Jaeah is a former reporter at Mother Jones. Her writings have appeared in The Atlantic, the Guardian, Wired, Christian Science Monitor,Global Post,Huffington Post,Talking Points Memo, and Grist. She tweets at @jaeahjlee.
Medical researchers have known for years that America's leading cause of death, heart disease, kills people of color at a higher rate than it does white people. A new study out this week suggests that the reasons why may bemuch more heavily influenced by systemic issues, such as emergency room care, than previously thought.
Researchers found that California hospitals with the highest share of black patients exceeded emergency room capacity more frequently than other hospitals, which forces them to reroute ambulances carrying overflow patients to other medical facilities. The study, funded by the National Institute of Health and published in the medical journal BMJ Open, reviewed data on medical emergency services in 26 California counties serving nearly 30,000 patients between 2001 and 2011.
This rerouting process, known as ambulance diversion, can lead to life-threatening delays in treatment for time-sensitive medical emergencies like heart attacks and increases the likelihood that patients will die, the authors say.
"Cardiologists often say that time is muscle, or time is heart tissue," says Renee Hsia, an ER doctor and professor at the University of California-San Francisco who co-wrote the study. "When you have a clot, every minute matters. Even if you don't die right away, you have a poorer heart over the long term."
The study found that both black and white patients whose nearest hospitals were affected by ambulance diversion were less likely to receive standardtreatments and less likely to livebeyond a year after their heart attack, compared with patients at hospitals that don't divert ambulances.
While the study focuses on California counties, the issue likely affects other states as well, Hsia said.
This new research may help illuminate why the rate of deaths related to heart disease is 33 percent higher for black Americans than it is for the overall US population, according to American Heart Association figures. Other experts have documented a variety of reasons for this disparity, ranging from less access among people of color to insurance and consistent medical care, longer waits for emergency medical help from first responders, less knowledge about symptoms, and implicit bias among physicians.
Emergency room overcrowding is caused by a long list of issues, Hsia said, and gravely ill patients are a special challenge at busy hospitals because they require more care.
Each new patient—especially one with a critical condition like a heart attack—requires extensive staff attention and technological resources before and after a physician sees him or her. When a person with a heart attack arrives in a hospital's ambulance bay, for example, they must be unloaded by paramedics, directed to a bed by a triage nurse, undressed by a technician or medical assistant, and taken to have blood drawn by a nurse, Hsia said. Then a radiology technician must take a chest X-ray and process and print it, while another nurse or technician needs to take an EKG.
"All of these things take time," she said, adding that such patients have more specialized needs after they are diagnosed."If the physician decides the patient needs treatment for a heart attack, they have to activate cath lab, and a clerk has to page all the staff that needs to come in. Then you need all those people to come in, and you need a transport team to take the patient to the lab."
"Those are all the steps where you could see bottlenecks happen," Hsia said.
The authors found that hospitals with the 10th-highest share of black patients experienced overcapacity more frequently relative to other hospitals, forcing them to reroute ambulances to the next closest facilities. The same trend held for emergency rooms serving at least twice as many black patients as other hospitals within a 15-mile radius.
Previous studies have found that hospitals serving areas with a relatively high share of black residents have other problems that may affect the care they provide. Such hospitalsare more likely to experience money shortages, in part because they are more likely to rely on public funding. Also, their patients are more often uninsured or covered by Medicare or Medicaid—which typically reimburse bills at a lower rate than private insurers. The shortage in funding can in turn make it tough to compete with privately funded hospitals when hiring specialized medical talent, such as cardiologists.
"These are structural disparities that people can't see but are very real," Hsia said.
"I will fight you, no matter how insurmountable it may seem, and to the death if need be."
Jaeah LeeMar. 3, 2016 6:46 PM
Update, Wednesday, March 9, 2016: The Baltimore City School Police officer who slapped and kicked a student in a hallway last week has been charged with assault, abuse, and misconduct, according to NBC News. Last week, a widely-circulated video of the incident prompted a public outcry and criticism from city officials. A second officer shown in the video has also been charged with assault and misconduct.
Baltimore officials have launched a criminal investigation into a recent incident involving a city school police officer who slapped and kicked a 16-year-old boy in a hallway. In a graphic and profanity-laden cellphone video, which surfaced on Tuesday and quickly spread on social media, the teen stands with his back against a wall as the officer strikes him multiple times, yelling, "get the f*** out of here." A second officer stands by watching.
Both officers in the video, as well as Baltimore City School Police Chief Marshall Goodwin, have been placed on paid administrative leave pending the investigation, according to the Baltimore Sun. The incident has been condemned by Mayor Stephanie Rawlings-Blake and Karl Perry, the district official in charge of school safety, who said he was "appalled" by the video and that the officer's behavior was "unacceptable."
Documents obtained by Mother Jones give some insight into how cops working for Baltimore's public school system are trained—and they suggest that officers are sanctioned to use violently aggressive tactics when necessary.
Baltimore City Schools says video of officer slapping student happened late today. "Vigorously" under investigation pic.twitter.com/GW5OKeOPF2
One lesson plan in the training documents, dated April 2015 and prepared by a Baltimore City School officer, indicates that the mission of the school police is to ensure "that students and staff have a safe environment in which to learn and teach." The lesson stresses three core roles that each officer should embody: scholar, statesman, and warrior. One section describes the importance of understanding the law, being "driven by a moral compass," and acting as a "servant of the people."
Another section, however, suggests an altogether different mentality. The section quotes from "One Warrior's Creed," a doctrine authored by a Steven R. Watt, a retired police veteran in Utah and a colonel in the state's Army National Guard. "You may defeat me," it says, "but you will pay a severe price and will be lucky to escape with your life." It reads:
Another lesson plan contained in the documents, created by a Baltimore school police training instructor, teaches the value of "verbal judo," defined as "a set of communication principles and tactics that enable the user to generate cooperation and gain voluntary compliance in others under stressful conditions." The Baltimore school police department uses "verbal judo," one page explains, because officers "must attempt to GENERATE VOLUNTARY COMPLIANCE [sic] from difficult people, and we should train our officers in this most difficult and important part." It goes on: "The cost of neglecting such training will be measured in blood, money, and public opinion. Our officers must be as competent with words as they are with firearms."
The video is the latest in a series of disturbing and violent encounters involving school cops. As Mother Jones first reported last July, there have been at least 29 incidents across the country since 2010 in which school-based police officers used questionable force against students on K-12 campuses, including those as young as eight years old. Many of those incidents resulted in serious injuries and, in one case, death. Training and oversight of school cops has been insufficient and data on their use of force has been lacking—even as their presence has grown significantly over the past few decades.
The latest investigation comes several months after another Baltimore public schools cop pleaded guilty to multiple assault charges following a similar incident that took place in October 2014. School surveillance footage shows the officer, Lakisha Pulley, hit three middle school girls with a baton, leading to serious injuries that left one of the girls with 10 stitches. The encounter prompted calls for school police reform by student advocates and parents. Last September, the NAACP's Legal Defense and Educational Fund requested that the US Department of Justice expand its civil rights probe into the Baltimore Police Department to include the Baltimore City School Police Force. The two agencies operate independently.
David Pontious, a 17-year-old senior at Baltimore City College High School and a student activist, told the Sun this week, "Even though we've had a lot of meetings, a lot of input, a lot of discussions with the school system, we've still seen very little training that school police get, and very little accountability."
An undisclosed investigation into Tanisha Anderson's death raises questions about the Cleveland PD's account.
Jaeah LeeFeb. 22, 2016 7:00 AM
Since Tanisha Anderson's death in November 2014, few details have been made public about how the 37-year-old black woman died while in the custody of two Cleveland police officers. Anderson, whose family reported she was mentally ill, died after falling unconscious while lying handcuffed on a sidewalk outside her home. The 15-month-long investigation is now in the hands of Ohio Attorney General Mike DeWine: In a statement last Tuesday, Cuyahoga County Prosecutor Timothy McGinty requested DeWine take over the case following a Cuyahoga County sheriff's investigation, which McGinty said revealed "facts that created a conflict of interest" for his office. McGinty—who led the controversial investigation into the police killing of 12-year-old Tamir Rice and is running for reelection next month—did not specify what that conflict of interest was.
The recently completed sheriff's investigation, which has not been disclosed publicly, raises questions about the Cleveland Police Department's official account presented in November 2014. According to a law enforcement official familiar with the sheriff's investigation who spoke to Mother Jones, the investigation reveals significant details that the Cleveland PD's account did not include. One is that the officers put Anderson in the back of their squad car before she became agitated and a physical struggle ensued. Another is that Anderson remained handcuffed after an EMS team arrived and began administering aid, even though she was unconscious.
The investigation also shows that Anderson was on the ground in handcuffs for approximately 20 minutes before the EMS team arrived, the law enforcement official told Mother Jones. The Cleveland PD's initial account did not specify how long Anderson was on the ground prior to EMS arriving; the officers later told sheriff's investigators in a written statement that Anderson was on the ground for approximately 5 to 10 minutes.
The initial police account included no details about how or why Anderson fell limp on the sidewalk.
According to the Cleveland PD's account, officers Scott Aldridge and Bryan Myers arrived at Anderson's home around 10:51 p.m. on November 12, 2014, in response to a call about a mentally ill family member causing a disturbance. After speaking with the officers, the Cleveland PD account stated, Anderson agreed to be escorted to a hospital for a psychiatric evaluation, but as the three approached the squad car, she "began actively resisting the officers." After they handcuffed her, Anderson began to kick at the officers, and "a short time later the woman stopped struggling and appeared to go limp." The officers said they "found a faint pulse" on Anderson "and immediately called EMS and a supervisor to respond to the scene at 11:34 [p.m.]." Within the hour, Anderson was taken to a nearby hospital, where she was pronounced dead. The initial police account included no details about how or why Anderson fell limp on the sidewalk.
According to the sheriff's investigation, Aldridge and Myers placed Anderson in the back seat of their squad car with her feet still hanging out, and she began yelling and struggled to get out of the car. As the officers tried to put her back in the car "a physical altercation ensued," the law enforcement official told Mother Jones, and they soon had Anderson in handcuffs and on the ground.
In their written statement to sheriff's investigators, the officers said Anderson was laying on the ground and handcuffed by 11:20 p.m., when they radioed for a police supervisor to come to the scene. The officers subsequently requested an EMS response, the official said. The officers estimated that Anderson was in that position for a total of 5 to 10 minutes. According to call logs and witness interviews reviewed by sheriff's investigators, the EMS team arrived at 11:41 p.m.—indicating that Anderson had been on the ground for at least 20 minutes. When the EMS team checked Anderson's condition, one member found a faint pulse while a second was unable to find one, the official said. The handcuffs remained on Anderson as they began rendering aid; they asked the officers to remove them because they were interfering with their work.The officers complied with that request, the official said.
A spokesperson for the Cleveland PD declined to comment on the case, citing the ongoing investigation. Attorneys representing the two officers did not respond to a request for comment.
According to the lawsuit, Anderson's family members said that one of the officers grabbed her, "slammed her to the sidewalk, and pushed her face into the pavement."
Anderson's family members, who filed a wrongful death lawsuit against the city of Cleveland on January 7, said she suffered from bipolar disorder and schizophrenia. Family members who lived with Anderson dialed 911 to request medical assistance after Anderson became disoriented and walked out of her house into the cold, wearing only a nightgown, according to the court filing. The family had already called for police assistance earlier in the night after Anderson walked outside; another pair of officershad come to the scene but left after Anderson went back into her house, the family said.
According to the lawsuit, Anderson's family members said that after Anderson started to panic in the squad car, Aldridge grabbed her, "slammed her to the sidewalk, and pushed her face into the pavement." Aldridge then pressed his knee on Anderson's back and handcuffed her while Myers assisted in restraining her, the family said, and within moments Anderson lost consciousness. The lawsuit also alleged that when family members asked the officers to check on her condition, the officers "falsely claimed she was sleeping" and delayed calling for medical assistance. "During the lengthy time that Tanisha lay on the ground," the family said, Aldridge and Myers "failed to provide any medical attention to Tanisha."
Anderson's family told sheriff's investigators that a few weeks prior to the incident, she had been released from a psychiatric hospital. In January 2015, the Cuyahoga County Medical Examiner's Office announced that Anderson's death was ruled a homicide and classified as a sudden death in association with "physical restraint in a prone position," "ischemic heart disease," and "bipolar disorder with agitation."
"You wouldn't have known that Tanisha was bipolar unless she told you," Anderson's mother, Cassandra Johnson, told Fox 8 Cleveland in December 2015. "That day was just a bad day."
According to personnel records obtained by Cleveland.com, Aldridge was hired in April 2008, and in 2013 he was suspended for three days without pay over a Taser incident that involved a female suspect. (He was also one of the officers involved in the car chase that led to the deaths of Timothy Russell and Malissa Williams in 2012.) Myers was a rookie cop who joined CPD in 2014, after graduating from the police academy that August. Cleveland.comreported that Aldridge and Myers received 16 hours of crisis intervention training while at the academy, but it is not clear whether they received any further such training once on the job at Cleveland PD. The two remain on desk duty pending the outcome of the investigation.
Here’s what we know about the death of Gynnya McMillen.
Jaeah LeeFeb. 18, 2016 7:00 AM
Last month, 16-year-old Gynnya McMillen became part of a disturbing trend—one of a growing number of girls across the country who've been detained after getting charged with a misdemeanor. Then mysteriously, one day after she was booked into a Kentucky detention center, McMillen was found dead in her cell.
On the morning of January 11, an employee at the Lincoln Village Regional Juvenile Detention Center found McMillen, who was not breathing. "She is cold and stiff, there is no respiration, no vital signs," the employee told a 911 dispatcher. About an hour later, McMillen was pronounced dead. Little is known about why McMillen wound up dead while in juvenile detention, a locked facility where young people charged with crimes are held while they wait for future court dates or other action in their cases.
The incident, and the limited information that has been released to the public about it, hassparkedoutrage from McMillen's family and their supporters. State officials have launched two parallel investigations into the girl's death, including a full autopsy. Kentucky's Justice and Public Safety Cabinet Secretary John Tilley has asked that those investigations "be expedited," a cabinet spokesperson told Mother Jones, adding that they "are nearing completion." The cabinet declined to comment further about specific details in the case, citing juvenile confidentiality statutes.
Here is what we know—and don't know—about the case so far:
McMillen was taken to Lincoln Village after the police responded to a domestic violence call. Shelbyville police officers arrived at McMillen's mother's house on January 10. McMillen had been living at the Maryhurst foster home in Louisville, Kentucky, and was visiting her mom for the weekend, where they got into a fight, according to BuzzFeed News. The Shelbyville police called a court-designated worker—a state official who makes legal decisions in cases involving juveniles—who then contacted a judge and requested that McMillen be detained. McMillen was charged with a misdemeanor assault and transferred to Lincoln Village, a state-run juvenile detention center in Elizabethtown. The police said McMillen's mother suffered minor injuries. Young people under the age of 18 who are charged with low-level crimes can be held in detention centers until a court decides what further action is needed. Their detention typically lasts about three weeks but can extend for much longer, according to the Office of Juvenile Justice and Delinquency Prevention. In 2014, Kentucky enacted a law that was meant to help teens like McMillen avoid the court system altogether. Maryhurst declined to comment specifically on McMillen's case, citing patient privacy laws.
McMillen had never been in detention before. A family member told48 Hours' Crimesider that McMillen's one night at Lincoln Village was the only time she had ever been in detention. Prior to landing in the foster home, BuzzFeed Newsreported, McMillen lived with her father, who was awarded custody of her. But in November 2014, he died in his sleep. When McMillen spoke at his funeral, she promised to do well in school and make her father proud, a family member told BuzzFeed News.
At the detention center, multiple staff members physically restrained McMillen. Officials said McMillen repeatedly refused to remove her sweatshirt when staffers tried to search and photograph her during the booking process. "The staff performed an Aikido restraint hold to safely remove the youth's hoodie," a spokesperson for the Kentucky Department of Juvenile Justice said. "The purpose of having multiple staff involved in a controlled restraint is to ensure the safety of the youth and staff." A female staff member then conducted the pat-down and removed McMillen's hoodie. "As far as I'm concerned, that is a completely inappropriate use of a restraint," Michele Deitch, an attorney and juvenile justice expert in Texas, told48 Hours' Crimesider. It is unclear if the restraint had anything to do with her eventual death, or if any other physical force was used against McMillen during her detention.
McMillen was placed in a cell by herself. The next morning, McMillen did not respond when staffers twice offered her food or later when they alerted her that her mother had called. Although McMillen did not reply to staff members for several hours, no one appears to have checked on McMillen during this time. A Kentucky Department of Juvenile Justice spokesperson said staff members generally do not enter a detainee's cell unless there are "obvious signs of distress." It's unclear why McMillen was confined in isolation to begin with. It is unclear whether McMillen was merely in a cell alone or had been placed in solitary confinement. Kentucky is 1 of 10 states that either have no limit or allow for indefinite solitary confinement for juveniles as a form of punishment.
Authorities don't know yet how she died. After a sheriff's deputy arrived to transport McMillen to court, Lincoln Village employees entered McMillen's cell and found that she was cold to the touch. Kentucky officials said McMillen appeared "to have passed away while sleeping." Following the initial autopsy, the Hardin County coroner said there were no outward signs of trauma, such as visual bruising, and that it was unlikely she had a heart condition. The state's Justice and Public Safety Cabinet has launched two investigations into the girl's death, including a full autopsy. McMillen's family has demanded that authorities release the surveillance footage that shows her final hours, as well as a recording of the emergency call that led to her arrest.
At least two Kentucky officials have lost their jobs in the wake of the incident, and one has resigned. One detention center staff member, Reginald Windham, was placed on leave for failing to check on McMillen's cell every 15 minutes, as is required for detainees placed in isolation. On February 9, the governor's office and justice cabinet announced that they'd fired Windham, following news reports about his long-standing record of "unacceptable behavior." Personnel files provided to BuzzFeed Newsrevealed that the Department of Juvenile Justice had disciplined or reprimanded Windham in five other incidents, including two that involved excessive use of force. In others, he was disciplined because he showed a lack of competency or professionalism. Bob D. Hayter, the head of the Department of Juvenile Justice, was dismissed from his job amid the investigation of the incident. The justice cabinet has not specified its reasons for Hayter's dismissal. According to the Kentucky Center for Investigative Reporting, the department's director of communications, Stacy Floden, also left her job in the wake of the state probe.
Gynnya McMillen's arrest is part of a growing trend. The share of young girls in the juvenile justice system has been growing over the past 20 years, even as the number of arrests of young Americans has been on the decline. (My colleague Hannah Levintova recently broke down these numbers.) The percentage of girls who are arrested, detained, and end up in court increased between 1992 and 2013. Arrests of girls rose from 20 percent to 29 percent during this time, while detention of girls rose from 15 percent to 21 percent, according to the National Women's Law Center. The trend has disproportionately affected girls of color: Black and American Indian girls were, respectively, 20 percent and 50 percent more likely to be detained than white girls. In 2013, black girls were the fastest-growing segment of the juvenile justice population.
Update, Thursday, February 11, 2016: Cleveland officials said they are withdrawing the claim saying the Rice family owed $500 for their son's last ambulance ride. At a news conference on Thursday, officials explained that the claim had been been closed in February 2015 after the city absorbed the cost, but that it was regenerated after the family's attorney asked the city to forward a billing statement for services provided on the day of the shooting. Mayor Frank Jackson apologized to the Rice family, saying they never intended to issue a bill.
Cleveland officials are holding a news conference to address a claim filed Wednesday notifying the Tamir Rice estate that it owes the city money for the boy's ambulance ride and medical services he received after he was shot by a police officer.
Less than two months after a grand jury decided not to indict the Cleveland police officer who shot and killed 12-year-old Tamir Rice, the city has filed a claim saying the boy owed $500 "for emergency medical services rendered as the decedent's last dying expense." In response to the claim, a Rice family attorney told the Cleveland Scene that the move "displays a new pinnacle of callousness and insensitivity."
The mayor's office could not be reached immediately for comment.