New data tells an old story of disparities in health care.

Despite awareness in the health care industry and the government of longstanding differences in medical care along racial lines, three studies in the August 18, 2005, edition of the New England Journal of Medicine demonstrate that gaps still exist between the quality of health care that African-Americans receive and the quality of care afforded to white Americans.

The first study, examining gender and racial differences among almost 600,000 patients in the treatment of heart attacks from 1994 through 2002, showed that compared with white men, African-American men and women received less care, with African-American women having the highest death rate. No change in these differences was observed over the period studied.

The second study examined data on the rate, by race, that nine major surgical procedures were performed on 27 million Medicare recipients from 1992 through 2001. The operations studied are common and remedy a broad array of conditions, including heart disease and aneurysms.

In 1992, whites had these procedures performed at higher rates than African-Americans. The researchers discovered that by 2001, that gap had widened for five of the procedures, remained unchanged for three, and narrowed for one. By studying rates for three procedures according to geographic region, the researchers also found that in no area was the discrepancy eliminated.

Only the third study, which looked at quality of care from 1997 to 2003 for thousands of participants in 183 Medicare managed-care plans, found a decline in racial disparities in care.

For Stephanie O'Connor, a nurse and medical malpractice lawyer in New York City, the studies' conclusions are not surprising.

"I don't have anything but anecdotal evidence through my work representing people of color," she said. "I can only tell you that more of the claims that I'm lodging or being presented with by African-Americans tend to be neglect and failure to respond by health care practitioners, as opposed to an outright act of malpractice like cutting off the wrong leg. For most of the white people I see, they have health care, they have a procedure, and something has gone wrong in the process. That's not the case for the African-Americans I see."

But, said O'Connor, racial disparities in health care generally are not a basis for an independent cause of action. Rather, she said, "it's another spin on neglect, with its roots in racism. When such cases are litigated, it is in the context of medical negligence because the Hippocratic oath doesn't draw a distinction between white people and people of color."

Considerable evidence shows disparities in many aspects of health care. For instance, a February report by the American Lung Association concluded that minorities suffer more respiratory ailments than white people, while a December 2004 study from the American Journal of Public Health showed that making the mortality rate of African-Americans the same as that of whites would save five times more lives than technological advances alone would.

A survey published in March in the American Heart Association journal Circulation demonstrated that only one-third of cardiologists surveyed believed that disparities in health care exist along racial and ethnic lines.

Having adjusted their data to take into account differences in eligibility for the study and contraindications for treatment, the authors of the first study in the August New England Journal of Medicine were unable to pinpoint the reasons for the disparities they observed. They speculated that an "unmeasured" characteristic might be at work, such as the greater likelihood--borne out by a 2004 study in the same journal--that an African-American patient would be treated by a doctor with fewer qualifications and less access to specialists than a doctor treating a white person.

New York City lawyer Susan Karten often handles medical malpractice cases that highlight such disparities. In one, an African-American woman, solicited by a breast cancer clinic that ran ads aimed at minorities, had a series of mammograms taken there. (Fagan v. Mem'l Hosp. for Cancer & Allied Diseases, No. 27824/03 (N.Y., Bronx County Sup. Ct. filed Dec. 11, 2003).) She alleged that even though these mammograms showed early signs of cancer, they were ignored and not properly followed up. Her cancer remained undiagnosed and untreated until she went to another hospital years later. By that time, she required a double mastectomy and chemotherapy.

Though the plaintiff later died from the disease, the case is ongoing. Karten said that a white woman's care and treatment likely would have been different, and she would have received more timely intervention.

Some health care disparities related to sex arise from clinical trials having fewer women than men, said Susan Dennehy, a New York City medical malpractice lawyer.

"There are actually some decent reasons for that," she said, noting concerns about testing drugs potentially harmful to fetuses on women of child-bearing age. "But the fact is that women's bodies are different than men's, and drug doses are pegged to men's size."

In general, said Dennehy, "not everyone enjoys the same standard of care, and black women in cardiovascular matters really get the least attention. They're more likely to be sent home, misdiagnosed, or told to wait in the waiting room."

O'Connor recently settled a case brought by an African-American woman who developed a fatal reaction to medication she was given for headaches and seizures. The lawsuit claimed the hospital failed to properly diagnose and treat the symptoms of that reaction. (Deveaux v. Woodhull Med. & Mental Health Ctr., No. 34142/02 (N.Y., Kings County Sup. Ct. filed Aug. 26, 2002).)

"Why would a health care provider be less responsive to someone? I don't know the answer to that," O'Connor said. "In this case, my client presented repeatedly to the emergency room. There is no explanation for why she was sent home repeatedly. Why didn't they pay attention to her complaints? I just have a feeling that if she had been a middle-class white woman like me, she would have gotten better attention."

"Often change comes about because lawyers make it financially unfeasible to continue these practices," said Dennehy. "Maybe that's part of the solution, because doctors have written about these inequities endlessly."