For months, 10 Latino patients, nearly all women, have been trying to have their voices heard. They have serious complaints about the quality of care they say they received at the East Boston Neighborhood Health Center.
Among their claims against the center: a pregnancy that was missed; a diagnosis of kidney disease in one case and stomach cancer in another that went undetected and thus untreated; and a gallstone surgery that was unduly delayed. In the most egregious and tragic allegation, an undocumented mother said her sick baby was sent home by the clinic only to die the following day.
“These patients were desperate to tell their stories of neglect because they told us that no one would listen to them,” said Patricia Montes, the executive director of Centro Presente, a Boston-based nonprofit that is advocating for the women along with Lawyers for Civil Rights. The groups sent a formal complaint to state authorities in March to request an investigation into EBNHC.
That letter prompted the office of Attorney General Maura Healey to investigate the claims, as well as federal and state agencies to conduct surveys that resulted in two deficiency reports. In June, the state determined that the deficient practices associated with its survey were corrected; the federal agency found that EBNHC “failed to report a significant unexpected death” as required by federal regulatory standards. EBNHC wouldn’t comment given patient privacy rules, but the incident’s dates and details coincide with those of the immigrant mother’s baby who died the day after being seen at EBNHC.
Healey’s office is trying to open a collaborative dialogue between the patients and EBNHC, according to a spokesperson. “The families are assessing further legal action,” said Iván Espinoza-Madrigal, executive director of LCR. Some of the cases, now at 12 patients, date back to 2018, Montes said.
It is in nobody’s best interest when patients from a community with persistent health care disparities and who are already vulnerable don’t have the confidence to seek medical care at their neighborhood clinic. Some of the Latinx immigrants with complaints don’t have legal status and all of them are on MassHealth.
It’s clear from the complaints filed with the state that the Latino patients believe they didn’t receive the quality of care they felt they deserved. Katherine Zabaleta-Alvarado, a 20-year-old Chelsea resident who came to Boston from El Salvador when she was 5 years old, told me she has been a patient at EBNHC almost since she moved to the area. She was diagnosed with a rare kidney disease called focal segmental glomerulosclerosis in 2020 at Massachusetts General Hospital.
“Basically, my kidney doesn’t function and I am waiting on a kidney transplant,” Zabaleta-Alvarado said. While at Mass General, doctors detected some protein in her urine, which eventually led to a kidney failure diagnosis. The specialist she was assigned to at MGH “told me that he saw in my record that I had protein in my urine since 2008, and that I had other symptoms of my kidney disease,” she said. But Zabaleta-Alvarado felt that her pediatrician at EBNHC was always dismissive of those symptoms.
Then earlier this year, when Centro Presente went public with the complaint, Zabaleta-Alvarado saw Montes on TV talking about it. “Sentí que una puerta se me había abierto,” (I felt like a door opened for me.) “A lot of people don’t believe us, maybe because we’re Hispanic or because we speak Spanish.”
EBNHC is located in the city’s neighborhood with the largest share of Hispanic residents. The center was founded 50 years ago to provide care to East Boston’s largely immigrant and economically disadvantaged population. It operates as a licensed satellite emergency facility under Boston Medical Center’s hospital license. Roughly 70 percent of patients at EBNHC are Hispanic and 60 percent of them prefer to be served in a language other than English, according to data provided by the center. About 40 percent of patients have MassHealth insurance and more than 20 percent are Health Safety Net patients, many of whom lack legal status. In contrast, just 22 percent of EBNHC’s clinical staff, such as doctors and nurses, are Latino and even fewer, 7 percent, speak Spanish. But the center has translators and a fair number of Spanish-speaking administrative staff.
In an interview, Greg Wilmot, president and chief executive officer of EBNHC, highlighted the center’s standing as a leader in provision of quality care to Latinx patients and said that there is no disparity in the quality of care delivered to Hispanic patients. In surveys commissioned by the clinic, Hispanic patient satisfaction score is quite high, according to data provided by EBNHC.
But one individual expressing serious concerns about patient care, let alone 10, is one too many, and Wilmot seemed to acknowledge that. “We take the topic of racial equity and health care access very, very seriously and the claims in the allegations very seriously,” Wilmot said.
So what does justice look like for Zabaleta-Alvarado and the other patients? Through the advocacy groups, the Latina patients asked EBNHC to commit to a set of reforms, such as enhanced cultural competency training and improved access to translation and interpretation services. Wilmot told me the center is already doing that, but the advocacy groups said they remain unconvinced about the center’s commitment.
One thing is clear: Health care inequities are stubbornly embedded in the system, even at dedicated providers with missions to treat underserved populations.