INDIANAPOLIS — An outside investigation into the death of a Black doctor while she battled COVID-19 has found that the treatment she received at IU Health North did not contribute to her death, IU Health said Wednesday.
However, the review by a panel of six outside experts concluded Dr. Susan Moore suffered from a lack of cultural competence on the part of those treating her at IU Health North in Carmel, parent IU Health said.
IU Health in its statement acknowledged a “lack of empathy and compassion” was shown in the delivery of her care.
Moore, 52, a family medicine physician who had practiced in Indiana since 2009, died Dec. 20, about two weeks after she was released from IU Health North and then admitted to a different hospital.
In a Dec. 4 Facebook post, she said she had to repeatedly ask for medication, scans and routine checks while admitted to IU Health North. She said a white doctor in particular seemingly dismissed her pain, and she said she didn’t trust the hospital.
IU Health did not specify the “empathy and compassion” issues, or identify which caregivers were responsible for Moore’ s medical care.
“We owe it to our patients to always show up for them, to treat them with dignity and respect, to appreciate their perspectives, and to validate their feelings when they are in our care,” IU Health CEO Dennis Murphy said in a statement.
“We did not live up to these values with Dr. Moore and acknowledge that we have more to do to become a more diverse, inclusive and anti-racist health system,” Murphy said.
Murphy told the Indianapolis Business Journal that no staff members will be terminated, at the recommendation of the outside review panel, which included four Black members. He said a small number of staff members will be placed on administrative leave while they receive diversity training, then will be returned to their clinical roles.
The hospital system has begun taking steps including — conduct training for all employees “to enhance compassion, encourage empathy and facilitate an optimal patient experience” — after receiving recommendations from the panel.
“The IBLC is disheartened with these findings,” said State Rep. Robin Shackleford, chair of the Indiana Black Legislative Caucus (IBLC). “Everyone deserves to be cared for with compassion and respect.”
Shackleford, who is also the ranking minority member for the House Public Health Committee said, on the other hand, she is happy with the external review committee’s response, and IU Health recognizing that this training is needed.
“That video went so viral and now you see the changes that need to be made,” said Shackleford. “I’m hoping her death is not in vain. I’m hoping the moment she decided to take out her camera, she knew that this is something that needs to be documented to make sure that it doesn’t happen again.”
“These recommendations reaffirm what the IBLC has been advocating for and what the Indiana Minority Health Disparities Task Force recommended in 2020: Indiana’s health care professionals need awareness and implicit racial bias training,” Shackleford said.
Shackleford introduced House Bill 1333, which would establish a cultural awareness and competence training program for healthcare professionals. It would require all healthcare professionals to complete two hours of this training each year.
The bill was not given a hearing in this past session, and was denied for an interim summer study topic, but she said the IBLC will continue to work on the legislation with the Indiana State Department of Health (ISDH), healthcare facilities, and community leaders over the summer.
Brian Tabor, President of the Indiana Hospital Association (IHA), said they support House Bill 1333, but at the same time, “we are as an industry — the community of hospitals — working towards the goal of providing that education.”
He said nearly every hospital in Indiana is already moving forward with a plan of education and training for their staff and said, “I think that this conversation will accelerate that, and that’s certainly needed.”
Tabor said, as an association, they will do what they can to take lessons from this individual case and share that throughout the state with the hospitals it oversees.
“I do think this can be an opportunity for all hospitals in Indiana to learn from this and then an opportunity to partner with public policymakers as well on proposals like the ones we’ve discussed,” shared Tabor.
He also shared that just days ago, the American Hospital Association (AHA) shared information with hospitals across the country, and in Indiana, that addresses humility training, as well as implicit bias training and education.
The AHA said, “the COVID-19 pandemic’s disproportionate impact on Black Americans, Native American tribes and tribal populations, Latino Americans and other communities of color is generating a renewed focus on advancing health equity.”
Denise Dillard, who is the chief advocate for Methodist Hospitals, a member of the IHA and serves on the Governor’s Health Disparities Council, said, “Populations that are having to see unfortunately an uptick in that kind of decision making — I think what we are seeing is people who aren’t maliciously trying to do certain things.”
She said she was disappointed to see that House Bill 1333 did not move forward.
“It just broke my heart that nothing stayed on the vine when it came to looking at true areas of equity — health equity,” said Dillard.
Dillard shared, “All of us are looking at how do we get aside the issues that are being political to really look at our constituents. Every Hoosier – rural, urban, cosmopolitan, it’s universal health.”
Although legislators have argued it could be costly to mandate training to all healthcare workers in Indiana, both Dillard and Shackleford said the needs would outweigh the costs.
“In the end we are talking about saving lives, and in the end, for us to do this training is to make sure that everyone is comfortable when they go to hospitals, when they go see their provider,” shared Shackleford.
“You’re not gonna get the cost down by throwing out the baby with the bathwater,” Dillard said.
IU Health, the state’s largest hospital system, also said it also plans to hire more patient care advocates, improve patient care coordination, and increase support for team members who experience burnout and poor patient outcomes.
The hospital system said it will talk to community leaders and stakeholders “to publicly acknowledge the history of racism in healthcare and Indiana, and how IU Health will work toward reconciliation and change.”
Shackleford acknowledged IU Health’s response, calling it a step forward.
“For the team to put that in there and say that they have to come out and say that, and how they’re going to work to eradicate racism, I think that’s another great step.”