the Center for Diversity and Health Justice from 2012 to 2015, said she had not seen a report but knew that analysis during that period had found that black patients had disproportionate calls.
Danielson and three others said hospital officials had been notified of the find.
“There is a silent reception. There is a complicity. “Yeah, we know that: we’re not going to do anything about it,” Danielson told a recent event with Crosscut. “Some actions have been taken over the past year. There is a calculation of the decade of action intervention. “
The hospital management has noticed a turnover since the first report. Gregorian joined the hospital in 2017, Fryzlewicz became vice president in 2018, and Andrew Lee joined a few months ago as vice president և chief share, diversity և inclusion officer. CEO ff springing started in 2015. Seattle Children said he was informed of the discrepancy at the time, that action had been taken, but did not elaborate when asked what it was.
Seattle children’s leaders said they believed they could now resolve the issue. The data will be reviewed regularly by senior management in the news of the Board of Trustees to track progress.
So far this year, the data show the same discrepancy.