Despite High Black Maternal Death Rate, California Hospitals Ignored Training About Bias in Care

More than two and a half years after a law took effect requiring maternity care staff to complete racism in medicine training, only 17% of hospitals were in compliance, according to an investigation published by the state Department of Justice Friday.

The training matters, Attorney General Rob Bonta and others said during a press conference, because of the state’s persistently high death rates among Black mothers.

Though California is often looked at as a national model for improving maternal outcomes, Black women are still far more likely than others to die during pregnancy. They account for only 5% of pregnancies in the state but make up 21% of pregnancy-related deaths, according to the California Department of Public Health.

The mortality rate for Black infants is also three times higher than for white infants and nearly 1.5 times higher than for Pacific Islander babies, the second highest mortality rate, state data shows.

Investigations into the cause of all pregnancy-related deaths by the California Department of Public Health determined that more than half are preventable.

“We need to listen to this data. It’s screaming at us to do something,” Bonta said. “Listen to these women and make substantial transformative change before another patient is hurt, or worse.”

No hospitals were in compliance when the department began its investigation in 2021, and not a single employee had completed training.

CalMatters is investigating maternal care in California. Have a tip or a story to share? Email health reporters Kristen Hwang and Ana B. Ibarra at info@calmatters.org

Lawmakers passed the California Dignity in Pregnancy and Childbirth Act four years ago in an effort to reverse the vast disparities in maternal deaths among Black women, who are three times more likely than any other race to die during or immediately after pregnancy. The law requires hospitals and other facilities to train perinatal care providers on unconscious bias in medicine and racial disparities in maternal deaths. It took effect in January 2020.

Bonta recommended lawmakers adopt additional regulations to strengthen the law, including setting clear deadlines for compliance, designating a state agency to enforce the law and introducing penalties for noncompliance.

Former state Sen. Holly Mitchell, the Los Angeles Democrat who authored the bill, said “clearly more must be done” to implement the policy.

“It is my full expectation that every hospital across L.A. County and across the state join in making sure that their staff take the training,” said Mitchell, who is now a Los Angeles County supervisor. “We are simply asking them to follow the law.”

According to the department’s investigation report, about 76% of more than 200 hospitals surveyed had begun training employees by August 2022 but had not completed training. Two hospitals had not fully trained any staff, and 13 did not provide the department with any information.

“Nearly a third of facilities to which DOJ reached out began training only after DOJ contacted them, suggesting that DOJ’s outreach caused compliance in many cases,” the report states.

Black women report mistreatment at hospitals

It is well-documented that racism in health care settings contributes to poor outcomes. Black women in California consistently report poor experiences with medical professionals during pregnancy, including mistreatment because of their “race, age, socioeconomic class, sexuality, and assumed or actual marital status,” according to a recent research review and report by the California Department of Public health.

They also struggle to convince providers that they are in pain and report mistreatment when advocating for their health during pregnancy. A national survey from 2016 revealed half of white medical students and residents believed false and debunked myths about the biological differences between white and Black patients. Those who endorsed the beliefs were more likely to dismiss patients’ pain and make inaccurate treatment decisions.

“What is so deeply offensive about that is it is within our power to change,” Mitchell said.

Implicit bias training is the “bare minimum” of what health professionals can do to improve outcomes, said Assemblymember Akilah Weber, a Democrat from La Mesa and a medical doctor.

Research also shows maternal and infant health disparities among Black women and babies persist regardless of patients’ education or income levels. Celebrities like Serena Williams and Beyoncé have spoken out about their near-death experiences during childbirth.

Recent maternal deaths in Los Angeles

Earlier this year, the deaths of two Black women, Bridgette Cromer and April Valentine, in childbirth shook Los Angeles. Valentine’s death led to a state investigation and a $75,000 fine levied against Centinela Hospital Medical Center where her daughter was delivered via C-section. The investigation stated the hospital “failed to prevent the deficiencies…that caused, or are likely to cause, serious injury or death” to Valentine, , including repeated failure to take steps to prevent blood clots, a common pregnancy risk, even when Valentine complained of feeling heaviness in her leg, numbness and leg swelling.

The Los Angeles County Medical Examiner determined she died from a blood clot that traveled from her leg into her lungs.

Centinela announced its intent to close the maternity ward permanently days after Valentine’s family filed a wrongful death lawsuit. The maternity ward, which delivered more than 700 babies last year, closed Wednesday.

In a GoFundMe post, Cromer’s family said they did not have autopsy results yet but noted that she was readmitted into the operating room after birth with major bleeding before dying.

Gabrielle Brown, an advocate with Black Women for Wellness, said Centinela’s maternity ward closure is “a stark reminder of how healthcare disparities persist in our society.”

“It reminds us of the implicit biases that have subtly influenced healthcare decisions, ultimately leading to an immense reduction in the accessibility and quality of care for many members of our community,” Brown said.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.