BILL NUMBER: S317

SPONSOR: SALAZAR
 
TITLE OF BILL:

An act to amend the public health law, in relation to requiring anti-
bias training for every medical student, medical resident and physician
assistant student in the state

 
PURPOSE OR GENERAL IDEA OF BILL:

To improve health care outcomes and care through educating medical
students about implicit and explicit biases.

 
SUMMARY OF PROVISIONS:

Section 1 amends Article 2 of the public health law by adding a new
Title 3-A, Anti-Bias Training, which contains a new Section 245, titled:
Training in bias awareness and elimination procedures.

Subdivision (a) of the new section 245 establishes the mandate that all
medical students, medical residents, and physician assistant students in
              

New York State take part in orientation programs that have been approved
by the New York State Department of Health for awareness of and the
elimination practices for both implicit and explicit biases.

Subdivision (b) of the new section 245 states that the individual must
provide documentation of having completed the training.

Subdivision (c) of the new section 245 states that the New York State
Department of Health should consult with the New York State Division of
Human Rights and the New York State Board of Medicine to develop guide-
lines for the training.

Subdivision (d) of the new section 245 states that a year after the
effective date of the law, the New York State Department of Health must
send a report to the Governor and the New York State Legislature on the
progress of these trainings.

Section 2 establishes the effective date.

 
JUSTIFICATION:

In recent years, the health care community has shifted its focus to
further address health inequity and its impact on individuals from
traditionally marginalized communities, including but not limited to
people of color, women, and the LGBTQ+ community. The COVID-19 pandemic
further illustrated these inequities. For example, a recent study
conducted in all five boroughs of New York City sought to gain under-
standing of the health care experiences of Latinx immigrant women. Four
themes were identified in this study. They were related to structural
inequities, discriminatory experiences in health care settings, victimi-
zation in public institutions, and overcoming discrimination. (1)

Additional research provides us with further information that illus-
trates these inequities:

-According to the Brookings Institution, childbirth-related deaths
disproportionately affect Black women, regardless of their income or
education. (2) See, also, Misogynoir in Medicine: How Bias in the
Medical Field Places Black Women's Lives at Risk. (3)

- A study conducted by the Center for American Progress found that 15%
of LGBTQ+ respondents, and 28% of transgender respondents avoided seek-
ing medical care when sick or injured due to previous experiences of
discrimination in a healthcare setting. Additionally, 32% of transgender
participants indicated that the healthcare provider intentionally
misgendered them, 38% indicated that the doctor was physically rough or
abusive when treating them, 34% indicated that a doctor refused to
provide healthcare related to their transition, and 49% indicated that
the doctor was visibly uncomfortable while treating them. (4)

One piece of a broader effort to address these concerns is to mandate,
early in professional training, education regarding implicit and explic-
it bias, in order to ensure these biases are not carried forward into
medical practice. See, Kenya Glover, Can You Hear Me?:  How Implicit
Bias Creates a Disparate Impact in Maternal Healthcare for Black Women,
43 Campbell L. Rev. 243 (2021) (Recommendations include early anti-bias
training for medical students.)

Currently, not all medical students in the state of New York receive
comprehensive implicit and explicit bias training, which could hamper
the goal of health equity for all. This bill mandates that all medical
students in New York State must take part in training regarding implicit
and explicit bias, so that they can be aware of and work towards reduc-
ing implicit and explicit biases. It is critical to have well-trained
and culturally competent providers who are educated about bias to ensure
the best possible treatment of all individuals, and to ensure medical
outcomes are not skewed because of bias, whether implicit or explicit.

This bill is supported by numerous advocacy organizations, including, NY
Lawyers in the Public Interest and the New Pride Agenda.

1-Damle, M., Wurtz, H., & SamaYI, G.72022) . RaciSm andheilfh care:
Experiences of latinx immigrant women in NYC during COVID-19. SSM -
Qualitative Research in Health, 2, 100094.
https://doi.org/10.1016/j.ssmqr.2022.100094

2 Young, C. L. (2022, March 9). There are clear, race-based inequalities
in health insurance and health outcomes. Brookings.  Retrieved December
16, 2022, from https://www.brookinqs.edu/articles/there-are-clear-race-
basedinequalitie s-in-health-insurance-and-health-outcomes/

3 https://oneill.law.georqetown.edu/misogynoir-in-medicine-how-bias-in-
the medical-field-places-black-womens-lives-at-risk/

4 Mahowald, L., Gruberg, S., & Halpin, J. (2022, August 22). The state
of the LGBTQ community in 2020. Center for American Progress.  Retrieved
December 16, 2022, from
https://www.americanprogress.org/article/state-lgbtq-community-2020/

 
RACIAL JUSTICE IMPACT:

This bill would enhance racial justice as there are significant racial
disparities in health care, and these disparities result in more nega-
tive health outcomes for people of color as compared with white people.
This legislation will help to reduce these disparities and improve
health outcomes by educating health care providers on their biases and
how these might impact racial disparities that exist.

 
GENDER JUSTICE IMPACT:

This bill would enhance gender justice by improving bias awareness in
medical students, whether said implicit and explicit biases impact
women, people of color, the LGBTQ community, and/or other vulnerable
members of our communities.

 
PRIOR LEGISLATIVE HISTORY:

SENATE:

2024: S319 (Salazar)- Referred to Health,Passed Senate.

2023: S319 (Salazar)- Referred to Health,Passed Senate.

2022: S3077 (Salazar)- Referred to Health

2021: S3077 (Salazar)- Referred to Health.Passed Senate.

2020: S6889 (Salazar)- Referred to Health

2019: S6889 (Salazar)- Referred to Rules

ASSEMBLY:

2023-2024: (Reyes) - Referred to Health

2021-2022: A1404 (Reyes)- Referred to Health

2020: A8741 (Reyes)- Referred to Health

2019: A8741 (Reyes)- Referred to Health

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act will take effect 180 days after enactment.