Who was Biddy Mason? After her portrait was found in a group of Works Project Administration (WPA)-era murals slated for destruction, a flurry of media reports has fostered a growing curiosity about Mason’s place in the pages of Black history and the history of nursing.
Biddy Mason is among the figures depicted in the “History of Medicine in California,” a 10-mural series completed by Bernard Zakheim in 1938. The murals, which have long been on display at the University of California, San Francisco, are housed in a building that is going to be demolished in 2022 to make way for a new medical center. The family of the artist was told that they would need to furnish the funds required for the preservation of the murals. As UCSF and the Zakheim family battled over the cost of preserving the murals, the conflict gathered a varied group of interested parties, including Mason’s descendants Cheryl and Robynn Cox. In June, the General Services Administration entered the fray. The GSA countered UCSF’s ownership claim, insisted that the paintings be preserved and stated that “ownership of the murals resides with G.S.A., on behalf of the United States.”
The debate over the fate of the murals continues, but one happy result is that Biddy Mason’s story has emerged from obscurity. And her story is a classic American journey. Mason began life as a slave in the Deep South. She toiled in slavery on the pioneer trail before gaining her freedom. Finally, after working as a free nurse and midwife, she became a wealthy (and charitable) community leader who improved the lives of her contemporaries and later generations as well.
Born enslaved in Mississippi, Mason ultimately became the property of a Mormon convert. As she traveled west in a caravan with her owner, his family, and their enslaved laborers, she performed midwife duties, herded cattle, and cooked. The caravan ultimately made its way to California. In 1856, five years after her arrival, Nelson successfully petitioned for freedom for herself and 13 members of her family. She then moved to Los Angeles, where she worked for $2.50 a day as a midwife and nurse for Dr. John Strother Griffin, one of the first formally trained doctors in Southern California. Eventually, she set up her own business.
She never learned to read, but Mason was canny with money. She invested her earnings in property in various locations around Los Angeles and became a wealthy woman. By the time she died in 1891, Mason was a prominent philanthropist, and left her heirs an estate worth 3 million dollars. In addition to donating time and money to relieve prisoners and the impoverished, Nelson founded LA’s oldest Black church, the First African Methodist Episcopal Church, a daycare for the children of poor working mothers, and a Traveler’s Aid center. She lived until 1891.
Visit here to see a more detailed history of Biddy Mason and her place in history. For an account of the debate over the UCSF WPA murals, see this article in the New York Times.
Data from National Nurses United (NNU) suggests that while only 4% of US nurses are Filipinos, some 30% of the nearly 200 RNs who have died from COVID-19 are Filipino Americans. NNU believes that overall, nurses are primarily endangered by PPE shortages and restrictive guidelines limiting access to tests, but Filipino nurses tend to face additional risks.
The odds of being exposed to the virus tend to be higher for Filipino nurses and healthcare workers. One reason for their vulnerability is based on sheer numbers, particularly in California and New York. One fifth of California nurses are Filipino, and according to a ProPublica analysis of 2017 US Census data, 25% of the Filipinos living in New York work in the health care industry. The types of jobs they take also increase the likelihood of exposure. A 2018 Philippine Nurses Association of America survey (cited by ProPublica) found a large proportion of respondents working in bedside and critical care, and a StatNews report noted that “because they are most likely to work in acute care, medical/surgical, and ICU nursing, many ‘FilAms’ are on the front lines of care for Covid-19 patients.” The StatNews story added that Filipino frontliners often “work extra shifts to support their families and send money back to relatives in the Philippines. Those extra hours, and extra exposure to patients, mean higher risk.”
Roy Taggueg, of the Bulosan Center for Filipino Studies at University of California, Davis recently told NBC News that in addition to the low rates of testing in their communities, Filipino nurses are also more likely to reside in multi-generational households, which makes them and their families more vulnerable to the virus. He explained, “One person might be going out, but they definitely are bringing everything back with them when they come home from work, because they’re forced to work out there on the front line. We’re talking about their parents, their kids, all of that. It’s a very particular position to be in, and it’s one that I think is unique to the Filipino and Filipino American community.”
While many nurses have been speaking out about the lack of tests and inadequate PPE, Filipino nurses usually find it more comfortable to remain silent. Cris Escarrilla at the San Diego chapter of the Philippine Nurses Association of America remarked, “We don’t really complain that much. We are able to adapt and we just want to get things done.” Zenei Cortez, president of National Nurses United and the California Nurses Association acknowledged this, saying “Culturally, we don’t complain. We do not question authority. We are so passionate about our profession and what we do, sometimes to the point of forgetting about our own welfare.” However, Cortez thinks that the younger generation of Filipino nurses seem to be finding their voices: “What I am seeing now is that my colleagues who are of Filipino descent are starting to speak out. We love our jobs, but we love our families too.”
After years of failed attempts and vociferous opposition, on August 31 California lawmakers adopted a measure to grant nurse practitioners the ability to practice without doctor supervision — but only after making big concessions to the powerful doctors’ lobby, which nonetheless remains opposed.
The bill—now being considered by Gov. Gavin Newsom—is fenced in by amendments that would stringently limit how much independence nurse practitioners — nurses with advanced training and degrees — can have to practice medicine.
Lawmakers credit these compromises, like them or not, for finally allowing them to push the issue over the finish line, capping years of political scrapping and perhaps one day altering the delivery of health care in California.
“This is not an intrusion on a hallowed profession, it’s a relief,” said state Sen. John Moorlach (R-Costa Mesa), one of four Republican senators who voted for the bill. Moorlach said the measure would get more practitioners into underserved areas that don’t have enough doctors.
“It’s like the cavalry coming up over the hill to provide reinforcements to a tired army of wonderful and overworked doctors,” he said.
California is behind most other states in empowering nurse practitioners. If the bill becomes law, the state would join nearly 40 others to grant some level of independence to nurse practitioners; 22 grant full independence, according to the American Association of Nurse Practitioners. California would have among the most restrictive policies on nurse practitioner independence in the country.
“I’m not going to say I regret any of these changes,” said Assembly member Jim Wood (D-Santa Rosa), who chairs the Assembly Health Committee and authored the bill, AB-890.
Wood opposed previous attempts to remove supervision requirements.
“I wish it could be a little less strict, quite frankly,” he said, adding that this was a reasonable compromise informed by his experiences as a dentist and what he learned from other providers.
Today, nurse practitioners must enter into a written agreement with a physician to oversee their work with patients. In exchange, physicians bill them between $5,000 and $15,000 per year, according to a report by the California Health Care Foundation and the University of California-San Francisco. (California Healthline is an editorially independent service of the California Health Care Foundation.)
“Where we are with the pandemic and the craziness of the world today, it highlights why there’s a need for this,” said Andrew Acosta, a spokesperson for the California Association for Nurse Practitioners. “The doctor shortage isn’t going away anytime soon.”
Under Wood’s measure, nurse practitioners would be able to see patients in their own practice, but only after working under physician supervision for at least three years. The bill also contains many other restrictions.
Nurse practitioners argue that the measure, even with its limitations, would ease primary care shortages, especially in rural areas — a problem the pandemic has made more stark.
Opponents, primarily the powerful California Medical Association, which is the doctors’ lobbying group, counter that stripping nurse practitioners of physician oversight would lead to a lower standard of care, and that nurse practitioners wouldn’t necessarily flock to rural areas once they’re free of physician supervision.
These arguments aren’t new in Sacramento, but lawmakers and lobbyists say this version of the bill succeeded because there are new leaders at the helm of influential legislative committees who were willing to make changes, and because the pandemic has changed health care.
“I think the legislature is starting to realize decades of evidence that nurse practitioners are safe, productive providers,” said Ed Hernandez, a former legislator who was termed out in 2018 and authored the last two failed bills. “I think the policy is finally overshadowing the politics” of the California Medical Association.
Still, the biggest difference this year is the bill itself. Hernandez’s bills, introduced in 2013 and 2015, were “clean” bills that granted independence to nurse practitioners without many requirements.
There’s nothing clean about Wood’s bill, which was heavily amended in the state Senate. Instead of simply lifting the supervision requirements on nurse practitioners, the measure imposes several hoops for nurse practitioners to jump through. Before they could practice independently, nurse practitioners would have to be certified by preapproved national nursing boards, and possibly complete additional California-specific testing if accredited out of state.
Once certified, they would have to practice under physician supervision for at least three years — up to six in some cases — before they could strike out on their own. And they would have to disclose to patients that they aren’t doctors.
The bill even prescribes a Spanish phrase for “nurse practitioner”: enfermera especializada. (Technically, this refers to a female nurse. The bill doesn’t provide the equivalent phrase for a male nurse.)
That’s not even all the amendments — and the measure wouldn’t take effect until 2023.
The requirements were inserted in response to criticism from the California Medical Association that nurse practitioners are not qualified to provide patient care without physician oversight, and that patients wouldn’t understand that they’re seeing someone with less training than a doctor, lawmakers said.
Despite the numerous amendments, the association remains opposed, saying the changes don’t address their fundamental concerns.
“We’ve increased the training required for physicians over the last couple years and now all of a sudden we’re allowing unsupervised providers to treat patients who have even less training,” said association spokesperson Anthony York.
Rounds of negotiations, major concessions and hourslong Zoom calls still could not get the doctors’ group on board, Wood said.
He said it was like chasing “goalposts that continue to move.”
“It’s very disappointing when you work with opposition and nothing is ever good enough,” Wood said. “CMA will never support this bill. They’ll never go neutral on it.”
York said that characterization is not accurate. He pointed to a different bill — SB-1237 — that would allow certified nurse midwives to attend to low-risk pregnancies without physician supervision. The association was initially opposed, but after negotiations and amendments to the bill, it changed its position to neutral. That bill is also headed to Newsom.
“You don’t have to look too far to find a case where we were willing to engage on a scope-of-practice issue,” York said.
David McCuan, a political science professor at Sonoma State University, called the association’s inability to kill Wood’s bill a political “watershed moment” for the group.
“Their M.O. for 70 years has been about blocking, stunting and preventing change,” McCuan said. “The deference toward the medical profession has changed. In that sense, it would be a momentous event if this is signed.”
Though the California Association for Nurse Practitioners is celebrating legislative passage of the measure, even in its amended form, it’s a different story at the national level. Sophia Thomas, president of the American Association of Nurse Practitioners, said in a statement that the bill is choked by too much red tape to provide any meaningful change.
“California’s so-called ‘solution,’ the flawed AB-890, would establish a cascading set of new restrictions on NP practice that would maintain California’s position among the most heavily regulated and restrictive in the nation,” Thomas said.
State Sen. Richard Pan (D-Sacramento), a pediatrician who chairs the Senate Health Committee, said he also opposed the bill, but not simply because he is a doctor or a member of the California Medical Association.
Yet many of his objections reflect those of the association, such as concerns about training and access to care in rural areas.
He also believes independence for nurse practitioners could exacerbate inequalities in the health care system, as people with less means see providers with less training.
“People with more resources are going to go with the person they think is more qualified. That’s just the way it tends to happen,” Pan said.
California Healthline’s Angela Hart contributed to this report.
In an interview with Florida International University’s FIU
Magazine, alumnus Cliff Morrison recounted the battle to treat AIDS
patients with care and humanity in a time filled with widespread fear and
misconceptions about the illness.
As described in the Johnson & Johnson nursing newsletter, “the stigma around the disease wasn’t limited to the general public, it also permeated healthcare systems around the world. Many healthcare workers were afraid to touch patients diagnosed with AIDS, sometimes refusing to provide treatment. Even as more information about the virus was discovered, patients were often isolated at their last stages of life, receiving reluctant treatment by healthcare professionals who hid behind layers of protective clinical uniforms.” As a clinical nurse specialist at San Francisco General Hospital, Morrison noticed—and was disturbed by—numerous instances of mistreatment owing to ignorance about how AIDS was spread. “I began to think, there are a number of people here who agree with me—nurses that I consider my allies, doctors of infectious diseases that I had worked with. So [I thought], maybe we should have an AIDS unit,” but instead of isolating patients, Morrison’s intention was to “develop the expertise and develop a standard of care.”
So, armed with evidence-based data from University of
California-San Francisco and medical experts at San Francisco General Hospital,
in 1983 Morrison founded San Francisco General’s Ward 5B for the care of AIDS
patients. In Ward 5B, according to FIU Magazine, “Nurses embraced their
patients, held their hands and even ate lunch with them when their friends and
family had abandoned them.” As Johnson & Johnson (which sponsored a
documentary on Ward 5B) puts it, “Nurses showed that you didn’t have to hide
behind heavy clinical gear while treating AIDS patients or burn their beds when
they passed away… By pushing back against stigma, the Ward 5B nurses showed the
world the power of compassionate care and exemplified the profound impact
nurses have on transforming human health.”
Morrison continued his crusade for the humane treatment of
AIDS patients and went on to administer the Robert Wood Johnson Foundation AIDS
health services program in 12 states. He attributes his advocacy to “a
combination of things: the family values that I was taught growing up, the fact
that I grew up with a religious foundation. I went into nursing, and all of
those things complemented each other greatly. My work matched where I was as a
person, and I stayed true to myself.”
The documentary on the revolutionary ward at San Francisco
General Hospital, Ward 5B, can be viewed on a variety of video streaming
When an employee told a group of 20-somethings they needed face masks to enter his fast-food restaurant, one woman fired off a stream of expletives. “Isn’t this Orange County?” snapped a man in the group. “We don’t have to wear masks!”
The curses came as a shock, but not really a surprise, to Nilu Patel, a certified registered nurse anesthetist at nearby University of California-Irvine Medical Center, who observed the conflict while waiting for takeout. Health care workers suffer these angry encounters daily as they move between treacherous hospital settings and their communities, where mixed messaging from politicians has muddied common-sense public health precautions.
“Health care workers are scared, but we show up to work every single day,” Patel said. Wearing masks, she said, “is a very small thing to ask.”
Patel administers anesthesia to patients in the operating room, and her husband is also a health care worker. They’ve suffered sleepless nights worrying about how to keep their two young children safe and schooled at home. The small but vocal chorus of people who view face coverings as a violation of their rights makes it all worse, she said.
That resistance to the public health advice didn’t grow in a vacuum. Health care workers blame political leadership at all levels, from President Donald Trump on down, for issuing confusing and contradictory messages on wearing masks.
“Our leaders have not been pushing that this is something really serious,” said Jewell Harris Jordan, a 47-year-old registered nurse at the Kaiser Permanente Oakland Medical Center in Oakland, California. She’s distraught that some Americans see mandates for face coverings as an infringement upon their rights instead of a show of solidarity with health care workers. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)
“If you come into the hospital and you’re sick, I’m going to take care of you,” Jordan said. “But damn, you would think you would want to try to protect the people that are trying to keep you safe.”
In Orange County, where Patel works, mask orders are particularly controversial. The county’s chief health officer, Dr. Nichole Quick, resigned June 8 after being threatened for requiring residents to wear them in public. Three days later, county officials rescinded the requirement. On June 18, a few days after Patel visited the restaurant, Gov. Gavin Newsom issued a statewide mandate.
But the use of masks has become politicized. Trump’s inconsistency and nonchalance about them sowed doubt in the minds of millions who respect him, said Jordan, the Oakland nurse. That has led to a “very disheartening and really disrespectful” rejection of masks.
“They truly should have just made masks mandatory throughout the country, period,” said Jordan, 47. Out of fear of infecting her family with the virus, she hasn’t flown to see her mother or two adult children on the East Coast during the pandemic, Jordan said.
But a mandate doesn’t necessarily mean authorities have the ability or will to enforce it. In California, where the governor left enforcement up to local governments, some sheriff’s departments have said it would be inappropriate to penalize mask violations. This has prompted some health care workers to make personal appeals to the public.
After the Fresno County Sheriff-Coroner’s Office announced it didn’t have the resources to enforce Newsom’s mandate, Amy Arlund, a 45-year-old nurse at the COVID unit at the Kaiser Permanente Fresno Medical Center, took to her Facebook account to plead with friends and family about the need to wear masks.
“If I’m wrong, you wore a silly mask and you didn’t like it,” she posted on June 23. “If I’m right and you don’t wear a mask, you better pray that all the nurses aren’t already out sick or dead because people chose not to wear a mask. Please tell me my life is worth a LITTLE of your discomfort?”
To protect her family, Arlund lives in a “zone” of her house that no other member may enter. When she must interact with her 9-year-old daughter to help her with school assignments, they each wear masks and sit 3 feet apart.
Every negative interaction about masks stings in the light of her family’s sacrifices, said Arlund. She cites a woman who approached her husband at a local hardware store to say he looked “ridiculous” in the N95 mask he was wearing.
“It’s like mask-shaming, and we’re shaming in the wrong direction,” Arlund said. “He does it to protect you, you cranky hag!”
After seeing a Facebook comment alleging that face masks can cause low oxygen levels, Dr. Megan Hall decided to publish a small experiment. Hall, a pediatrician at the Conway Medical Center in Myrtle Beach, South Carolina, wore different kinds of medical masks for five minutes and then took photos of her oxygen saturation levels, as measured by her pulse oximeter. As she predicted, there was no appreciable difference in oxygen levels. She posted the photo collection on June 22, and it quickly went viral.
“Some of our officials and leaders have not taken the best precautions,” said Hall, who hopes for “a change of heart” about masks among local officials and the public. South Carolina Gov. Henry McMaster has urged residents to wear face coverings in public, but he said a statewide mandate was unenforceable.
In Florida, where Gov. Ron DeSantis has resisted calls for a statewide order on masks despite a massive surge of COVID-19 cases and hospitalizations, Cynthia Butler, 62, recently asked a young man at the register of a pet store why he wasn’t wearing a mask.
“His tone was more like, this whole mask thing is ridiculous,” said Butler, a registered nurse at Fawcett Memorial Hospital in Port Charlotte. She didn’t tell him that she had just recovered from a COVID-19 infection contracted at work. The exchange saddened her, but she hasn’t the time to lecture everyone she encounters without a mask — about three-quarters of her community, Butler estimated.
“They may think you’re stepping on their rights,” she said. “It’s not anything I want to get shot over.”
Originally published byKHN (Kaiser Health News), a nonprofit news service covering health issues. KHN is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.
Dr. Geoffrey Watson, an internal medicine specialist and a leader in managed care in Oakland, California, is the founder of The James A. Watson Wellness Center, an African-American health care center focusing on disparities in disease within the African-American community. Dr. Watson also helped to facilitate the formation of an African American Primary Care Group to serve the needs of African Americans in San Francisco’s East Bay, including the development of preventive care programs focused on hypertension, asthma, diabetes, heart disease, substance abuse, and weight control. One of his areas of concern is the treatment of foot problems associated with diabetes. Below, Dr. Watson answers some questions about diabetics as an at-risk group for COVID-19 and describes a new over-the-counter transdermal device for patients with foot issues.
1. What should patients with diabetes know about COVID-19 and how it may affect them?
Those people who are at the highest risks of contracting COVID-19, are those over the age 65, have heart disease, liver disorders, diabetes and other underlying health issues. Because it effects the immune system and compromises the body’s natural defenses fight off infections, it is critical for a person with diabetes to have good blood flow circulation, reducing the chance of infection, ulcers and in worst-case scenarios, amputations.
2. How does Circularity’s over-the-counter (OTC) transdermal device help patients with foot issues?
D’OXYVA® (deoxyhemoglobin vasodilator) is validated to significantly improve macro- and micro-circulation of blood flow and certain nerve activities in the body, which together are widely reported to form an effective non-invasive, pain-free solution option for many conditions. It provides accelerated and comprehensive wound care — plus infection protection — in a painless, affordable non-prescription solution available in a clinical setting, or in the comfort and privacy of your own home.
D’OXYVA has shown significant promise for severe cases of diabetic foot ulcers. Its therapeutic effects have circulatory and neurological benefits as well.
3. Tell us about CO2, microcirculation, and its effects on the body.
D’OXYVA uses ultra-purified carbon dioxide, which has been shown to produce higher oxygen unloading by hemoglobin, thereby increasing oxygen-rich blood flow in the local microcirculatory system. This improved dermal microcirculation leads, in turn, to enhanced wound healing.
Good blood circulation has many important health benefits. Among the most prominent is the optimal oxygenation of bodily tissues and organs, which allows for efficient functioning of the heart, lungs and muscles. Active blood circulation also improves the immune response against disease by allowing the better transportation of white blood cells throughout the body. Furthermore, proper blood circulation improves cellular detoxification, while waste removal becomes more efficient. Among its other health benefits, D’OXYVA® has been also validated as a successful means of improving the autonomic nervous system.
4. What have clinical trials shown about how this device helps patients, especially diabetics with foot problems?
Studies with D’OXYVA have shown increased oxygen concentration and lower carbon dioxide concentration in the blood just 30 minutes after treatment that can last upto 60 minutes. Over two dozen studies demonstrated convincing results at clinics and at home with no adverse events.
Many treatments make bold online claims to help cure various conditions and restore you to health — pills, shots, creams, procedures, and devices. But only science-backed, one-of-a-kind D’OXYVA stands alone, delivering the remarkable physical, mental, and emotionally rejuvenating results.
5. As an Internist focused on prevention, what do you want diabetics to know about making their foot health a priority?
The heart is the engine that makes the body function. The foot though a far distance from the heart requires consistent blood flow. It requires open pathways. If those pathways are constricted, which is fairly normal occurrence with diabetic patients, those areas have a tendency to die off, because of the poor blood circulation. That is why it is key to some type of vasodilation to promote microcirculatory blood flow to supply adequate oxygenation the the feet. There by likely helping to prevent infections, ulcers and wounds.
A native and resident of Oakland, California, Geoffrey Watson obtained a Bachelor of Science in Health Care Administration from the University of California at Davis and a medical degree from Vanderbilt University in Nashville, Tennessee. Dr. Watson completed two years of his medical residency at the Vanderbilt Medical Center with his final year of medical residency completed at the University of California Medical Center in San Francisco. In 1985, Dr. Watson started his medical career in Oakland as a specialist in the art of Internal Medicine working as a staff physician at the Arlington Medical Center alongside his father, Dr. James A. Watson.
Dr. Watson has a special interest in education and has earned the position of Director of Continuing Medical Education at Fairmont Hospital in San Leandro and Alameda County Medical Center of the East Bay. In 1992, as a Board Certified Internist, his love for teaching and medical education has earned him a position as Assistant Clinical Professor of Medicine at the U.C.S.F. Medical Center. Also in 1992, as the Co-Medical Director of the Arlington Medical Center, Dr. Watson became a key player in the Oakland community as a leader in managed care and positioned himself as a Founding Member of the Alta Bates Medical Associates. He developed medical groups, leading the way in managed care, and helped to organize a merger of prominent physicians resulting in a powerful African American Primary Care Group geared towards serving the needs of African Americans in the East Bay, including the development of preventive care programs focused in the areas of hypertension, asthma, diabetes, heart disease, substance abuse and weight control.
Dr. Watson served as the Secretary for the Sinkler Miller Medical and the Golden State Medical Associations during 1994. In May, 1997, he was inaugurated into office as President of the Golden State Medical Association and served through 1998. From 1996 through 1997 he has been honored with serving as the President of the Sinkler Miller Medical Association of the East Bay. On March 1, 1997, Dr. Watson established a new medical facility, The James A. Watson Wellness Center, a legacy of his father, moving his practice to Pill Hill and continuing to provide high quality and sensitive care to patients by treating the physical, socioeconomic, spiritual and psychological ailments and employing medical and practical solutions with hopes of resulting in complete wellness.