Since Sharon's post (at this site, last Wednesday, June 20) about Edith Rodriquez, who died needlessly after her heart stopped in the emergency room of the Martin Luther King Jr. Harbor Hospital in L.A, California while police were wheeling her out on a suspected parole violation, all the while indifferent to her pleas for help for her severe abdominal pain, I have been checking the news daily for updates and responses to her death.
The questions that advocacy journalist Rosemarie Jackowski poses in her Memoriam to Edith are questions that most, if not all of us, have asked ourselves. Why did no one help her? Was this tragedy caused by the fact that she might not have had health insurance? Was the problem that she was sick while being Hispanic? Was this death by geography, by virtue of the fact that she was in the United States? Jackowski thinks so:
"Living in the U.S. can be dangerous to your health," she argues. "This is a country that puts profits before patients; capitalism before compassion."
In her condemnation of this tragedy, Jackowski's anger is directed not so much at the doctors, nurses and other medical personnel who were indifferent to Edith cries for help, as towards the system, a system that in Jackowski words "has lost any hint of humanity."
"Sadly, Edith is not alone. In the United Staes 18,000 die every year from lack of medical care. That is like a 9/11 every 60 days . It is worse that 9/11 because these are needless death that we are imposing on our own. These deaths will continue until there is a strong grassroots movement for a universal, single payer health care system."
Rafeal Azul also argues that the core of the problem is obscured by a single focus upon the indifference of singular individuals to Edith's cries for help. In his article, Death in Los Angeles hospital exposes social crisis in US, he points out that:
"Media attention has focused almost entirely on the reactions of the 911 operators, including the responses of an operator who treated with apparent contempt the pleadings of one caller who sought to get help to Rodriguez."
Yet our focus upon the actions of singular individuals, as shocking as those actions may be, may miss something more fundamental. His point is that:
"To stop at the actions of the individual operators or the hospital staff, however, serves to obscure the more fundamental issues involved. King-Harbor hospital is located in South Central LA, one of the poorest sections of the metropolis. The McCone Commission, appointed to report on the causes of the 1965 Watts riot, determined that lack of access to medical care was one of the main grievances of the 1.5 million residents of Watts, Willowbrook and Compton, which make up part of South Central. The hospital was something of a concession to residents and opened its doors in 1972. In its heyday, Martin Luther King Jr. Hospital (renamed King-Harbor only recently) was lauded for its world-class quality and for its many services to the community."
"... the social conditions that underlay the riots in the 1960s were not addressed, and this could not but have a profound impact on the hospital itself. In contrast with unemployment rates of 2 or 3 percent in Santa Monica or Orange County, South Central Los Angeles has double-digit unemployment—in some areas higher than 20 percent. Infant mortality in South Central—13 per 1,000 births—is the highest in California and twice the state average. A hospital in many ways concentrates within its doors the social ills in the community at large, magnifying these ills a hundredfold. Drug abuse, violent crime and gang shootings, the persistent and corrosive effects of poverty upon the physical health of a community, the flooding of emergency rooms by poor workers or unemployed residents unable to afford health insurance—all of this places great strains on the staff, which is invariably overworked and underpaid. Moreover, a hospital like King-Harbor will have continual difficulties trying to attract the most qualified staff. Those who can will often work elsewhere, in better-funded hospitals in more prosperous areas. Recent reports indicate that 60 percent of the nurses at the hospital failed parts of competency examinations. There are no doubt many extremely dedicated doctors and nurses at King-Harbor, as there are at any hospital, but this by itself is inadequate without the devotion of sufficient social resources."
Edith Rodriguez herself, is a product of the social and cultural problems endemic to the area:
"She had no steady job or address. She survived on odd-jobs and lived with relatives. In the coroner’s ruling, Rodriguez is described as a “quasi-transient” woman with a history of abusing drugs. There is evidence that she used methamphetamines, a highly addictive stimulant that is an increasing problem in the US. Like other patients of the hospital, she represented those that society had left behind."
"It is not difficult to imagine a likely perspective of the hospital workers who refused to treat Rodriguez. Perhaps they were angered by her repeated visits. Perhaps they blamed her to some extent for her apparent drug problems, adopting an individualist approach to such social problems that is common in the US. Perhaps they did not quite believe her complaints of extreme pain. No doubt coarsened by the continual trauma of death that transpired within the hospital doors, for whatever reason there was no attempt to help Rodriguez as she suffered and ultimately died."
Although there is no excuse for the treatment that Edith received, it is imperative that we understand where it comes from. Only then can we work through these problems in order to change the future:
"The bureaucratic and Kafkaesque response to the working poor is not limited to a handful of overworked Los Angeles nurses or emergency dispatchers. Across this country the citizens of the inner cities or rural areas, the elderly, the mentally ill, and those battling addictions have often become invisible to overburdened and underfunded institutions that provide barely minimal service at the lowest possible cost. Individuals who work within these institutions can come at times to reflect the indifference, even hostility, that official society has for the lives of the broad mass of the people. Such was evidently the case with the 911 calls made in an attempt to get Rodriguez treatment when none was forthcoming at the hospital itself.
On the issue of the indifference to those who looked on around her:
"People are coarsened, but they are reflecting a coarsened society. To the extent that they may exhibit indifference, that they may lose for a period certain basic instincts of compassion—or these instincts may become weakened—it is a reflection of a more profound indifference, and sickness, in the social structure itself. Contemporary American society is characterized by enormous levels of social inequality. The vast majority of society’s resources are controlled by a small minority, directed toward the accumulation of profit and personal wealth, with only a few relatively small crumbs left for such essential social services as health care. From the standpoint of the ruling elite, people like Rodriguez are expendable.
"Less directly, the continual barbarism of the American government must have an effect—the war in Iraq, Guantánamo Bay, Abu Ghraib. Particularly in the absence of an organized political opposition, these examples of indifference and contempt for human life on a grand scale, coupled by the relentless propaganda of the media, are bound to filter down into the consciousness of certain layers of the population."
Edith's case is simply one among many similar cases at King Harbor:
"Beginning in 2003, a series of reports in the Los Angeles Times shed light on substandard care that had led to the deaths of several patients, attributed to neglect and lack of training for nurses. Inspections by federal authorities in 2004 and 2006 resulted in the partial closure of the hospital, including the elimination of the trauma center. The hospital now has only 48 beds and is a hospital of last resort. Citizens of South Central dubbed it “killer King,” to be avoided by whoever has the transportation to go elsewhere. King-Harbor is typical of many other inner city hospitals, such as the notorious Greater Southeast hospital in Washington D.C. and Detroit’s Riverview, which are equally deficient ... The problems at King-Harbor are being used by the federal government to threaten a cut off of federal funding, threats that have been renewed after the death of Rodriguez. This will only further intensify the underlying social problems."
He concludes by noting:
"The media concern for Edith Rodriguez lasted only a few days. Networks and newspapers are already moving on to the next item."
But before moving on, here is a thoughtful post by A Female Physician about bystander indifference, also known as bystander effect, or bystander apathy, with some suggestions for breaking out of its cycle so as to change our response in the future.
In A Female Physician's words:
"What bothers me about the Edith Rodriguez case is that I easily could have been one of the bystanders in that hospital lobby and contributed to her death ... We all want to think we would have been the different ones ... we all imagine we would have bent down in concern toward Edith Rodriguez and at least tried to figure out what was going on, if not offer actual assistance. I think I would have done this, I hope I would have ... but I also think deep down we all know that it's easy for ANYONE to be swept into the middle of an inert crowd and stay there dumbly looking on."
While the medical profession failed Edith Rodriguez and those that loved her, egregiously, she admits:
"the only personal offering I can make at this point is a commitment not to rest smugly in the position of critic and judge, thinking, well, I would have seen her there, and I would have done something, I'm not blind. Sure I am. Or can be."
In her words:
"All I can honestly say is I would like to think I would have treated the situation differently. But I cannot say that I would surely have been immune to group blindness or inertia."
In her closing comments, her call to us, as I read it, is to acknowledge and work-through our own complicity in group apathy so as to change how we act in the future. If we do not acknowledge it and work through it, then we will simply repeat it:
"I think we need to learn to acknowledge our blind spots and make a promise to all patients," she suggests. "We don't always see well, but we will always work to see better."