The settlement agreement promotes diversity and equity efforts and is grounded in healthcare nondiscrimination protections—both of which are under threat by the new administration.
President Trump’s executive order banning decades of diversity, equity and inclusion (DEI) practices erodes the federal government’s ability to hold hospitals accountable for their treatment of Black birthing people, and their important role in improving Black maternal health. This is especially troubling as the order comes a few weeks after the Biden Administration reached a historic settlement agreement between the United States Department of Health and Human Services, Office for Civil Rights (HHS OCR) and Cedars-Sinai Medical Center (Cedars-Sinai) in the Kira Johnson case.
In 2016, Kira Johnson tragically lost her life after giving birth to her second child through a routine C-section at Cedars-Sinai in Los Angeles. Despite concerns voiced by Kira and her family about her condition, Kira was allowed to bleed internally for more than 10 hours before the medical staff took action.
Kira should be alive today, and her two sons should have a mother. Four out of five pregnancy-related deaths are preventable. Kira was “sunshine personified,” as Charles Johnson IV, Kira’s husband, describes her. She lived quite an extraordinary life—she was fluent in five languages, had her pilot’s license, raced cars, ran marathons—and was loved beyond measure by her family.
Kira’s story is not an anomaly. Black birthing people are 3.5 times more likely to die from a pregnancy-related cause than white women, regardless of education or income.
Six years after Kira’s death, in response to a complaint filed by Charles Johnson IV, the Biden Administration launched a civil rights investigation into Cedars-Sinai’s treatment of Black birthing people, to ensure the hospital’s compliance with Title VI of the Civil Rights Act of 1964 (Title VI) and Section 1557 of the Patient Protection and Affordable Care Act (Section 1557). The 2024 final rule on Section 1557 prohibits discrimination in health care, including obstetric violence.
While Cedars-Sinai was not found in violation of either civil rights statute, they entered a resolution agreement with HHS on Jan. 16, 2025, to take significant steps toward ensuring all families receive respectful and high-quality maternity care.
Under the agreement, Cedars-Sinai will:
- Provide training on the hospital’s obstetric hemorrhage management policy and create a pain management protocol for assessing and managing acute pain for birthing patients;
- Update guidelines for trial of labor after cesarean delivery and continue to track the vaginal birth after cesarean section success rate;
- Administer an online bias reporting tool to document incidents of bias or suspected bias experienced by patients and the public;
- Require staff to complete respectful care trainings; and
- Develop and implement a program to provide doula resources to patients.
The settlement agreement promotes diversity and equity efforts and is grounded in healthcare nondiscrimination protections—both of which are under threat by the new administration.
Despite hostility or disinterest from the current Administration, Cedars-Sinai has an important opportunity to build trust with Black birthing people and families in Los Angeles by still implementing the measures in the agreement. Doing so is an essential step in being accountable and transparent with the community about their treatment of Black birthing people. Cedars-Sinai can lead by example in best maternity care practices, as the actions outlined in the agreement can be pursued by any hospital system seeking to build a safer and more dignified maternity care system.
Here are some resources if you want to learn more about Kira’s case and Black maternal healthcare:
- Kira Johnson’s Story
- 4 Kira 4 Moms
- The Momnibus: Kira Johnson Act
- Resolution Agreement Between the HHS OCR and Cedars-Sinai Medical Center
- Section 1557 Final Rule: Non-Discrimination in Health Programs and Activities
- Irth App—provides “prenatal, birthing, postpartum and pediatric reviews of care from other Black and brown women.”
