Massachusetts General Brigham's Hospital to Black Infants..."Fuck You"

    I read a piece not long ago that involved a conversation between two women with one describing to the other what her thoughts were when it was time to take her newborn home from the hospital. She remembered looking at the nurse and thinking, "You're just going to let me take this thing home? I have no idea what I'm doing." While I myself have never been in that brand new parental situation, I'm pretty sure the thought of having no idea what to do has crossed a lot of minds over the centuries. I mean, what could go wrong? The infant might catch a virus or they might not be eating enough at some point. Even worse, as time goes on they could get severely injured by a well-meaning toddler. 

    All of the above, and much more, are no doubt tough enough to deal with when one is sober and of sound mind. Now, dear reader, imagine trying to deal with all of that...and more...when you're high or suffering withdrawal. Surely, one of the certainties in life is that if any parent needs a nurse or doctor to check up on them before taking a baby home, it is a parent using drugs. That previous sentence is probably one of the few sentences I've ever typed that would get near-unanimous agreement. I mean, other than, "Peter, you're an idiot." Thankfully, I typed "near-unanimous." Because it would seem that Mass General Brigham's Hospital in Boston, disagrees. Based on multiple reports and their own public statements, the Boston hospital has enacted a new directive that will discourage medical professionals from reporting mothers who test positive for illegal substances to the state's child welfare agency. The new policy will also require written consent for testing of any expectant woman or infant outside of emergency situations. It also limits testing to circumstances where results "will change the medical management of the pregnant person or infant." I really dislike lawyers...

    Having lived just outside of Boston for more than a few years, I am well aware of Brigham's reputation as one of the finest hospitals in the land, going back to its days when it was generally known as Brigham & Women's Hospital before it was integrated into the Massachusetts General family of hospitals. Not only has B&W been a nationally top-rated hospital for decades, but it has also been a first-class teaching hospital for Harvard University. 

    So...why would a distinguished institution like this adopt such a policy? I mean, I understand that fetal exposure to drugs is a hard problem. Doctors want and need to help without frightening patients away and generally they want to bring in the welfare authorities as a last resort. But I already sense that some of you have beaten me to the answer. You guessed it: to avoid perpetuating...say it with me now..."systemic racism." Representatives of Brigham's administration's "United Against Racism" initiative found that "Black pregnant people (Notice the phrase "pregnant people" instead of "pregnant women"? Morons...) are more likely to be drug-tested and to be reported to child welfare systems than white pregnant people." And because of this finding the hospital will "update policies that automatically trigger mandatory filings with child welfare agencies when a pregnant individual (for the love of Gloria Steinem, am I the only one who types the word "WOMAN" anymore?) is engaged in treatment for substance use disorder, absent any other concerns for potential abuse or neglect." Unbelievable...these people have no business being in positions of authority. Sarah Wakeman, MD, is Brigham's senior medical director for Substance Use Disorder. She described the policy as "the latest step in our efforts to address long-standing inequities in substance use disorder care." It either has not occurred to her or she doesn't give a damn, that drug testing SHOULDN'T be equally applied across groups; it should be driven by the circumstances of each individual patient. And for reasons that are too long and complicated for this space (and will cause me to be even more ornery about this topic than I already am), the majority of infants at Brigham's who are born with drugs in their systems are black. And if this can be detected immediately, personnel can fast-track their mothers to treatment and vital social support. 

    Anyway, can we get one thing out of the way right now...please? Racial disparities are not in and of themselves (or prima facie, as the lawyers would say) evidence of racism. But like the comedy GOAT and social humorist Dave Chappelle likes to say, "Everything is funny until it happens to you." And as I like to say, "Everybody wants to follow the science, or the math if you will, until it puts them in a bad light." And here's a fact for everyone: Black children are THREE times more likely to die from maltreatment as white children, so it is not unreasonable to assume that they are at higher risk. Having said that, it's also not unreasonable to assume that black mothers would get reported to child protective services more often than white mothers. But it seems, at least to the Woke at Brigham's, that fact is the uncomfortable problem. 

    Now, up to a point, it makes sense for a doctor NOT to report a mother who discloses that she is in treatment, admits to methadone use for control of an addiction, but displays no other negative behaviors. And no one has accused Brigham's of reporting those women. 

    That said, here's the kicker. This new policy says that "reports after delivery should be filed only if there is reasonable cause to believe that the infant is suffering or at imminent risk of suffering physical or emotional injury." That's a high bar kids, which is also going to invite trouble. And what does "imminent risk" mean, anyway? You can only report mom if she's high when she leaves the hospital and forgets to put the baby in the car seat, and you think she's so stoned she'll forget to feed said baby?

    And why are hospitals so afraid of getting child-welfare involved, even as a last resort? I mean, I know I've written a couple of pieces in this space about child-welfare agencies run amok. That said, just because they find the mom is using, or the baby tests positive for drugs in utero, it doesn't necessarily mean the child will be taken away. It just means the investigations begin to determine if the child is safe or not, and if the parents need help with rehab. Do black children and families deserve this intervention less than white families?

    This new policy comes at a time when social justice is infecting medicine and public health. These clinical considerations flow from the politics of group identity, not from the best interests of individual patients, which should be the North Star of medical ethics. Brigham has decided to conceal potentially valuable health information from medical professionals in the name of social justice. In doing so, it seems clear this policy will end up disproportionately compromising the well-being of black women and babies. The success of this, or any new policy should be judged by whether it improves health outcomes for all, not because doctors drug-tested fewer black patients. 

    In recent years, an average of one infant who has tested positive for drugs at birth has died every month in New Mexico. And most of those who died did so because of later exposure (often when a little one got hold of fentanyl) or unsafe sleeping arrangements while a parent was intoxicated (typically the parent would roll over onto a child and suffocate him or her). The assumption that infants born substance-exposed are fine to go home with their parents without follow-up is, how do I put this diplomatically...frighteningly stupid. And it ignores the growing evidence that doing so poses enormous risks. As a nation, we seem to be moving toward a less-punitive approach to substance use by adults. If that continues, we just cannot assume the kids will be alright.

 

write to Peter: magtour@icloud.com