Mendelsohn: Racism alive and well in SC health-care system

America has a bad history with syphilis.

From 1932 to1972, the U.S. Public Health Service denied syphilis treatment to 600 impoverished African-American sharecroppers in order to study the disease, resulting in numerous deaths in the infamous Tuskegee experiment.

Fast forward 40 years to Charleston County, and we still have a problem with race and medicine. At a community health center in Hollywood, a majority of my patients are African-American, and half are uninsured. Many routinely forgo recommended treatments and specialty care because the cost is out of reach. Yet even I was shocked to see how race and poverty intersect by a recent patient.

An otherwise healthy African-American man was diagnosed with syphilis, known as “the great imposter” because of its ability to manifest in a myriad of symptoms. He had received two rounds of penicillin over the past year, but the infection had not cleared. The health department sent him for a referral to an infectious disease doctor. He needed a lumbar puncture to diagnose probable neurosyphilis, which does not respond to the usual treatment. Neurosyphilis is an infection of the brain and spinal cord that typically occurs 10-20 years after the initial syphilis infection. It can cause confusion, blindness, mood changes and dementia. Untreated, it can lead to permanent disability or death. However, with intravenous penicillin — nothing fancy — it can be cured.

I promptly referred the patient to infectious diseases at the Medical University of South Carolina. Unlike insured patients, all uninsured cases at MUSC must be “reviewed” by the department before the patient can schedule an appointment. A few weeks after faxing the referral, I received MUSC’s stock rejection letter stating that the patient could not be seen because he “was not a teaching case,” a code for uninsured. Clearly neurosyphilis is a noteworthy teaching case — it is virtually non-existent in America today — yet even intellectual curiosity, and the basic well-being of the patient, did not trump finances. Appeals to a private specialist failed, as did a second attempt at MUSC. In desperation, I emailed a sympathetic African-American administrator who called in a favor and got the patient an appointment at MUSC. The patient’s treatment was delayed an additional two months as he saved up money for the lumbar puncture. Because he was poor, my patient suffered five months more than necessary from a disease that is universally recognized as a public-health hazard.

This story is not meant to demonize MUSC, which did treat my patient in the end. Instead I want to demonstrate how the default response of the medical system is to deny uninsured people access to health care. In this case, had an administrator not intervened, MUSC may have never treated my patient for a highly curable disease using a relatively inexpensive treatment, just because he is poor.

Segregation is gone in the South, but as we were so painfully reminded by the massacre at the Mother Emanuel Church, racism still festers. This other “great imposter” manifests in a myriad of pathologies in society, including in the health-care system. There racism operates through invisible structural features, and intersects with poverty and indifference to prevent many poor people from obtaining basic care. In South Carolina, the victims are disproportionately African-Americans. The implications are momentous; you can’t succeed if you are sick.

Everyone in South Carolina was rightfully horrified by the massacre, just as people of all races were shocked by Tuskegee. Yet every day, smaller but systemic cruelties play out around us. Many who have access to health care are unaware of the extent to which poor people do not receive the most basic of treatments. In this case, both midlevel administrators and physicians denied another black man treatment for syphilis. They were not doing it in the name of experimentation — we already know that untreated neurosyphilis can kill you. But they, and the system they operate in, were prepared to let him suffer simply because he might not be able to pay — a form of profound indifference nearly as cruel as the original Tuskegee trial.

As we reexamine our history and racism, let us not forget the systemic changes needed to rid us of the “great imposter” in all its ugly forms. Affordable medical care, including Medicaid expansion, is one fundamental building block necessary to protect the human rights of all South Carolineans — black and white, rich and poor.

This story was originally published July 12, 2015 at 7:59 PM.