HHS, OCR Close Case on Medical Racial Discrimination, Care Access

The HHS Office for Civil Rights (OCR) has officially reached an agreement with Florida’s Hillsborough County Fire and Rescue to ensure patient access to care and health equity following an investigation into racial discrimination.

The agreement includes a revised nondiscrimination policy for Hillsborough County Fire and Rescue to ensure individuals receiving care from paramedics will receive equitable medical attention.

This agreement follows a 2018 case brought to light by public press reports detailing a situation in which Hillsborough County Fire and Rescue paramedics “refused to transport an African American woman to the hospital because they assumed she could not afford the ambulance cost due to her race,” HHS said in a statement.

HHS and OCR indicated that this is a clear case of medical discrimination and an example for the nation of the importance of building policies that protect health equity.

“This case is a reminder that bias in our medical system can result in death,” OCR Director Melanie Fontes Rainer said in a public statement.

“The Office for Civil Rights takes these issues seriously by ensuring health programs and services improve their awareness and compliance with Federal civil rights laws including laws that prohibit discrimination on the basis of race, color, and national origin,” Fontes Rainer added. “This case should serve as a notice for health care providers everywhere of the importance of federal civil rights laws and providing health care, free from discrimination based on biases and stereotypes.”

OCR began its investigation into the case in 2018 and looked particularly at Hillsborough County Fire and Rescue’s response to the incident. The OCR investigation also zeroed in on the policies Hillsborough County Fire and Rescue had in place to prevent and enforce medical racial discrimination.

The investigation, which included interviews with the deceased woman’s mother, the Hillsborough County staff who were involved in the incident, and the Hillsborough County NAACP Chapter President, showed some flaws in the county’s system.

OCR outlined certain regulations that should have kept this incident from happening, including Title VI, which prohibits entities like Hillsborough County Fire and Rescue from denying services based on a person’s race and requires those entities to make reasonable accommodations for those with limited English proficiency.

The compliance review led to a reworking of Hillsborough County Fire and Rescue policies and procedures in accordance with Title VI and other relevant statutes. For example, the county has worked with OCR to revise its nondiscrimination policies and create new procedures for providing reasonable assistance to individuals with limited English language proficiency.

Hillsborough County Fire and Rescue also worked with OCR to issue the revised nondiscrimination policies, notify staff that the policy is in effect, and publicize the policy through its facilities and on its website.

Additionally, the county will appoint a staff member to serve as its Title VI Officer. All staff members will be required to complete civil rights training that OCR will provide.

Discrimination in healthcare is not isolated to this incident. Per 2022 figures from The Commonwealth Fund, nearly a quarter of Black and Hispanic adults over age 60 have experienced some form of discrimination in healthcare. Particularly, survey participants told researchers that their providers treated them unfairly or did not believe their symptoms.

And like the case in Florida, these reported instances of healthcare discrimination resulted in poor patient access to care. Of those who said they experienced discrimination, 27 percent said they did not receive the care they needed because of it.