OPINION: A Time of Reckoning for Seattle Children's Hospital

by Ben Danielson

I am a Black male pediatrician. I have severed my relationship with Seattle Children's Hospital (SCH) and I expect they will soon make efforts to disparage my character. Leaving has been a deeply painful and difficult decision, particularly because in leaving SCH I must therefore stop working in its community clinic: the Odessa Brown Children's Clinic.

The clinic, spiritually and physically separate from the hospital, is a special place with an amazing staff and a wonderful community of patient families that will forever hold my heart. A clinic born in the later days of another reckoning: the civil rights era. A clinic owned by SCH but brought into being by a mostly Black community that wanted their own space in the health care system. A place that treated them with dignity. A place where staff looked like them, in the heart of their community. And still today, a community of mostly poorer families from diverse backgrounds.

I have been part of the SCH organization since 1992 when I first cared for patients as an intern. I have continually worn an SCH badge ever since, working in just about every medical area of the hospital. I settled into my dream job with them when I became the medical director of the Odessa Brown Children's Clinic in 1999. In the intervening years, the hospital itself has grown into a corporate behemoth. In the intervening years, our clinic's community has been displaced by gentrification and the families we serve have suffered the consequences. By many measures, societally, our country has left Black families further away from the "American dream" than they were when MLK was alive.

Over the years, the hospital has manifested institutional racism in ways that are not all that unique compared to other organizations. My experiences as a Black man are not unique, and they pale in comparison to the struggles that many others, especially Black women, have faced. Yet the lack of uniqueness, the incomparability to others' journeys, the near normalcy of it by no means makes any of it okay. This is why some of us have no wish to return to "normalcy" in a post-pandemic time.

Many — if not all — institutions in this country are infected with institutional, structural, and interpersonal racism, as well as many other forms of bias and denigration. So in a way, it should not be a surprise to know that BIPOC families are treated worse at SCH than white families. It should not be a surprise to know that a worried Black or Brown mother or father is likely to be unfairly punished for expressing their grief or angst. SCH's history of calling security disproportionately on worried Black parents is not that different from preschools disproportionately suspending or expelling Black young ones. It is not that different from the disproportionate policing that plagues this nation and makes police bullets the seventh leading cause of death for Blacks in their late teens and early young adult years. Such is the pervasive nature of racism in our society. Yet it does not make any one organization's practices okay.

These are the ways racism plays out in our nation and in our institutions. It would likely not be a surprise to know that families with limited English proficiency have fewer, briefer conversations with the SCH medical teams. This is not unique to SCH; it is the unfortunate pattern in most hospitals. Maybe it is not a surprise to know that, during these financially uncertain times, SCH leadership is contemplating eliminating all in-person interpretation, just like many other hospitals. This is not unique, yet it is not okay.

These are the ways racism shows up across our nation. It might not be a surprise to know that there has been misogynistic and racist behavior among the ranks of SCH leadership. It might not be a surprise to find that during my time at SCH a leader has used the N-word in referring to me when speaking to other staff members. If you look more closely, it may begin to raise bigger concerns to know that top leadership at the time dismissed this as mere cussing. It may raise somewhat more concerns to find that what the hospital calls an "investigation" exonerated this person. It may raise even higher concerns to see the hospital lift this person up as a champion for diversity. These things start to speak to the disconcerting issue of how an organization responds to its problems. Perhaps this too is not completely unique — maybe it is seen elsewhere. Yet it is still unacceptable.

I also know it is not okay for the hospital to try to pit BIPOC folks against each other. My experience has been that SCH tries to use some Black and Brown folks to help marginalize or push out other Black or Brown folks. Especially if those other Black and Brown folks are speaking up against the hospital's racist practices. It is a classic strategy by status quo power to eliminate threats to their power. It is an almost standard practice. It is part of our past "normalcy." And it is not okay.

A good way for power-clenching institutions to hold tight against equity efforts is to build equity centers and offices. The key component in this strategy is to make sure the office has no authority. SCH is rather unusual among children's hospitals nationwide in creating a Center for Diversity and Health Equity, but the strategy is by no means unique. Symbolism in the place of meaningful change is tried and true go-to strategy. So, at SCH anyway, the center can find out about disproportionality in calling security on Black families or the lack of time spent with limited English proficient families, but nothing changes for a decade. Any changes that occur today are coming more from exposure and shame rather than any commitment to equity. These are the ways racism thrives in our institutions today. We have to ensure that they will not be part of our institutions in the future.

The nature and voice of diversity matters in our institutions. I represent a rarity at SCH, yet I know my experiences are not unique. It is hard to name another Black male in any leadership role at SCH. Why is this? It is not uniquely the hospital's fault. Black male physicians are rare in this country. According to a 2015 report by the Association of American Medical Colleges, in 1978 1,410 Black males applied to U.S. medical schools. In 2014 it was 1,337. Maybe 2—2.5% of total applicants. Only 7% of applicants are admitted to medical school, so the proportion that are Black males is quite small indeed. So the issue is a systemic one and I am a national rarity, perhaps worthy of entry on an endangered list. Yet by 2019 records, SCH has 1,760 active medical staff. And let's look beyond physicians: as of 2019 SCH has 8,460 overall employees. Is the rarity of my position as a Black man in leadership still okay?

In a broader dialogue, SCH has other forms of diversity. But in my 28 or so years with the hospital, I can see that those who make up this diversity are not always treated very well. This has shown up in ways that are below the surface of diversity pie charts. I have seen brilliant Black women elevated to leadership positions and then heaped with responsibilities that are untenable. The promise of institutional power is used to compel people to compromise their values. For any who have risen up from poverty, the promise of financial remuneration further ties their fates to the fate of the hospital's status quo. I haven't worked for other hospitals; I don't know how representative this exhausting pattern is in other institutions. But I know this is another strategy institutions around our country use to stymie anti-racist efforts. And I know that it is not okay.

In my career I have cherished the opportunity to work at the Odessa Brown Children's Clinic. I am humbly appreciative that it was a community panel that had voice in my hiring, a practice the now very corporate hospital no longer seems to utilize. The opportunity for transparency and accountability to Black and Brown communities has dimmed.

In the past year, I have watched SCH become increasingly brazen in its efforts to silence or erase those who call loudly for equity. In some cases this has been done by implicitly offering position or pay in exchange for silence. In some cases it has been encouraging louder voices for equity and justice to leave. In one astonishing situation this year, a social justice advocate was fired for what I deem to have been promoting the diversification of their field. It is difficult to learn about these erasures because SCH uses nondisclosure agreements upon departure with what I would call ferocity. Common practice, almost normal, effective in preventing accountability.

I guess I must thank the hospital for denying me opportunities over time for organizational advancement within SCH. I should be thankful for the titles without authority and the lack of invitation to participate in various forms of hospital leadership. I should be thankful because it has kept my gaze outside the hospital. I have found highly rewarding leadership and partnership opportunities in the community and across the state. I have grown because of those hospital exclusions. But it doesn't make the marginalization okay.

In the past year I have experienced what I deem to be retaliatory acts against me by the hospital in order to quiet my voice — in order for the hospital to cover up problems. I have also seen just how callously SCH disregards poor communities and BIPOC communities. I have seen policies play out that have, in my view, put the communities I have served at higher risk for the worst outcomes from coronavirus — a reminder of just how many ways the pandemic has been the great revealer of the depths of this country's racism.

So I have severed my relationship with SCH. I have done this not because I think SCH is wholly unique, but because it is time for each of us to say that these systems are not okay. I have done this because institutions make symbolic gestures and tout them but will not really change. And if you see this happening, then it is your duty to cry out and say it is not okay. I have done this because SCH has problems with leadership, culture, and policy that are toxic. I have done this especially because our institutions seek to keep things unseen, silenced, covered up in a way that is poison on top of its original transgressions. And that is really not okay. I have done this because the hospital has acted, once again, in a racist manner. It has used the weight of its substantial power to erase people like me.

This time of reckoning is one in which I must also look inward. In what ways has my continued presence with SCH complicitly perpetuated the hospital's racist practices and symbolic gestures? If a hospital leader knows they can call me the N-word and knows that I will remain — while the racist hospital leader faces few consequences — how have I contributed to further ingraining racist practices? Has the privilege of working for a beloved community clinic kept me tied to a larger racist organization? Can organizations simply wait out this current moment of reckoning? Have I not done enough to support and lift up the other BIPOC folks who are part of SCH? Should I have used my voice better, more articulately, more convincingly? What more should I have done to make SCH more accountable to its communities? What of other Black professionals in this country who keep saying they will bide their time, keep quiet, until they reach the next higher rung?

These are the questions I will continue to wrestle with, and I do so willingly. Because this is my own reckoning too. The painful price I must pay is to lose my chance to walk through the doors of the Odessa Brown Children's Clinic every day. No sincere reckoning comes without a painful price.

No court would ever find SCH guilty of anything. Legal protections abound to sustain the elements founded in racism. I don't think most powerful entities give up an iota of power voluntarily. I don't think SCH will go through any meaningful change until its leadership leaves and an anti-racism-focused process brings in new leadership. I don't think our institutions will change until their policies are scrutinized through an equity and anti-racism lens. I don't think big organizations will change until their culture changes such that hate speech and its ilk are unequivocally not tolerated.

I believe we need to let institutions, especially those with nonprofit status, know that a time of reckoning demands a renewed transparency and accountability in their practices. Especially nonprofits, which enjoy financial gain by avoiding taxation, with the explicit bargain that they will address the needs of their communities. This time of reckoning requires the anti-racist cleansing light of transparency.

These institutions are us. Make no mistake in my words: corporations are not people. And I appreciate the wisdom in the Reverend Dr. Martin Luther King Jr.'s words when he said that groups tend to be more immoral than individuals (there are many, many good individuals at this hospital). Yet organizations are still the compilation of our presence, and their actions are a true representation of our values. Or at least they represent those things our values have ceded: the things we are willing to tolerate despite our spoken values. They are the most honest and revealing manifestations of us — our most discerning and summating mirrors.

We need to be guardians of the honor we bestow on our institutions. We need to let them know that we see them and that we will continue to be watching. I believe that we can no longer accept symbolism, even expansive symbolism, as change. I believe we have an obligation, no matter how tired we are, no matter how much we fear putting our careers at risk, no matter our sense of historic complicity, to act right now, in this moment, to make the right decisions and make the right kind of noise even when it feels hardest. This is our time of reckoning for racism.

What are you willing to do?

Ben Danielson is a Seattle-based pediatrician.

Featured image by Susan Fried.