HHS Office for Civil Rights and Cedars-Sinai Enter Into Mutual Agreement to Advance Civil Rights and Improve Maternal Health for All

Agreement Takes Important Steps in Addressing Racial Disparities in Maternal Health Outcomes by Ensuring That Black Women and Other Women of Color Have Access to Treatment During the Full Course of Their Care

Today, the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR), and Cedars-Sinai Medical Center (Cedars-Sinai) entered into a Voluntary Resolution Agreement (Agreement) to improve maternal health outcomes for Black, Latina, and other maternal patients of color. In June 2022, OCR opened a compliance review of Cedars-Sinai based on concerns expressed by patients. This Agreement concludes OCR’s review into Cedars-Sinai’s compliance under Federal civil rights laws that prohibit discrimination on the basis of race, color or national origin, resolving allegations of racial bias in healthcare, treatment and access to health care services. OCR did not determine any violation of Federal law by Cedars-Sinai in its review. Title VI of the Civil Rights Act of 1964 (Title VI) and Section 1557 of the Affordable Care Act (Section 1557) are laws that prohibit discrimination on the basis of race, color, or national origin.

OCR initiated a compliance review in response to media reports and complaints alleging racial bias in maternal care at Cedars-Sinai. Prior to OCR’s compliance review, Cedars-Sinai had undertaken substantial efforts to understand and mitigate the effects of discrimination and bias in healthcare. For example, Cedars-Sinai instituted mandatory annual unconscious bias education for staff while creating internal quality improvement programs and collaborating closely with community partners to improve Black maternal health outcomes. Today’s Agreement demonstrates OCR’s and Cedars-Sinai’s shared goals of promoting health equity and eliminating bias and discrimination in healthcare.

“Disparities in maternal health outcomes for Black and Latina women and other women of color continue to get worse across the nation as racial bias permeates our health care system, affecting how decisions are made and the treatment given to women of color. Our entire health care system must work to ensure that every woman has equal access to care at every single stage—through pregnancy, birth, and postpartum,” said OCR Director Melanie Fontes Rainer. “We are encouraged by these important steps taken by Cedars-Sinai to address health disparities for women of color at its facilities and look forward to their continued work in this area to support its patients. OCR is committed to fully enforcing our civil rights laws to ensure all people can access health care, free from discrimination.”

Christina Harris, M.D., chief health equity officer at Cedars-Sinai, said, “We embrace the opportunity to partner with OCR to strengthen our longstanding commitment to equity for all those who entrust us with their care. We are dedicated to ensuring safe and equitable outcomes through education, accountability, and rigorous quality initiatives aimed at addressing disparities in maternal health. We appreciate the voices of the patients and the community in advocating for progress as we continue to advance this urgent work.”

Today’s Agreement follows a letter of concern OCR issued to Cedars-Sinai and resolves allegations that it violated Title VI and Section 1557 and denied patients equal access to health care services.

Under the Agreement, Cedars-Sinai Medical Center will collaborate with OCR to:

• Update and implement recommendations to Cedars-Sinai’s Obstetrics and Gynecology Department’s staff, including early maternal warning systems to facilitate timely recognition, diagnosis, and treatment for pregnant women developing critical illness;
• Update its training program addressing Federal legal nondiscrimination requirements, preventing discrimination and harassment in health care, and promoting diversity and equity, and will make recommendations to its Executive Committee to require these trainings for re-credentialing medical staff;
• Update its guidelines and continue to track success rates for vaginal births after cesarean section and pain management process to assess and manage acute pain for birthing patients, and provide training for these protocols and for obstetrical hemorrhage management;
• Review by Cedars-Sinai leadership, the current oversight, supervision, and peer review practices and make recommendations to be incorporated into onboarding and annual trainings of staff;
• Update or enhance its reporting tool to document incidents of bias or suspected bias experienced by patients and the public;
• Incorporate completion of courses that raise awareness about racial disparities in maternal mortality and morbidity rates in the United States into its training program; and
• Develop and implement a program to facilitate patient access to doula resources and utilization of doulas in the Obstetrics and Gynecology Department during labor and delivery.

OCR will monitor the resolution agreement for three years. A copy of the Agreement can be found at https://www.hhs.gov/civil-rights/for-providers/compliance-enforcement/agreements/cedars-sinai-ra/index.html

This action is the latest in a series of efforts OCR has made to advance and protect the civil rights of people not to be discriminated against on the basis of race, color, or national origin. This includes the announcement of the Section 1557 of the Affordable Care Act final rule.

For information on the nondiscrimination provisions in Section 1557 of the Affordable Care Act, visit: https://www.hhs.gov/civil-rights/for-individuals/section-1557/index.html.

For more information on Title VI of the Civil Rights Act of 1964 and how it prohibits discrimination on the basis of race, color, or national origin, visit: https://www.hhs.gov/civil-rights/for-individuals/race/index.html.

If you believe that you or someone else has been discriminated against because of their race, color, national origin, age, sex, or religion, or on account of their disability, please file a complaint with the HHS Office for Civil Rights at https://www.hhs.gov/civil-rights/filing-a-complaint/index.html.

Follow HHS OCR on X (formerly Twitter) at @HHSOCR.