OPINION | Black Infant Mortality in King County Is Already Over Triple the White Rate

So why doesn't this safety-net hospital catch any babies?

by Bruce L. Davidson, M.D., M.P.H.

King County has more than triple infant mortality in Black babies compared to white babies. In my opinion, it's because UW restricts our public-owned hospitals for high-paid surgery — a cash cow for top UW surgeons and administrators — limiting maternity.

The CDC calls the infant mortality rate, infants dead before their first birthday per 1,000 live births, "an important marker of the overall health of a society," but it's also a surrogate for the larger number of surviving children with lifelong injuries burdening themselves, family, schools, and society, and for maternal premature deaths and lasting disabilities. For King County overall in 2020, it's 4.1 deaths per 1,000 live births. Twelve years ago, in 2010, King County reported 5.9 for Blacks and 3.8 for whites. But for 2019,CDC reportsKing County at 12.8 for Blacks, 217% worse, and 3.7 for whites. In contrast, in U.S. military base hospitals, infant mortality in Blacks and whites, 3.3 and 2.6 respectively, are similar.

A prevalent fiction is that community-based grants and support for minority pregnancies would fix the problem. The latest study debunking that fantasy showed intensive home nurse visits didn't improve bad newborn or maternal outcomes. What works is hospital beds to stop preterm labor, treat preeclampsia, etc., until at least 32—34 weeks of pregnancy, followed by adjacent neonatal intensive care cribs for weeks until babies are safe. Surprised? Ex-Vice President Dick Cheney benefitted from two treated heart attacks, angioplasty, coronary bypass surgery, and heart-assist implantation before his heart transplant — not from community nursing grants. Repairing the "social determinants of health" doesn't save a smoking, drinking, meth- and heroin-injecting grown-up shot three times on a city street — rapid transport to an excellent hospital allows discharge on his own legs four weeks later.

King County has four government-owned general hospitals — County-owned Harborview and Valley, and State-owned UW and Northwest, each under the administrative and medical direction of UW School of Medicine Dean Paul Ramsey, until his retirement last month. Harborview, in 1928 funded 500 beds for "indigent sick, the injured, and maternity cases," averages only 321 filled beds and delivers zero babies nor any neonatal ICU care, unlike most other large urban public hospitals. Dallas Texas' Parkland Hospital at State-owned University of Texas Southwestern Medical School, nationally known for trauma and burn care, delivers 30 babies a day, 10,900 a year, 58% of that county's Medicaid deliveries. UW's other three hospitals altogether deliver about 17 babies a day, about 7 of them (5 a day at Valley Medical Center in Renton) to Medicaid moms, 40% of the King County Medicaid total.

Why under Dean Ramsey was indigent maternity and neonatal care excluded from Harborview, our physically large but bed-shrunken County hospital? Maternity and neonatal care, like acute psychiatric and adult medical illness, is staff-intensive but reimbursed by insurers at a lower rate than trauma, burns, and complicated surgery. Using beds for the former means there are fewer available for high-paying complex brain, chest, and burns and trauma surgery with quadruple the case-mix-index, maximizing reimbursement, from Washington, Alaska, Idaho, and Montana. Who benefits? Not King County poor families with dead infants nor residents assaulted by a mentally ill person denied inpatient treatment becoming violent on the street.

Making matters worse, Harborview announced it is turfing to private hospitals sick local poor patients who don't yet need advanced life support, where they'll face bills from private hospitals rather than their County charity hospital. Recipient hospital systems include two health systems that bilked patients out of charity care — one from whom the Office of the Attorney General collected $42 million in a 2017 lawsuit and another from whom it's now seeking over $70 million in debt relief, refunds, and penalties.

"Harborview seeks to 'preserve our ability to be the Level I trauma center and ensure all trauma and critical illness have a place to go,'" UW exclaims, without telling reporters that Level II trauma centers in Everett, Tacoma, Bellingham, Vancouver, and Spokane provide essentially the same acute care. But wealthier insured patients with the money to buy air transfers from Alaska, Montana, Idaho, and distant Washington to Harborview, reach our County beds. The result is our own indigent sick patients, many minority, being frozen out of our County-owned charity hospital, not only for maternity and infant care, but other physical and mental illness. Why?

Paul Ramsey has been CEO of a nonprofit, UW Physicians, reporting $341 million in annual revenue in June 2020, year after year bumping his State UW salary, $336,000 in 2020, recently to over $1.02 million. Six other physician faculty, neurosurgeons, a chest surgeon, and a plastic surgeon, round out Ramsey's $1 million-plus club as of June 2020. If these are incentive bonuses or tips, why do they seem restricted to top earners and administrators? Why is it necessary to also hoard $45 million in cash plus $111 million in stocks and bonds while restricting Harborview beds as care needs soar? These full-time State employee physician-professors, insulated by layers of State-paid fellows, residents, and staff, are receiving huge annual cash increments for their usual official hours' work at County- and State-owned facilities, for which they already receive high pay and lifelong benefits, while minority families in King County experience high infant and maternal mortality.

Fixing this by opening beds for King County's indigent high-risk mothers and acutely ill won't be easy. Our Health Department's chief medical officer reports up to the dean. His policy manager wrote recommending "universal income" — not hospital beds — as an infant mortality remedy! Our politician-dominated Board of Health's two health representatives work for UW. For all of these, all this happened on their watch, unaware or with their consent.

Ordinary physicians are repulsed by academic physician leaders gulping at the public trough resulting in preventable death and disability. "Whatever adults may have done to harm their own lives, it's unfair for their children to begin life with their chances for success preemptively sabotaged … it's cruel … unsportsmanlike," wrote columnist Joe Queenan. But that's life in Seattle-King County in 2022.

Editors' Note: A previous version of this op-ed cited 2020 King County data stating that the infant mortality rate was at 9.8 for Blacks, 66% worse than in 2010, and 3.1 for whites. The author informed the Emerald of more accurate CDC data, and we updated the sentence to reflect that data, to "12.8 for Blacks, 217% worse, and 3.7 for whites." The author also informed the Emerald that the data in the sentence "UW's other three hospitals altogether deliver about 10 babies a day, less than 4 of them to Medicaid moms, fewer than 20% of the King County Medicaid annual total" was sourced from Valley Hospital and Medical Center in Spokane Valley rather than the Valley Medical Center in Renton, and we updated that sentence to reflect data from the correct location: "UW's other three hospitals altogether deliver about 17 babies a day, about 7 of them (5 a day at Valley Medical Center in Renton) to Medicaid moms, 40% of the King County Medicaid total." We thank the author for his updates and apologize to our community for the errors.

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Bruce L. Davidson, M.D., M.P.H., a pulmonary and public health physician and clinical professor of medicine at Washington State University, served in multiple roles in County, State, and federal health departments

Featured Image: Photo by Holly Anne Cromer/Shutterstock.com