At the start of a critical election year, in which health care was expected to be hotly debated, Lizzie Presser decided to try to understand what was wrong with the system through the prism of one disease; diabetes was preventable, yet ubiquitous and deadly. Though researchers had made great strides in diabetes care, innovations weren’t reaching those who needed them most; it was disabling and killing poor Americans at startling rates, and in particular, Black Americans. She took a statistic known in the medical community – Black Americans are three times more likely than others to suffer diabetic amputations – and sought to understand how and why this came to be.
In a riveting, high-stakes narrative, she examined the mechanics of the healthcare system that got us here, from government-mandated reimbursements, to screening protocols, to how vascular imaging is withheld from the most vulnerable patients. Her painstaking reporting allowed her to pick apart a problem that felt, to many, too big or intractable to face, and put its causes and consequences in stark relief. Diabetics were being denied screenings that could’ve saved their limbs. Surgeons were being incentivized to cut off feet and legs without the proper diagnostic imaging. Presser found that doctors across the country were shirking professional guidelines and resorting to an “amputation-first” strategy for patients with non-healing wounds, rather than considering amputation as a last resort. Mapped out, it was the Southern diabetes belt where patients were least likely to get the recommended endovascular care before amputation. When she dug deeper, she discovered how a government task force’s decision not to endorse reimbursements for vascular disease screenings were leaving tens of thousands of people undiagnosed, unmedicated, and at risk of amputation.
Presser applied her experience as a narrative investigative journalist to push her immersive reporting beyond scene-gathering into an on-the-ground tale of accountability. She wanted to embed with Dr. Foluso Fakorede, a Black cardiologist in Mississippi crusading to reduce amputations. He rejected her appeals several times, but she persisted, showing up on his doorstep. Shadowing him for a month allowed her to bear witness as flawed policies and practices exacted catastrophes on people’s lives. She was there when Henry Dotstry was scheduled to have his leg needlessly amputated. It was the only one he had left. Fakorede recognized that more than a limb was at stake; diabetic amputees are likely to be dead within five years of surgery. She watched as Fakorede acted against the hospital to run imaging tests of his patient’s arteries and opened up his clogged vessels to avert an amputation.
She did her reporting in January, but we held the story as Presser contributed to coronavirus coverage. We published it in May, just as the racial disparities of COVID-19 were becoming apparent, along with the devastating toll on diabetics: they made up 40% of those dying from the virus. As politicians separated Americans into those with “underlying conditions” and everyone else, dismissing comorbidities as a subject of personal responsibility, Presser’s story injected a new layer of understanding – and accountability – into the idea that comorbidities, and the nation’s response to them, were fueling the disparate outcomes from COVID-19.