Nearly 9 years after a Black mother's death at Cedars-Sinai, advocates say they haven't seen enough change

Just hours after the birth of their second child, Charles Johnson lost his wife Kira at Cedars-Sinai Medical Center in west Los Angeles.

Kira Johnson was a healthy 39-year old Black woman. Her C-section took just 17 minutes. But more than 10 hours later, she died after waiting for treatment that came too late for internal bleeding, according to Charles Johnson and a civil rights lawsuit filed in the aftermath.

After his wife's death, Charles Johnson had a painful revelation when he began to learn about the Black maternal mortality crisis and that Black patients are three times more likely to die due to pregnancy-related issues than white patients.

" I couldn't understand why we begged and pleaded for hours for them to do something and nobody did anything," Johnson said.

"When I really got to see the data [I was] like, oh my God, this is what happened," he added. "The greatest risk factor was not Kira's race — it was racism."

That was 2016. But it was just last month that Cedars-Sinai resolved a federal investigation into its treatment of Black patients and other patients of color by coming to an agreement with the Department of Health and Human Services Office for Civil Rights.

But some advocates for Black maternal health — including Charles Johnson — say that agreement doesn't go far enough. Later this week, they plan on demonstrating outside of the hospital to say so.

Federal investigation found 'concerns' with Cedars-Sinai care

In November, the HHS Office for Civil Rights sent a letter to the medical center. It raised "concerns that a lower standard of care is provided to Black patients compared to their white counterparts," particularly during and before obstetric hemorrhage, “which results in the risk of higher rates of adverse maternal health outcomes for Black patients.”

That letter, provided to LAist by Charles Johnson, did not include any final determinations. But it did lay out "evidence that may be indicative of noncompliance" with federal anti-discrimination laws.

In January, the federal civil rights agency and Cedars-Sinai came to an agreement that resolves the investigation, while not constituting "an admission of liability" from Cedars-Sinai.

Among other items, it requires the medical center to work with and report to the Office for Civil Rights on its obligations.

What was in the Cedars-Sinai agreement?

The voluntary agreement laid out multiple obligations for Cedars, including:

• Staff training on hemorrhaging management policy.
• Submission of a protocol for assessing and managing acute pain of birthing patients.
• Update of early maternal warning systems for pregnant women developing critical illness.
• Training on federal nondiscrimination requirements.
• Development of a tool for reporting bias in treatment, with findings made public annually.
• Development of a program to support patients' access to doulas.

A spokesperson for Cedars-Sinai said the medical center had offered to meet with Johnson's organization, 4Kira4Moms.

"The recent agreement with the Office of Civil Rights demonstrates our continued commitment to ensuring safe and equitable outcomes through education, accountability and rigorous quality initiatives aimed at addressing disparities in maternal health," the spokesperson said in an email. "We have embraced the opportunity to partner with the Office to strengthen our longstanding dedication to equity for all those who entrust us with their care."

What are other demands?

But 4Kira4Moms says Cedars needs more external monitoring.

 "One of the challenges that we see with medical systems around the country is that they are attempting to police themselves, and it's a fool's errand," Johnson said.

That's why Johnson's group wants the medical center to agree to a series of additional demands, including issuing a statement acknowledging "systemic failures in maternal healthcare," establishing an independent oversight board to investigate racial inequities, and making its Office of Patient Advocacy independent.

" We need an independent review of, particularly, deaths, to make sure that problems are being identified and solutions are being recommended to the hospital that can't be watered down by internal considerations," said Carmen Balber with the advocacy group Consumer Watchdog, which has joined the effort to pressure Cedars-Sinai.

Charles Johnson also said he wants more transparency around how Cedars-Sinai will implement its obligations.

"There's a commitment to a doula program, but that has no parameters of who has access to these doulas," he said. "Who are they for? Who is helping orchestrate them? What credentials do they have?"

The medical center's spokesperson pointed to a number of efforts to address alleged bias in healthcare at Cedars over the past decade, including creating an anonymous online tool to report suspected bias during labor and delivery and implementing mandatory unconscious bias training.

Fate of the HHS Office for Civil Rights uncertain

The Department of Health and Human Services that signed an agreement with Cedars-Sinai last month already looks very different under the new administration of President Donald Trump.

Last week, Robert F. Kennedy was confirmed as Health Secretary and there's a new acting director of the HHS Office for Civil Rights, Anthony Archeval. Trump's administration has ordered the shut down of programs advancing equity, leading some advocates to wonder if the new office will prioritize enforcing the agreement with Cedars-Sinai.

"In addition to holding Cedars-Sinai accountable with this protest, we are also calling on the Trump administration to continue to fund and support the [Office for Civil Rights]," Johnson said.

In Trump's transition to power, the government website reproductiverights.gov went dark. And the Centers for Disease Control and Prevention failed to publish its weekly report on morbidity and mortality for the first time in decades. (Weekly reports have been published again in February.)

" The Office [for] Civil Rights is there specifically to make sure that people are protected,  and have a place to go when they feel like laws related to discrimination are being violated," said Regina Davis Moss, president of In Our Own Voice: National Black Women’s Reproductive Justice Agenda. " We want to see that funded."