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EGACY Yesterday. Today. Tomorrow.
WEDNESDAYS • June 30, 2021
INSIDE Hospitals end suits for medical debt - 2 A Q & A with a breast cancer warrior -3 A sincere ‘thank you’ to our readers - 4
Richmond & Hampton Roads
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Black mothers have worse health outcomes Advocates in Virginia want bias training for doctors, but can it narrow the racial gap? KATE MASTERS
Like many health experts, Dora Muhammad was dismayed when national headlines began to highlight growing racial disparities in maternal mortality. Virginia was no exception. Black women in the state are more than twice as likely to die in childbirth than White women, according to the most recently available data from the state Department of Health. But Muhammed, the health equity program manager for the nonprofit Virginia Interfaith Center, was even more concerned about why. “It’s already well-known that the rates are higher,” she said. Not as familiar was a 2019 report from the Virginia Maternal Mortality Review team, which analyzed the role of chronic illnesses in pregnancy-related deaths. Among women with long-term conditions, Black women died at more than double the rate as White patients. But 44 percent of all deaths, researchers found, were linked to at least one provider-related failure, including “a lack of diagnosis, treatment or follow-up.” “The most common thread I hear is that a Black woman will come in with pain, with a condition where she knows something is wrong with her body,” said Muhammed, who worked with the governor’s office to coordinate a series of listening sessions across the state. “And instead, she’s just not taken seriously by her doctor.” Those experiences have informed a growing push to require implicit bias training for Virginia’s medical professionals. The concept isn’t new for the state’s General Assembly, which recently passed a similar law requiring teachers to be assessed on “cultural competency.” While the trainings sometimes go by different
Tiffany Casby cradles her newborn son Zayne, shortly after birthing him at Embrace Midwifery & Birth Center in Richmond, circa 2017. PHOTO: Cheyenne Varner names, the underlying concept is similar, Muhammad said. The idea is that poor outcomes, whether in education or health, can be linked to unconscious differences in how people of color are treated. But if providers learn to recognize and counteract those biases, treatment could improve. Other states, including Michigan and California, have passed similar laws aimed at ending discrimination in doctor’s offices.
“It’s a training to undo that level of thinking that comes with seeing race,” Muhammad said. “Like, when you hear the exact same thing coming from a Black woman that you hear coming from a White woman, why is the response different?” It’s an approach the Virginia Board of Medicine
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2 • June 30, 2021
Study: VCU and UVA hospitals led nation in suing patients before ending practice last year
Researchers found that between January 2018 and July 2020,
VCU initiated court action against patients 17,806 times — more than
any other institution reviewed. UVA’s medical center came in second, initiating legal action 7,107 times. VCU and UVA both announced in 2020 they would stop suing patients over unpaid medical bills and both institutions later said they would cancel a backlog of judgements and liens against patients that date back to the 1990s. The action followed a 2019 investigation by Kaiser Health News and published in the Washington Post that focused on the two institutions. The Virginia Mercury first reported on the volume of medical debt lawsuits filed by Virginia hospitals in 2018. Johns Hopkins University’s research found that the volume of medical debt lawsuits dropped nationwide after the practice began drawing public scrutiny. © Virginia Mercury
“Education does not, I don’t think, tend to impact what we have as an already inherent bias,” said Dr. David Archer, the board’s vice president. “And when you say, ‘You have to do that’ to doctors, you tend to get some pushback.” Right now, there’s no clear evidence on whether continuing education has been effective at improving patient outcomes. While multiple studies have confirmed that many medical professionals do hold implicit biases — and that those biases affect the quality of care — there’s little conclusive research showing whether bias training is actually effective. The board also hasn’t assessed whether the current opioid education has reduced improper prescribing. But given how extensively discrimination can affect patient care, many members were supportive of the requirement.
“In this particular case, the bias impacts such a large percent of Virginians that I think this is a special issue,” said Dr. Joel Silverman, a psychiatrist representing Richmond. “I am not in favor of having 15 different training requirements, but I think this one is relevant to a whole host of different issues.” While the board didn’t submit or endorse legislation that would specifically mandate implicit bias training, it did take two concrete steps. First, the members voted to recommend the training — and send out a list of available courses — to licensees across the state. The board’s executive director, Dr. William Harp, also clarified that the training would count toward relicensure, which requires 60 hours of continuing medical education per two-year renewal cycle. Additionally, members voted to request legislation that would grant
them the authority to mandate new training for licensees — similar to existing statutes governing the Board of Pharmacy. President Blanton Marchese, one of the board’s citizen members, said it would allow them to require up to two two-hour courses in whatever medical subject matters they deemed relevant. “So when something like this comes up, we would have the authority to say, ‘Right here, today, everyone needs those two hours to keep their license,’” he said. Muhammad supported the measure, but said the Interfaith Center still plans to submit a bill that would specifically require implicit bias training. “It has to be mandated,” she said. “Because a lot of people don’t think they hold these biases. And then they won’t bother taking it because they think it doesn’t apply to them.” © Virginia Mercury
NED OLIVER Hospitals operated by Virginia Commonwealth University and the University of Virginia filed more lawsuits against patients over unpaid bills than any other large medical groups in the country, according to an analysis by Johns Hopkins University and Axios released last week. Both health systems ended the practice last year amid growing scrutiny of their debt-collection efforts against low-income and uninsured patients. The new review, which studied debt-collection efforts of the country’s largest 100 hospitals, shows for the first time the extent to which the two institutions stood out nationally for their billing practices, which executives initially described as standard operating procedure.
(from page 1) also tentatively endorsed at a Thursday meeting. Currently, members don’t have the authority to mandate new training for licensees (the Board of Pharmacy is the only regulatory board with that ability under state law). But after submitting the proposal in April, Muhammad hoped members would back legislation to require implicit bias education for licensed providers across the state. Support for a mandate, though, wasn’t universal. Some doctors have been divided by a 2016 law requiring two hours of continuing education on opioids every two years. For those opposed, there’s often resistance to the idea of lawmakers inserting themselves into medicine — and to mandating training that might not be relevant for all providers.
Annie Washington, one of the thousands of VCU Health patients facing lawsuits for unpaid bills in 2018, waits outside the hospital after a medical appointment. PHOTO: Ned Oliver
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June 30, 2021 • 3
Surviving cancer: A Q&A with Diana C. Awuor By MARIA-PAULA Diana C. Awuor's diagnosis of stage 2 breast cancer in November 2020 shocked her to the core. The wife and mother of three; ages 6, 1, and 5 months, at diagnosis, never expected this but she has now reached a point of acceptance and is ready to share her story in a bid to help others. Below are her thoughts on how the diagnosis has changed her life, her family, relationships and her career. 1. Can you share how your diagnosis came about? Three weeks after my youngest child was born, in May 2020, I felt strange on my left breast though there was no lump felt. My husband and friends, just like my OB-GYN, downplayed my concerns when I shared what I felt. Two weeks later, in mid June, when pumping milk, I felt like something gave way and lots of milk came out from my left breast which never produced a lot of milk. In the next few days, I felt a tiny lump which later disappeared and resurfaced, prompting my second visit to my OBGYN. Upon missing him, his nurse practitioner also sent me away alleging that nursing moms have a lot of such lumps due to milk ducts. The following weeks were uncomfortable, prompting my visit to my primary care doctor who then sent me for a mammogram. Results showed lumps on both my left and right breasts, which the radiologist said were fibroadenoma since they had no features found in cancer tumors. However, the report [also] indicated suspected malignancy on the left side lump. My primary care doctor referred me to a breast surgeon for excision biopsy. [The surgeon] told me that it was not cancer and that I should continue nursing my baby until she was four months old. Despite my fears, I chose to trust the surgeon, though the tumor was twice as big in a month. Upon my review, he said he was not sure if the tumor was a galactocele because cancers don’t grow that fast. These are milk-filled cysts. My kids’ pediatrician then advised me to seek a second opinion, which I did. I found an oncology surgeon who accepted to see me quick. She told me no doctor should tell a patient that a growing lump isn’t cancer and that a biopsy should be the only way to determine [whether it is or not]. She asked me to insist on getting a biopsy referral from the surgeon which turned to be an uphill task. The surgeon eventually granted my wish leading for a biopsy on the 28th of October 2020. On November 2nd, it
was confirmed this had been cancer all along. 2. What is your family history with cancer? Apart from my maternal grandfather who passed on from prostate cancer in his mid 90s, there’s no history of cancer in my family lineage. A genetic test done on me came back negative, meaning cancer is not in our genes. This was just that, stray. 3. What has been your course of treatment, including surgeries? I had a double mastectomy by choice though the surgeon preferred the treatment for my left breast for clearer margins because I did not have chemotherapy at the beginning to shrink the tumor. After the mastectomy, I had five months of intense chemotherapy because the cancer was aggressive as determined by the oncotype test done on me. I am scheduled for a second surgery, total hysterectomy, which I opted for to help reduce the amount of estrogen in my body because the cancer was feeding a great deal from estrogen. With the ovaries being the top producers of this hormone, I am having them all taken out. I know it will get me into early menopause at 36 years old but at this time, I just want to do everything possible to be here longer to see my kids grow. This surgery will also eventually help reduce the amount of medication given to me like injections every three months. After the surgery, I will begin radiation. 4. What side effects have you experienced from the medication? I lost all hair on my body. I had to shave all hair from my head the morning of my first chemotherapy infusion, January 8th, 2021. All my nails have turned black. You see, chemotherapy targets fast growing cells. Cancer is fast growing just as nails and hair cells. Additionally, “chemo brain” affected me too. I have a slight problem with my memory and forget some names in addition to putting some things in the wrong places and such like. I have lost weight too but this is mostly because of the workouts I have been doing during treatment to help me maintain a healthy weight and for sanity. 5. How has this affected your family: spouse, children, parents, siblings? Our life has changed. It has been a roller coaster of feelings. But, being a religious and very spiritual family, God has already pulled us out of a dark place. This diagnosis affected us more as immigrants with most of my close family members being in Kenya and I in the U.S. Then, there was COVID-19 and my oldest was homeschooling. This has put
Diana poses for a picture during a chemotherapy infusion session. us between a rock and a hard place. My husband [Kennedy Osara], who works with the U.S. Army, can hardly find time to be home. Additionally, my mom has been unwell with no insurance. This has strained us financially but well-wishers are currently raising funds and donating to
help us have funds to take care of mom for the duration that she will be with us this year to help so that we can take care of her health too as she is elderly and straining her body with three little kids.
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4 • June 30, 2021
Op/Ed & Letters
Thank you! Dear reader, We’ve come through 16 months filled with challenges across our communities and businesses. But one constant that we want to take a moment to celebrate is you. We’re thankful for The LEGACY Newspaper readers like you because you care enough about your community, and your place in it, to keep up with what’s happening around you. You are engaged and concerned. You have thoughts to share, and what we deliver to you in words, photos and graphics helps you inspire and drive conversations. From our coverage of local news, state news and more, we have strived to be your most trusted, local source for news. A good local newspaper should both celebrate the community’s accomplishments and challenge its assumptions. You don’t always like or agree with what we write, and some of you tell us so. We respect and appreciate that. Don’t ever lose that spark and, please, keep reading your local newspapers, in print and online. They need you. The LEGACY Newspaper Vol. 7 No. 27 Mailing Address P.O. Box 12474 Richmond, VA 23241 Call: 804-644-1550 Online www.legacynewspaper.com
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P.T. Hoffsteader, Esq.
June 30, 2021 • 5
Spotlight the grifters I hope there’s a special place in hell reserved for the ringleader of an overseas scam that fleeced thousands of Americans — mostly the elderly — of an eye-popping $10 million. They included a Chesterfield County woman, listed in federal court records as “VICTIM #1,” who was taken for nearly a half-million dollars. That was most of her savings, “June” told the Richmond Times-Dispatch. I’m guessing the woman, who’s in her late 60s and cares for an adult son, didn’t want to use her full name because she’s embarrassed. Or, as June told the newspaper: “I can’t tell you how deeply ashamed I feel because I’m a smart person, but smart people supposedly
don’t let this happen to themselves.” She shouldn’t be so hard on herself. Nor is June alone. You may think I’m being too harsh with the Hades allusion I’ve trotted out for Shehzadkhan Pathan and the hundreds — if not thousands — of his ilk around the globe. Sure, the crimes he faced were not murder, rape or assault. Yet schemes such as Pathan’s drain bank accounts, diminish individual feelings of security and leave people questioning their own sanity. The 40-year-old Pathan, who operated a call center in India, pleaded guilty earlier this year to conspiracy to commit mail and wire fraud and aggravated identity theft. He’ll be sentenced July 1 at the U.S. District Court in Richmond. His scams disproportionately targeted
the elderly, federal prosecutors said. Many Americans by now have learned about variations of Pathan’s ruse. I’ve been writing about them since at least 2014, when the oldest of the Chesley Trio received a scam call at our abode in Hampton Roads. Using spoofing technology, a phone call to your home or cellphone says it’s coming from the “Social Security Administration.” In the latest come-on, if you pick up or return the call, you’re connected to a reputed agent with the U.S. Drug Enforcement Administration. Someone claims your bank records were found inside a car far, far away with lots of illegal drugs.. Cash is demanded — by mail — to make your alleged lawbreaking go away. And if you make the mistake of
paying up? Requests for more money will keep coming. And coming. The Virginia Attorney General’s Office noted that Americans lost more than $1.9 billion to fraud and scams in 2019 — a 28 percent increase from the year before. AG Mark Herring says, “... [Be] wary of any calls, emails, or contact where someone is promising money or goods for little or nothing in return, and pay special attention to any deals that require you to send money or pay up front. Don’t give unknown callers your financial or other personal information. Readers who believe they may be victims of a scam or fraud should contact the state’s Consumer Protection Section at (800) 552-9963 or use the consumer@oag.state.va.us email. Roger Chesley
6 • June 30, 2021
The LEGACY
(from page 3) COVID-19 has not made things better either. Younger caregivers have been denied visa interviews by the U.S. embassy in Kenya since the B1/B2 visa category interviews have been put on hold. This leaves my mom as the only option we have because my elder sister’s visa expired when she went back home to Kenya after my surgery. My education has also been interfered with. I was scheduled to graduate with my doctor of education degree in May this year (2021) which was postponed to, hopefully, December 2021. 6. What has been the effect on your mental state? My mental state was affected. I think I almost became suicidal. I actually requested the doctors to “put me down” because I could not go through this. They recommended a psychiatrist. I accepted. This has helped me a lot and I still have sessions with her. She had put me on some pills to help me sleep and keep me off frequent thoughts of death. I am incredibly happy that now I do not need the pills to sleep. I exercise enough and pray. All these, together, with a supportive community has helped me “come back to life.” 7. What kind of discrimination have you faced since your diagnosis? I would not say that I have faced any kind of discrimination. I have so far received great medical care from my team of doctors, save for the general surgeon who caused a delay in my treatment. My primary care oncologis,t being of African descent, made me feel more at peace with my medical team with studies showing that White doctors treat Black patients differently, leading a lot of Black people to die. That is why, my lead oncologist being a Black woman meant a lot to me. 8. What advice would you give the average woman in the community regarding breast cancer? Check what you eat. Read leaflets of all medications you are given, especially the hormonal birth control medications. Scan yourself often in order to enable early diagnosis. With or without cancer history in your family, begin your screening earlier than 40 years. I was diagnosed with cancer at 36. I also want everyone to know that seeing a psychiatrist is not bad at all. It helps. 9. What are the red flags you recommend others watch for? Watch out for strange back pains, abnormal breast sensations and lumps. Women who have never have kids and those that have their first child at age 30 or above are at risk for breast cancer. Also, women who have been on hormonal treatment and women with breast or ovarian cancer in their family history are more at risk.
Left to right: Diana, her husband Kennedy Osara, and their children before her diagnosis; and Esther Otieno. “I think that depending on what someone is going through, most people may think that financial help is the ultimate need but being there just offering spiritual and emotional support is very important as well. “I believe that when someone re-ceives a life changing diagnosis, it’s not only their physical body that needs healing, but their spirit and soul all needs to heal together. A strong spirit makes it easier for the body to heal and be healthy. It lifts the body’s ability to fight off diseases and gives it a better chance of winning the fight.” -Esther Otieno 10. How did the community hold your hands from the time of diagnosis to date? From my congregation, Williams Chapel Church, led by Apostle Nixon from North Carolina; my bible study group at Champion Forest Baptist Church-Klein Campus in Spring, Texas; to the Kenyan community in Houston led by Elsa Kiprotich. In addition to a prayer group by Carolyne Njenga, Rachael, Gladys Chumba, Sam Houston State University, and the higher education leadership department, my dean, Dr. Stacy Edmonson visited several times. Dr. Matthew B. Fuller ensured that I had a scholarship to enable me to study when undergoing treatment not forgetting family and friends in Kenya, I am forever grateful. Kenyans in the U.S., at large, led by Esther Otieno, a [Fredricksburg] Virginia resident, assisted by Sharon Adundo, virtually brought a number of women to join my family and I during infusion sessions. Having stayed in the U.S. for 10 years, Otieno knew how much medical expenses burdened families and felt the need to offer me emotional, spiritual and financial support. It was wonderful. I have recordings of several of those [virtual] sessions and when I watch, I get so emotional. The meetings will go on until the end of my treatment. Post-COVID pandemic, technology can be used to be there for patients so that they do not feel alone while fighting giants like cancer. People should use social media and technology such as Zoom or Google Meet to offer support when physical in-person support cannot be achieved. Using technology can be just as important as being physically present. It’s literally the second best thing. With nationwide
limits to social gathering due to the COVID-19 pandemic, we used Zoom sessions heavily to catch up. Otieno’s group used zoom sessions to share what was going on in our lives and I would give an update on the progress of my treatment. They would occasionally get to say hi to the nurses that were attending to me. During every Zoom session, we invited guest speakers to share with us the Word of God and to pray with us briefly, a period of about 30 minutes. During this time, they would share with us words of encouragements and testimonials. We had different speakers ranging from pastors, evangelists, friends, and even family members. The Zoom sessions also enabled us to meet new people and, make new friends. These live zoom sessions were attended by friends and families who live and work in different states here in the U.S., Canada, UK, and even families and friends who live in Kenya. Friends and well-wishers helped raise funds to pay for my elder sister’s ticket to the U.S. to be on time for my mastectomy surgery and for my mom right on time when chemotherapy began when I needed help and support more so because of the young ones. 11. Paying it forward I feel that I will have done wrong by not educating people about breast cancer through sharing my experiences and lifestyle change. Also, I want to be there for others so that they do not go through the same alone. It is because of these reasons that I am now speaking through my YouTube channel “Candid Diana”. Also, at Williams Chapel Church in Spring Lake, North Carolina, we are beginning a virtual cancer care group called “Safe Haven of Hope” that will be a safe haven for cancer patients from
all over the world and survivors too. We will have messages of hope, volunteer counselors, psychiatrists and more, just to hold the hands of those in need. Please call the church at (910) 4363186 if you wish to be part of it as a patient, survivor or caregiver. There is no one who can help someone suffer from a chronic illness other than someone who has also suffered in the same way. 12. What kind of support do you look forward to more from the people and community around you? We are still receiving financial support to sustain us throughout this treatment year. That helps with my diet and my mom’s medical care. We are also stranded with child care and wish to have someone to help us with child care at home or be able to afford daycare so that we can take the kids when I begin radiation and later days of recovery from the second surgery. This is because my mom leaves just after my surgery and will not be back until months later. You can support us via CashApp ($DianaCarole), PayPal (@dawuor) or Zelle (dianawuor@gmail.com). I am also looking for a career opportunity in student affairs leadership, preferable international student services or multicultural services. If you have a vacancy and would like to interview me, please, connect with me and I will share my credentials. I am Diana Carole Awuor on Linked-In. Lastly, I need you to know that breast cancer is not a death sentence. Medicine and research have advanced. Be your own advocate and follow your intuition since doctors are not always right. Do not wait until cancer strikes to change your lifestyle.
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NOTICE IS HEREBY GIVEN THAT THE CITY OF RICHMOND BOARD OF ZONING APPEALS
Will hold an electronic Public Hearing due to the state of emergency that exists as a result of the spread of COVID-19 pursuant to and in compliance with Ordinance 2020-232 on July 7, 2021, to consider the following under Chapter 30 of the Zoning Code: BEGINNING AT 1:00 P.M.
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The case plans and agenda will be made available on the City’s legislative website not later than June 16, 2021: https://richmondva.legistar.com/Calendar.aspx The public may listen to the Microsoft Teams electronic meeting and offer comment by calling 804-316-9457 and when prompted entering code 870 566 969#. For video access by computer, smart phone or tablet visit https://richmondva.legistar.com/Calendar.aspx. Select the Board of Zoning Appeals drop-down and 2021 drop-down, click meeting details for July 7, 2021 meeting and then click video access. In the event you have difficulty accessing a public hearing you may contact Mr. William Davidson at 804-396-5350 or by email at William.Davidson@richmondgov. com for assistance. In accordance with Ordinance No. 2020-232, please be advised that an inability to access one of the enumerated public hearing through video means shall not be considered a prerequisite for participating in the subject public hearing. In order to ensure your participation it will be necessary for you to call in at 1 PM and stay on the line until such time as your case is called. Please be advised that the Board of Zoning Appeals Rules of Procedure provides that in the case of an application for a variance or a special exception, the applicant, proponents or persons aggrieved under §15.2-2314 of the Code of Virginia, in that order shall be permitted a total of six (6) minutes each to present their case. For this reason the Board respectfully requests that you be as brief as possible in your comments when your case is called by the Chairman to allow other individuals the opportunity to participate. For the purposes of the record it is also requested that before addressing the Board you identify yourself and spell your name. The public may offer comments in advance of the scheduled electronic meeting by directing them to the email address listed below and the subject comments will be made available to the Board Members prior to the electronic meeting. Roy W. Benbow, Secretary Phone: (804) 240-2124 Fax: (804) 646-5789 E-mail: Roy.Benbow@richmondgov.com
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