82% of California hospitals didn't finish mandatory bias training: DOJ

The vast majority of California hospitals have not fully complied with a California law that requires implicit bias training for all perinatal care providers, according to an October report from the state's Justice Department. 

On Jan. 1, 2020, the California Dignity in Pregnancy and Childbirth Act took effect, requiring implicit bias training for perinatal care providers at covered hospitals, primary care clinics and alternative birth centers. The law also requires providers to complete a refresher training every two years after the initial training, and hospitals to provide implicit bias training to new nursing graduates they hire. 

The law was signed in response to racial disparities in maternal mortality. In California, women of color — specifically Black women — are three to four times more likely to die during childbirth than non-Hispanic white women, regardless of socioeconomic status. Though Black women make up five percent of pregnancies in California, they account for 21% of total pregnancy-related deaths. The state believes the training mandated by the act could improve infant and maternal mortality rates, according to the report. 

The California Justice Department issued letters or surveys to 258 hospitals to gauge their compliance, and 242 responded with data. 

"A substantial number of facilities had not completed or even begun training staff until after receiving DOJ’s August 23, 2021 letter, despite the January 1, 2020 effective date of the training requirement," according to the report. 

Only 42 facilities — 17.35% of the total sample — had completed training all the required staff. Just over 76% of facilities had trained some, but not all covered providers by the DOJ's deadline; among these facilities, an average of 77.54% of the required providers were trained. 

The majority of hospitals chose to use a one- to two-hour asynchronous video training. 

One reason for the lack of total compliance might be confusion, according to the report. Covered facilities reported that they were unsure exactly who needs to undergo bias training; some believed it was only clinicians, although the act calls for all employees who might be involved in perinatal care — including front desk, telephone and support staff — in any unit and in any outpatient setting under covered facilities' umbrella. 

More specific language in the law could help improve compliance, the report suggests. It also recommends more transparency and public access to compliance data: for example, a publicly available registry. 

"Those who do not fulfill the requirement are unlikely to face repercussions because a lack of public access to compliance data makes it challenging for consumers to know whether or not their covered provider has fulfilled its obligation," the report says. "Additionally, California Maternal Mortality Quality Review Committees' records pertaining to maternal and infant deaths are shielded from public view and accountability, enabling noncompliant facilities to skirt liability."

Read the full report here.

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