The Health Care System Earned Black Coloradans’ Mistrust

Terrence Hughes was seven, maybe eight, years old when he fell out of a cherry tree near his home in Toledo, Ohio, around 1973. Hughes’ uncle rushed him to the emergency room, where X-rays revealed a severe wrist fracture. The doctor, who was white, told his young, Black patient, “This is gonna hurt.” He then roughly grabbed Hughes’ wrist and squeezed it, hard, to reset the bones. “I thought I was going to hit the ceiling,” Hughes says.

About a decade later, Hughes joined the U.S. Air Force just as his wisdom teeth began poking through his gums. The military’s dentist, who was white, examined Hughes and filed them down. When the pain returned, Hughes visited a civilian dentist, who explained wisdom teeth needed to be removed from the root and sent Hughes to an oral surgeon to properly extract them.

Then, in 2002, the veteran woke up one morning in his Denver home, feeling as if someone were wringing out his quadricep muscle like a wet towel. His wife, Rachel, drove him to the Rocky Mountain Regional VA Medical Center emergency room. The doctor he saw told Hughes to take ibuprofen, but didn’t take any diagnostic scans. Hughes returned to the medical center three more times as the pain and swelling grew. Again, the doctors didn’t scan the leg and simply recommended ibuprofen. Four days after the pain began, and unable to move his leg, Hughes went to University of Colorado Hospital (UCH). There, a doctor quickly diagnosed a torn quad and called the VA to set up an emergency surgery for Hughes.

By that third encounter, Hughes knew what was happening. “I’m referring to implicit bias,” he says. “I’m referring to—how do I want to put it—a subconscious thought about a person or a group of people that will affect the way you treat them as a patient.”

You’d be hard-pressed, Jeff Fard says, to find a Black person without horror stories akin to the ones Hughes tells. Fard is the founder and executive director of Brother Jeff’s Cultural Center in Five Points, a neighborhood gathering place for Black Denverites and a launchpad for one of Fard’s life goals: reducing the HIV/AIDS epidemic’s disproportionate impact on Black Americans, an issue he’s advised the Colorado Department of Public Health and Environment (CDPHE) and the Centers for Disease Control and Prevention (CDC) on.

Fard has seen the way implicit bias plays out at doctor’s offices and in hospitals. A nurse may come off as cold, or a doctor may express doubt when a Black woman describes her pain level. “There’s a lack of trust, where a person might not feel comfortable explaining what they’re going through,” Fard says. “So a medical provider may not be picking up on cues of pain.”

This dynamic explains, in part, the way many Coloradans view our health care system. In a 2020 survey administered by the Colorado Health Foundation that polled a representative sample of Centennial Staters, 49 percent said they believed Black Coloradans are more likely to receive poor quality or inadequate health care compared with white Coloradans. Studies show that those who believe they’ve been treated unfairly in a health care setting may forgo further interactions with the system: A new report from the Colorado Health Institute, a nonpartisan research group, found that more than five percent of Coloradans passed up care to avoid this risk.

The COVID-19 pandemic is only the latest, and most acute, demonstration of health care inequities in America. On April 13, 2020, the CDPHE released its first round of race and ethnicity data for COVID-19. Black Coloradans made up seven percent of cases, despite representing just under four percent of the Centennial State’s population. Hispanic Coloradans, who represent 21 percent of the Centennial State’s population, had contracted 28 percent of cases. Native Hawaiians and other Pacific Islanders, just 0.1 percent of the population, made up 0.6 percent of cases—and 1.6 percent of deaths. Unfortunately, the data were—and remain—incomplete, because 25 percent of those early cases did not include information on race and ethnicity when they were reported to the state.

The press release that accompanied these statistics included a quote from Jill Hunsaker-Ryan, the executive director of CDPHE: “There is much to be learned from this disaster, and the uneven effects of COVID-19 on different communities will perhaps be one of the most profound lessons.” (The department’s media team declined to connect 5280 with leadership at the CDPHE for this story.) Erin Brown, deputy chief of staff for Mayor Michael Hancock and the head of the two-year-old Office of Social Equity and Innovation, expressed a similar sentiment: “A bright light was shined on disparities when COVID-19 occurred,” she told 5280.

For community advocates and researchers, this is old news. “This is not something we discovered with COVID,” says Matthew Wynia, a bioethicist at the University of Colorado’s Anschutz Medical Campus. Illnesses have historically hit communities of color hardest—Black people were more likely to die of influenza during the 1918 pandemic, for example, and in 2006, the CDC confirmed that between 2001 and 2004, most diagnosed cases of HIV/AIDS were among Black Americans. (The threat is most potent for Black queer men; in 2016, the CDC predicted that half of Black men who have sex with men would be diagnosed with HIV if trends continued unabated.) BIPOC individuals were hospitalized with H1N1 flu more often than white people in 2009, as well.

Decades of studies help to document this disparity, Wynia says, and Hunsaker-Ryan herself outlined some of those factors in the CDPHE press release from April 13. “There have been generations of institutionalized barriers to things like preventive medical care, healthy food, safe and stable housing, quality education, reliable transportation, and clean air,” she said in the statement. “Research shows that these types of factors are the most predictive of health outcomes.”

Those variables contribute to higher rates of pre-existing conditions that correlate with worse COVID-19 outcomes. In 2019, 11.6 percent of Indigenous Coloradans, 10.6 percent of Hispanic Coloradans, and 9.6 percent of Black Coloradans reported having diabetes, compared with six percent of white Coloradans, according to the Centers for Disease Control and Prevention. Indigenous, Black, and Hispanic Centennial Staters also had higher rates of hypertension and heart disease that year.

Many of these conditions can be partially explained by a lack of access to health care: More white Coloradans have health insurance than any other racial or ethnic group, for example. But many advocates in Colorado also agree that what takes place within the health care system has contributed to the problem. “We have a history that goes back in this country,” Hughes says, “of Black and brown people’s pain being ignored.”

Harriet Washington details that history in her 2006 book Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. One man, called John Brown after his escape from slavery in Georgia, told the story of Dr. Thomas Hamilton’s “treatments,” which occurred in the early 1800s and involved blistering Brown “to ascertain how deep my black skin went.”

The falsehood that Black people have thicker skin, Washington says, was peddled by many white doctors in the 19th century, helping enslavers justify slavery on the grounds that Black people were inherently different—tougher and better suited for hard labor—than whites. Those ideas persist today: In 2016, more than 11 percent of U.S. medical students believed Black people felt less pain than whites.

Such baseless beliefs came into play as certain medical disciplines were developed. During the 19th century, Dr. James Marion Sims, known as “the father of American gynecology,” experimented heavily on the enslaved women who fell under his “care,” Washington writes. His assistants held down Black women as he cut into their genitalia, then sutured them closed, in his quest to find a treatment for vesicovaginal fistulas. (These tears occur between the wall of the vagina and the bladder, causing painful incontinence, and are often the result of malnutrition and improper use of forceps during labor. An assistant of Sims, however, said that the doctor sometimes created the tears in Black women himself.) Sims didn’t give the women anesthesia and repeated the erroneous assertion that Black people “did not feel pain in the same way as whites.”

Ultimately, Sims discovered a treatment for fistulas. The Black women he tortured were rarely acknowledged, and Sims often described them as willing subjects.

The terrorizing of patients of color didn’t end with Sims. Doctors forcibly sterilized Black women through most of the 1900s (a practice also used on one-third of women in Puerto Rico in the 1930s through 1970s; immigrant women in ICE detention centers were sterilized, too, according to a 2020 whistleblower). Researchers tested the impacts of radiation and hormone injections on majority Black cohorts. According to Washington’s book, U.S. scientists administered unapproved doses of an experimental measles vaccine to mostly Black and Latino children in Los Angeles as recently as 1991, even after the injections killed hundreds of children in other countries, like Senegal.

In perhaps the most infamous example of medical malfeasance against Black Americans, the Tuskegee Syphilis Study, the U.S. Public Health Service didn’t inform 399 Black men in Macon County, Alabama, that they’d caught the bacterial infection. Instead, the researchers observed how the disease impacted them for 40 years without intervening, even when a treatment, penicillin, was approved. Those men unknowingly passed syphilis to their partners, who often gave birth to children with the disease.

“There’s no way you can be a minority patient, understand that history, and not worry about the quality of care you might be getting,” Wynia says. Hughes, who is the pastor of Denver’s New Covenant Christian Church/Alpha Omega Ministries, has heard that concern from his parishioners, who say they aren’t sure they’ll receive proper health care if they go to the hospital with COVID-19 symptoms. (Health care workers still disregard Black patients’ pain more than whites’—even Black children are less likely to receive pain medication than their white counterparts.) They’re also worried about the vaccine’s safety—61 percent of Black respondents said they would get the COVID-19 vaccine in a March Pew Research study, compared with about 70 percent of Hispanic and white respondents. “Everyone should be treated equally, with the best evidence, the best advice,” Hughes says. “Right now, we’re failing in that. We’ve been failing in that, and we’re continuing to fail in that.”

In February of last year, Hughes began feeling faint and short of breath. He checked in to the VA hospital in Aurora on March 9, 2020.

The news of Hughes’ hospitalization captured media attention: The well-known social justice advocate, nicknamed “Big T,” was the first COVID-19 case at the VA hospital. He was also campaigning to represent District 7 in the Colorado House of Representatives. His candidacy came to an end, though, as his fight with the coronavirus escalated. His doctors at the VA’s intensive care unit (ICU) put him in a medically induced coma, where he stayed for seven weeks as well-wishes poured in to his wife, who had also been diagnosed with COVID-19 and was quarantining at home.

Hughes recovered and returned home in May, and he credits the excellent care he says he received at the VA. But he wonders about the Coloradans who weren’t met with that same compassion and focus—or who never trusted the system enough to ask for help in the first place.