A look at healthcare in Freddie Gray's Baltimore: 5 major takeaways

There is the Baltimore with access to high-quality care and academic medical centers, and then there is the Baltimore of Freddie Gray.

On August 12, 2015, 25-year-old Freddie Gray was arrested for possessing what police identified as an illegal switchblade. While being transported in a police van, Mr. Gray sustained a high-energy injury to his neck and spine — similar to one sustained after diving into shallow water — and fell into a coma. He died at Maryland Shock Trauma Center a week later, and his death incited protests on the streets of Baltimore.

As part of a reporting partnership between Kaiser Health News and University of Maryland College Park's Philip Merrill College of Journalism, NPR has published a 4,000 word story about healthcare disparities in Baltimore, specifically those between the academic medical institutions the city is known for and the community perceptions of healthcare in Sandtown, where Freddie Gray lived. Here are five major takeaways from the piece.

1. The story is centered on residents of Baltimore's Sandtown neighborhood, where Freddie Gray lived and was arrested. The life expectancy of Sandtown citizens is 69.7 years, the same life expectancy of grossly impoverished North Korea.

Residents of the ZIP code that includes Sandtown accounted for the city's second-highest per-capita rate of diabetes-related hospital cases in 2011, the second-highest rate of psychiatric cases, the sixth-highest rate of heart and circulatory cases, and the second-highest rate of injury and poisoning cases. Asthma, HIV infection and drug use are common.

2. Baltimore resident Robert Peace is placed at the article's forefront. Mr. Peace suffered a shattered pelvis in a car accident. A bone infection developed after surgery. A lack of follow-up care brought Mr. Peace back to the operating room five subsequent times, leaving him homebound for a year with joint damage and a severe limp.

3. The story highlights many factors that keep impoverished citizens of Baltimore away from the health system.
• Many avoid medical institutions because they see them in the same light as the justice system that failed Freddie Gray, noting that medical privacy laws allow hospitals to assist law enforcement by tracing suspected fugitives.
• Care is often disturbed by physician turnover and simple follow-up care is often denied to impoverished citizens for fiscal reasons. For instance, the story mentions a home-oxygen company denied service to a discharged lung patient due to his $27 balance.
• Even small copayments deter low-income residents from seeking care, and the Medicaid qualification process is tediously slow due to heaps of paperwork and limited administrative resources. Further, simply navigating networks of insurance is burdensome. For example, 2,000 low-income Medicaid members, many in Sandtown, had to change coverage in August or search for new physicians because UnitedHealthcare dropped University of Maryland physicians from its Medicaid network due to a contract dispute.

4. In Sandtown, distrust toward healthcare institutions is similar to distrust toward the police. "When you walk into a hospital, it's like walking into a courtroom. You know who's in charge, and you know who's not," one source told reporters.

Catholic, nonprofit Bon Secours Baltimore Health System is the closest inpatient provider to Sandown. While its death rates for Medicare patients with major conditions varies little from national scores when adjusted for illness severity, the distrust of this institution — and of medical institutions overall — is strong. Bon Secours is known throughout West Baltimore as "Bon Se-Killer." Many residents, unprompted, relayed grim stories to interviewers of loved ones dying in Bon Secours.

Further, the story of Henrietta Lacks, an African-American woman whose tissue was used without consent by Johns Hopkins Hospital in the 1950s, is known to many in Sandtown. It recalls the tales of "night doctors," boogeymen of African-American folklore. These "doctors," under the cover of night, abducted black children for medical experimentation. John Hopkins, for the citizens of Sandtown, has long been associated with such lore.

5. Impoverished citizens of Baltimore have seen little improvement in their healthcare services, although Maryland is undertaking an ambitious overhaul of hospital reimbursement and the Baltimore Health Department is pressing hospitals to collaborate on high-risk patients. In fact, the report cites recent instances of reduced access to and funding for care. In 2014, People's Community Health Center closed three nonprofit clinics for low-income patients. On Dec. 9, Maryland regulators cut funding by two-thirds for a proposal to create hospital jobs in poorer neighborhoods. Other initiatives do little to address the low incomes and unemployment linked to Sandtown's poor health, or simplify the maze of insurance and provider networks patients must navigate to receive care.

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