At Seattle Children’s, a father’s request for staff to use a needleless injection device on his child – as the doctor ordered – instead of a numbing cream ended with security taking him from the room.
“As a black man, being escorted away from my very sick child by a security officer left me powerless, embarrassed, and seen in the eyes of other families on the unit as a criminal,” he said, according to an internal report led by the hospital’s Center for Diversity and Health Equity.
The report found that from 2008 to 2011, security calls on Black patients at Seattle Children’s were more than twice as likely than they were for white patients. It was done almost a decade ago, recommending immediate action.
That same disparity exists today. Seattle Children’s called security on Black patients at twice the rate of white patients since late 2014, according to a Seattle Times analysis of data from the hospital’s inpatient and observation units. The data included calls for patients’ family and visitors only if the child was involved.
Hospital leaders said they recognize there is a disparity in the use of “Code Purple,” in which staff call for security and a mental health professional when they feel there is unsafe or threatening behavior. They made some changes to the process late last year.
“Our ultimate goal at Seattle Children’s is to eliminate the Code Purple disparity altogether,” hospital spokesperson Jen Morgan said. “Systemic and institutional racism exists across our health care system and we are not immune, but we are committed to becoming the anti-racist organization that our patients, families and work force deserve.”
But some former and current employees questioned why action was not taken sooner, as the disparity has long been known. Hospital leadership has seen turnover in recent years, and current leaders said they were unaware of the earlier analysis, which six current and former employees told the Seattle Times they recalled.
Dr. Ben Danielson, the former longtime director of the hospital’s Odessa Brown Clinic, said hospital leaders were told of the disparity in the past but didn’t take action. He resigned last year, citing institutional racism within Seattle Children’s, including with Code Purple calls.
“It’s malfeasance if leaders are not aware of the report,” Danielson said. “Or poor practice, that they knew for eight to 10 years and that not until September was there a decision to act.”
Seattle Children’s, which serves the largest region of any children’s hospital in the country, has faced a reckoning following Danielson’s resignation. After his concerns became public, first in Crosscut - a nonprofit news site - late last year, the hospital system was hit with calls for action. It brought in former U.S. Attorney General Eric Holder to conduct an investigation, which is expected to conclude by the end of June.
Seattle Children’s staff have called an average of about 700 Code Purples a year since 2015, for situations ranging from a patient assaulting staff to a distressed parent.
The Code Purple response typically consists of one or two security officers and a psychiatry and behavioral health nurse or social worker, according to the hospital.
Seattle Children’s staff has historically been encouraged to use the code, according to an interview longtime security director Jim Sawyer gave to an industry publication in 2019.
“We tell our nurses that at the first sign of possible escalation to call it early. When you intervene early, you can usually de-escalate the situation and everyone goes home a winner,” Sawyer said. “Code Purple is all about perception, early intervention, de-escalation, and safe physical restraint, but the foundation and point of emphasis is just ‘don’t wait.’”
Myra Gregorian, senior vice president and chief people officer, and Bonnie Fryzlewicz, vice president of patient care and chief nursing officer, said the process is intended to be supportive for patients and staff. But they recognize that it doesn’t feel that way for all patients.
Black patients had the highest rate of Code Purples, as they received 15% of calls but made up only about 6% of hospital stays from October 2014 through March 2021.
White patients were slightly overrepresented in the data for this time frame, compared to their large share of hospital stays. But when looking at the patients who were subject to security calls, the percentage of white patients who received Code Purple calls aligns with their share of the patient population, while the disparity for Black patients remained.
Studies have found similar disparities at other hospitals. An eight-year review of data from a Midwestern hospital, for example, found Black patients and their visitors were more than twice as likely as white patients and their visitors to receive security standby requests.
At Seattle Children’s, a work group reviewed Code Purple data and made recommendations to address the disparity in 2019. The hospital made some of those changes in December. Leadership, security and nursing staff now receive weekly data updates. The hospital is expanding diversity, equity and inclusion training and plans to provide de-escalation training to front-line staff, which it hopes will decrease the number of Code Purples called.
The hospital also started requiring the staff member who called the code and the unit leader to be present for the response and to debrief after. Otherwise, the hospital said it did not make significant changes to the response process.
Dr. Carmen Black, an assistant professor of psychiatry at Yale’s School of Medicine, said there should be safeguards to determine in the moment whether a Code Purple is appropriate, or if a visit from a patient advocate would help.
“It’s very important to validate that our front-line providers are going into extremely complex situations when patients are experiencing behavioral distress,” Black said. “But security doesn’t even need to be seen by the client until we do an analysis of what’s going on.”
Children’s leadership and some staff have praised the security officers.
“They do not carry weapons, they are a very diverse team, and we have a very different model for security,” spokesperson Jen Morgan said. “They build rapport, are experts in de-escalation and strive to build relationships where other staff members cannot.”
Black, however, said she doesn’t understand why other hospital professionals wouldn’t be able to fill those roles.
“No matter what others may say, black and brown communities have every historical and current contextual right to be alarmed by the involvement of police or security in their care,” Black said in an email.
It’s clear some families of color have had negative experiences with security at Seattle Children’s.
Abigail Echo-Hawk, director of the Urban Indian Health Institute, wrote that security guards “aggressively demanded” her 12-year-old leave after visiting hours.
Sakara Remmu, lead strategist for the Washington Black Lives Matter Alliance, wrote on a personal website that security was stationed outside her son’s hospital room when she consulted doctors. Remmu also wrote that a social worker said her show of emotion the night her 2-year-old received his first chemotherapy treatment made nurses feel unsafe.
The disparity in calls has not improved since the earlier report, which found Black patients made up 7% of patients but 16% of Code Purple calls a decade ago.
In fact, many of its recommendations – debriefing Code Purples, developing an oversight team and increasing diversity and de-escalation training – gained traction only recently.
The hospital could not find a record of that report, which was shared with the Times by a former employee, and at first questioned if it was legitimate. The hospital later said leaders were not aware of an earlier review of the disparity but did not dispute it may have been done.
Six current and former employees, most of whom spoke on the condition of anonymity, said they saw or discussed the data and disparity around 2012 or 2013.
Cynthia Roat, who worked in the Center for Diversity and Health Equity from 2012 to 2015, said she didn’t see a report but knew an analysis around that time found Black patients represented a disproportionate amount of calls.
Danielson and three others said hospital leadership was briefed on the finding.
“There’s a tacit acceptance. There’s a complicity of, ‘Yeah we know this and we’re not going to do anything about it,’” Danielson said in a recent event with Crosscut. “Now in the past year, there’s been some action on that. There is a reckoning for the intervening decade of no action.”
Hospital leadership has seen turnover since the first report. Gregorian joined the hospital in 2017, Fryzlewicz became a vice president in 2018 and Andrew Lee joined as vice president and chief equity, diversity and inclusion officer a few months ago. The CEO, Jeff Sperring, started in 2015. Seattle Children’s said he was then made aware of the disparity and that there was action taken, but did not elaborate when asked what it was.
Seattle Children’s leaders said they believe they will be able to address the issue now. The data will be reviewed regularly by senior leadership, with updates to the board of trustees. So far, the data for this year shows the same disparity.
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