Hospital Flight from Minority Communities: How Our Existing Civil Rights Framework Fosters Racial Inequality in Healthcare
DePaul University Journal of Health Law, 2006
56 Pages Posted: 14 Feb 2006
In this article, I address the failures of civil rights laws in preventing the disparate allocation of health care resources by focusing on Title VI challenges to hospital closures. I use these cases to critique our current civil rights framework and to show how certain structural and ideological foundations of this framework have undermined our fight for true equality in health care. First, despite the importance of government funding as the means to fight racial disparities, the government has consistently and consciously made funding decisions that foster racial inequality, creating a health care system that is incompatible with racial equality. Second, the government has also undermined its purported commitment to civil rights by rendering the administrative arm responsible for civil rights enforcement ineffective and by abandoning its facilities planning responsibility to ensure the fair allocation of hospital services. Finally, courts have refused to provide a meaningful check on the government failures in this area, creating doctrinal barriers that make it impossible to use Title VI to prevent hospital flight from minority communities. These failures have exacerbated racial disparities in health care, and engendered feelings of despair and anger among minority communities who feel betrayed by the political, judicial, and health care systems. These failures have also shaped our civil rights discourse in ways that discourage an honest critique of the hospital closure problem and stymie our vision for meaningful reform. In the final part of this Article, I use lessons from the hospital relocation problem to argue for a more comprehensive and creative plan of action to address the unequal allocation of hospital resources.
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