Background: Studies have shown that Black patients die more frequently following coronary artery bypass grafting than their White counterparts for reasons not fully explained by disease severity or comorbidity. To examine whether provider care team segregation within hospitals contributes to this inequity, we analyzed national Medicare data. Methods: Using national Medicare data, we identified beneficiaries who underwent coronary artery bypass grafting at hospitals where this procedure was performed on at least 10 Black and 10 White patients between 2008 and 2014 (n=12 646). After determining the providers who participated in their perioperative care, we examined the extent to which Black and White patients were cared for by unique networks of provider care teams within the same hospital. We then evaluated whether a lack of overlap in composition of the provider care teams treating Black versus White patients (ie, high segregation) was associated with higher 90-day operative mortality among Black patients. Results: The median level of provider care team segregation was high (0.89) but varied across hospitals (interquartile range, 0.85–0.90). On multivariable analysis, after controlling for patient-, hospital-, and community-level differences, mortality rates for White patients were comparable at hospitals with high and low levels of provider care segregation (5.4% [95% CI, 4.7%–6.1%] versus 5.8% [95% CI, 4.7%–7.0%], respectively; P =0.601), while Black patients treated at high-segregation hospitals had significantly higher mortality than those treated at low-segregation hospitals (8.3% [95% CI, 5.4%–12.4%] versus 3.3% [95% CI, 2.0%–5.4%], respectively; P =0.017). The difference in mortality rates for Black and White patients treated at low-segregation hospitals was nonsignificant (−2.5%; P =0.098). Conclusions: Black patients who undergo coronary artery bypass grafting at a hospital with a higher level of provider care team segregation die more frequently after surgery than Black patients treated at a hospital with a lower level.

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Accusations of hypocrisy in law and politics typically invoke hypocrisy as a personal failing. This locution misses the much more dangerous way laws and legal institutions themselves can be hypocritical. Hypocrisy can be equally revealed when an institution not only deceives another but acts against its avowed values or does not act in ways required by the values professed. Thus, legal actors, institutions, and norms can, in their institutional role, act against the values they avow, displaying legal hypocrisy. By avowing attractive values while acting in ways that undermine those values, laws and legal institutions victimize citizens to achieve goals that could not be openly justified. In doing so, hypocritical laws not only harm their victims but, by obscuring the injury, undermine the victim’s ability to call the law into account. Hypocrisy is important to highlight precisely because it suffocates the voice of its victims. Because hypocrisy takes advantage of a person while only pretending to justify one’s actions, hypocrisy not only harms citizens but treats them with a form of contempt. The vicious irony is that hypocrisy in the law not only harms its “direct victims” but ultimately undermines the very rule of law.

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