Masai Ujiri Could Be Charged in Altercation After Raptors’ Title Win, Authorities Say

Masai Ujiri, the president of basketball operations and general manager of the Toronto Raptors, may be charged with assault after an altercation with a California sheriff’s deputy late Thursday, shortly after his team won Game 6 of the N.B.A. finals, the authorities said on Friday.

The Alameda County Sheriff’s Office said that it would pursue misdemeanor assault charges against Mr. Ujiri, one of the N.B.A.’s most celebrated front-office executives.

The incident is said to have occurred at Oracle Arena in Oakland, Calif., moments after the Raptors defeated the Golden State Warriors to give Canada its first N.B.A. championship.

Mr. Ujiri made his way to the court to join the celebrating team, but an Alameda County sheriff’s deputy stopped him because he did not have the proper credentials, said Sgt. Ray Kelly, a spokesman for the sheriff’s office.

The deputy was not aware that Mr. Ujiri was a high-ranking team executive until after the altercation, Sergeant Kelly said.

The sheriff’s office said that Mr. Ujiri tried to push the deputy out of the way. After several shoves back and forth, Mr. Ujiri struck the deputy’s face, according to Sergeant Kelly.

At that point, several others pulled Mr. Ujiri away from the deputy and onto the court.

Journalists posted videos that caught the end of the incident, showing a man pleading with deputies to allow Mr. Ujiri to pass.

Mr. Ujiri was not arrested at the arena. “Instead of creating a more significant incident at this international postgame event, we decided to take the high road and cease and desist,” Sergeant Kelly said.

“What we’re now doing is compiling witness statements and video body cam evidence to submit to the D.A. next week for review,” he added. “It’s up to the D.A. to file charges for misdemeanor assault on a police officer.”

Greg Wiener, a 61-year-old Warriors fan and season ticket holder, told The Associated Press that he witnessed the encounter and did not see Mr. Ujiri strike the deputy in the face. Mr. Wiener said the deputy did not ask for credentials before putting his hand on Mr. Ujiri’s chest and pushing him, at which point Mr. Ujiri shoved back before bystanders intervened, The A.P. reported.

Sergeant Kelly said that security had been heightened because it was the Warriors’ last game at Oracle Arena before the team moves to San Francisco.

“We were told by the N.B.A. and security officials to strictly enforce the credential policy,” Sergeant Kelly said.

The Raptors’ path to the championship was largely orchestrated by Mr. Ujiri, who is Nigerian and one of the few black general managers in a league dominated by black players but largely controlled by white team owners and front-office executives. Mr. Ujiri won the N.B.A.’s executive of the year award in 2013 when he was with the Denver Nuggets.

“We are in contact with the Raptors and local authorities and in the process of gathering more information,” Michael Bass, an N.B.A. spokesman, said on Friday.

The Raptors could not be reached for comment. The Oakland Police Department said it was also investigating the matter.

Can This Man Keep the A’s in Oakland?

“Dave! Dave! Dave!” the women shouted, eyes wide with surprise. They were high in the stands at the Coliseum when they came upon Dave Kaval, president of the Oakland Athletics, who was mountaineering up, step by step, from field level to the nosebleeds.

“We’re behind you, Dave, 100 percent!” someone yelled from the seats.

Below, the A’s were battling the Los Angeles Angels, but Kaval was missing most of it. Instead, wearing a gray suit and a green tie, he was greeting fans, one by one, in his tired, dog-eared stadium. He was like a political candidate on a hot streak. Some fans shrieked when they saw him. Others stood, dumbstruck. He gushed over babies, posed for photos and heard stories about the Athletics’ glorious past.

He shared tales of his own, about how he had grown up in Cleveland, a die-hard devotee of the 1980s Browns, and how devastated he felt when the Browns decamped for Baltimore in the ’90s. He wasn’t going to let that happen in Oakland.

“Thank you, thank you, from the bottom of my heart,” said a woman wearing an A’s cap. Tears welled in her eyes. “We hope you can save our team.”

Can he?


The Coliseum has been home to the A’s since 1968.CreditCayce Clifford for The New York Times

Kaval thinks it’s crucial to mothball the Coliseum. Built in the mid-1960s in an impoverished neighborhood of East Oakland, the amphitheater was considered a jewel and served as the home of the A’s and the Oakland Raiders.

But the Coliseum is now a relic. Its stern, utilitarian architecture is long out of date. In recent years, it has become as well-known for raw sewage leaks as it has for its legendary games. The Raiders will soon be playing in Las Vegas, and the Warriors will abandon their arena next door when the N.B.A. playoffs are over, heading off to glitzy new digs in San Francisco.

For much of two decades, the A’s have flirted with uprooting to another city. But then, in 2016, as Kaval took the helm, the interest in fleeing Oakland ended. “The team has had very serious near-death experiences in the past, what with all the talk about going somewhere else,” Kaval said. “But we don’t see Oakland as a liability. We see it as a strength.”

First, he tried to move the A’s to a site near Oakland’s Chinatown. The attempt was scuttled last year after loud opposition from the neighborhood. Now, he wants to construct the stadium on an asphalt-topped stretch of the Port of Oakland known as Howard Terminal, and start playing there in 2023.

Beyond a new stadium, he intends to build housing for businesses and thousands of people both on the property surrounding the old Coliseum and at Howard Terminal, making the A’s the biggest land developer in major league history.

His intense and omnipresent advocacy of the A’s, of staying in town and building at Howard Terminal, has made Kaval the face of the franchise — not the slugger Khris Davis, who has hit more than 200 home runs in his major league career, or even Billy Beane, the A’s vice president of operations and the star of “Moneyball,” the book and the movie.


Kaval, in the stands at the Coliseum on opening day, has become the face of the franchise with his enthusiastic push for the stadium project. CreditCayce Clifford for The New York Times

On television, social media, in newspapers; at hundreds of hearings, community meetings, and private talks with politicians; even in the bleachers during baseball games, there is Kaval, lionizing Howard Terminal. Such campaigning is exceedingly rare for a team president in the staid major leagues. He is “unique in the game,” Beane said.

Kaval engages politicians who don’t trust his plans, agencies that must approve them, activists who say he is trying to dodge environmental regulations, trade groups and union members who expect his ballpark to cost waterfront jobs. He meets leaders in East Oakland, where he is leaving, and others in West Oakland, where he wants to build, who fear the impact on African-American and Latino neighborhoods. He even contends with ship captains, who say light from the new stadium might blind their pilots as they navigate the harbor.

Plenty of hurdles remain. A key, final review of the project’s environmental impact won’t be done for months. Kaval must continue persuading the state legislature, land use commissions and the Port of Oakland to give the project the green light. And early next year, Oakland’s City Council is slated to take a final vote on the waterfront plan.

“You can’t have doubt,” he said. “Changing the status quo is not easy. People resist it, and you need to have perseverance and resiliency.”

At 43, Kaval is one of the youngest team presidents in Major League Baseball. He is arguably the most dynamic. For the A’s, Beane continues to oversee the on-field product: trades, contracts, draft picks and the like. Kaval handles everything else.

Most club presidents come up through the ranks, Beane said, often from the finance department or baseball operations on a big league team. “But Dave didn’t come up that way,” he added. “He comes up from an entrepreneurial background. It gives him a different way of seeing things.”

Kaval’s baseball experience comes straight out of Stanford’s business school, where he and a classmate drew up an against-all-odds idea to start their own minor league, which they got off the ground not long after graduation: the Golden Baseball League.

To fill the stands, he provided the last-gasp professional stops for Jose Canseco and Rickey Henderson, rented a crop duster to drop 5,000 $100 bills on fans of the Yuma Scorpions and hired a female knuckleballer to start for the Chico Outlaws.


Kaval greeted the A’s legend Rickey Henderson, who once played in Kaval’s short-lived Golden Baseball League.CreditCayce Clifford for The New York Times

The Golden Baseball League wasn’t affiliated with the majors, and it fizzled after six seasons. Kaval’s next stop was San Jose, where he ran Major League Soccer’s Earthquakes, guiding the construction of an 18,000-seat stadium for the team.

But baseball was always his passion, and he is now running the A’s with the creative moxie that he honed in his minor league. Last year, when the A’s celebrated their 50th season in Oakland, they hosted the White Sox — and every ticket was free. Each week, Kaval holds office hours for A’s fans, who ply him with ideas. Their suggestions have led to new lounges, new seats for families, new food trucks and a new spring training logo.

But these pale against what he wants to do with the old Coliseum property and the new stadium at Howard Terminal. The stakes are high. If his plan succeeds, the A’s will stay put for the long haul. “Rooted in Oakland” is a phrase Kaval repeats with great constancy. It is also on A’s billboards all over town.

But if the grand plan fails?

On a recent sunny afternoon, Kaval walked briskly through Jack London Square, a waterfront district filled with apartments, bars and restaurants near downtown Oakland.

He stopped. “The stadium will be right there!” He pointed just north, a few dozen yards away, to a 50-acre stretch of asphalt. “Beautiful!”

Howard Terminal doesn’t look beautiful right now. It’s a parking lot filled with semitrailer trucks and shipping containers. The land is lined at the water’s edge by towers for cranes that once loaded and unloaded vessels.

On one side is Jack London Square. On another is West Oakland, one of the city’s long-suffering, predominantly African-American neighborhoods. On another is one of the nation’s busiest anchorages. A next-door neighbor for Kaval’s proposed stadium is a recycling plant, fronted by a massive pile of metal scraps. The plant rattles and clanks. Last year it caught fire.

On a nearby street are train tracks, bustling with Amtrak, commuter and freight cars — potential hazards for auto traffic and pedestrians.

Around his new ballpark, Kaval would develop 3,000 townhouses and attendant businesses, including units for low-income tenants. At the old Coliseum and Oracle Arena site, he is poised to bid up to $165 million of the A’s money to buy the entire parcel, and then add 3,000 townhomes, low-income units and business space.


The A’s have struggled to draw fans to the expansive Coliseum, but Kaval wants to use the site to build a great deal of new housing.CreditCayce Clifford for The New York Times

Kaval won’t say how much the entire plan would cost, or what it might cost the city to improve nearby streets and infrastructure. But the team has vowed to build with private financing; Oakland, strapped for cash, refuses to fund a new complex for any team.

The Howard Terminal stadium, he said, would hold about 35,000 fans. It would have a landscaped rooftop park, open even when there were no games.

The plan would “activate” the often-sleepy waterfront, he said, by drawing people to games and attracting new residents. He has an unyielding optimism and a salesman’s zeal. But not everybody is buying.

“This is a land grab,” said L.J. Jennings, pastor of the Kingdom Builders Christian Fellowship in East Oakland, where the Coliseum has reigned for decades. Voicing a commonly heard concern, he worries that Kaval and the A’s will not keep their promise to redo the Coliseum grounds. And if they do, he fears they won’t do it right.

Pastor Jennings said he thought Kaval’s development might drive up rents and push residents out of one of Oakland’s poorest neighborhoods. “The end result,” he said, “will be to force black and brown people out of the city.”

There is concern in West Oakland, as well. Both East and West Oakland are emerging from years of neglect. They’ve weathered drug wars, a crack epidemic and the effects of deadly pollution. In both neighborhoods, Kaval’s grand plan has stoked not only great optimism, but also distrust.

Mike Jacob, vice president for the Pacific Merchant Shipping Association, a trade group that represents maritime business at the port, said Howard Terminal was “a terrible location to build a ballpark.” Jacob said the new stadium would “hamper the port and cost thousands of working people their jobs.”

To which Kaval responds that Oakland’s mayor, Libby Schaaf — a critic of spending taxpayer dollars on the construction of stadiums for professional sports — is working alongside him because she knows his plan will be good for the entire city. Naysayers, he says, will soon agree.


Kaval watched some of the A’s opener with fans. “Changing the status quo is not easy,” he said. CreditCayce Clifford for The New York Times

The A’s, he says, can clean up the toxic waste and be environmental stewards. They can find a solution to the scrap metal and noise at the recycler, maybe by walling it off.

As for the ship captains, the drivers and pedestrians needing to cross rail tracks to get to the game, Kaval says the stadium will be designed to ensure their safety.

None of this will be easy.

And behind all of this exists the primary question: What if he can’t pull it off?

What will the A’s do then?

That is the question all of Oakland is asking. Its football and basketball teams are just about gone.

This is a city in fear of the last shoe falling.

“We’re focused on making Howard Terminal happen,” Kaval said. “That’s all. There is no Plan B.”

The End of the Warriors as We Know Them

CreditCreditJim Wilson/The New York Times

May 10, 2019

OAKLAND, Calif. — There was a game at Oracle Arena, the clunky old building that squats tight to the old erector-set of a coliseum, two time capsules next to a freeway. Inside, the lights glared and the scoreboard flashed, and the sellout crowd roared for another runaway victory by the Golden State Warriors.

A day later, there was a tour of the team’s new home in San Francisco, Chase Center, its swirling facade wedged into the cocoon of glassy new skyscrapers. Inside, the light was cavelike dim and hard hats were mandatory. The few installed seats were covered in protective plastic, and the only sounds were the beeps, whirs and bangs of construction equipment.

“We’re not leaving a city,” the Warriors team president Rick Welts told reporters invited along. “Just a building.”

The Warriors, two-time defending N.B.A. champions, winners of three of the last four titles, are paddling for one more in Oakland against an undercurrent of change and the foreboding sense that these good old days are ending.

All dynasties fade, even those — especially those, maybe — building new temples for themselves.

The Warriors lead the Houston Rockets, 3-2, in a best-of-seven second-round playoff series heading to Game 6 on Friday night. They will be without the injured star Kevin Durant, who may or may not stay with the team in this summer’s trading. If the series goes to a seventh and deciding game, it could be the last at Oracle Arena, the Warriors’ home for nearly five decades.

The Warriors’ move after this season comes amid concerns about an aging roster, the future contract status of Durant and others, and creaks in the team’s run of exuberant dominance. Most meaningfully, the Warriors are wading through the churning gulf between Oakland and San Francisco.

Between one night’s game at Oracle Arena this spring and the next afternoon’s tour at Chase Center, the distance felt far wider than the 10 miles or so across the bay, as the sea gull flies, or the 16 miles and $7 toll through the knots of traffic across the Bay Bridge.

The Warriors, understandably, want people to think that location does not matter. They will always be the Bay Area’s team, they say.

But it does matter. Of course it matters. And it matters most to Oakland, where the Warriors have played for 47 seasons.


Fans brought their typical exuberance to Wednesday’s game at Oracle Arena. The Warriors won 104-99. CreditJim Wilson/The New York Times

“They can spin it any way they want, wrap it in any wrapping paper they want, but when there has been an intimate relationship for years, and then you move, it changes everything,” said Paul Brekke-Miesner, author of “Home Field Advantage: Oakland, CA, The City that Changed the Face of Sports” and a lifelong Oakland resident.

“Ten miles, 20 miles — the bay might as well be 1,000 miles.”

Can something move and remain the same? Can anything be replanted without changing the landscape?

No place tries like California, a mind-set as much as a place. California always leans toward reinvention. It is closer to the future than anywhere else. Nothing feels permanent, even without earthquakes and fires. So it is with the Warriors.

It is so California to come up with something cool and coveted, and at its peak try to lift it to something bigger and better, risking all that made it cool in the first place.

It is why In-N-Out Burger expanded to Texas, why Levi’s made Dockers, why skateboarding is joining the Olympics.

Will Apple, with origins in a suburban garage, ever be as loved as it was before it grew big enough to build a $5 billion headquarters that looks like a spaceship? Will the San Francisco skyline ever be as beautiful as it was before the Salesforce Tower rose like a middle finger to the city’s low-slung aesthetic, amid a rising fist of preening (and leaning) towers?

The Warriors did not need to leave the grit of Oakland for the gloss of San Francisco. They chose to do so. Like most franchise leaps to new homes, it is a move borne of vanity, dressed as necessity.

What will Oakland lose when the Warriors move to San Francisco?

“I’ll answer it with a question,” Brekke-Miesner said. “What will the Warriors lose?”


The Warriors’ new home, Chase Center in San Francisco, is a $1.3 billion bet that old fans will join new ones.CreditJim Wilson/The New York Times

The franchise worries about any perception that it is abandoning Oakland. It says that roughly 70 percent of current season-ticket holders have bought into the new building, which is privately financed on private land, despite price increases and expensive seat licenses.

“Substantially we are keeping the same crowd,” Welts argued. It will take until next season to figure out how much the remaining 30 percent is missed, or what and where it represented.

At the regular-season finale on April 7, the team celebrated its Oakland heritage. Former stars like Rick Barry and Sleepy Floyd were on hand. The Oakland Symphony performed during a historical montage. After the game, the team raised a banner to the Oracle Arena rafters that read, “Oakland, California, 47 Seasons.” It, too, will move to Chase Center.

To help keep a physical presence in the East Bay, the Warriors will convert their downtown Oakland headquarters and practice facility into a community center. It will house nonprofit organizations and youth basketball camps.

“You heard it here first: The Warriors are not leaving Oakland!” Mayor Libby Schaaf said at a March ceremony.

Maybe Oakland already lost them — to success. For most of five decades, the Warriors were habitual losers loved only by the most faithful, an alliance of geography.

These days, you can find someone wearing a Warriors logo in any city in the world.

“There’s nothing particularly unique about being a Warriors fan — they’re not the town’s team anymore,” said Liam O’Donoghue, whose podcast, East Bay Yesterday, explores culture in and around Oakland. “They’re, like, the world’s team. I don’t know if that makes them less cool. But it makes them less Oakland.”


They were never the Oakland Warriors. But the team developed a strong bond with the city.CreditJim Wilson/The New York Times

By this time next year, there will be one main franchise left in Oakland: Major League Baseball’s Athletics, who, after decades of unrealized wanderlust, will stay behind, with plans to build anew on the Oakland waterfront. The N.F.L.’s Raiders are headed to Las Vegas.

Of course, Oakland would love to keep its teams, but not at the financial and moral costs of today. The corporate and gentrified world of professional sports no longer fits neatly in places as diverse and independent as Oakland.

N.B.A. revenues topped $8 billion last year, according to Forbes, and the Warriors are worth $3.5 billion — more than seven times the $450 million that a group led by Joe Lacob and Peter Gruber paid in 2010. Perhaps a move to a $1.3 billion arena in San Francisco is fitting, considering it has more billionaires per capita than any city.

Not so fast, said Pendarvis Harshaw, an author and public-radio arts columnist raised and living in Oakland.

“The N.B.A. tries to sell cool, sell hip, sell urban,” Harshaw said. “The N.B.A. tries to sell Oakland.”

Oakland has a rich history of producing artists and athletes, including basketball players like Bill Russell, Paul Silas, Jason Kidd and Gary Payton.

True adoration is reserved for the ones who stay true to their Oakland roots. It is why M.C. Hammer, Rickey Henderson, Marshawn Lynch and Damian Lillard of the Portland Trail Blazers, a Warriors’ rival, remain so popular. The film director Ryan Coogler could run for mayor after setting key scenes of “Black Panther” in his native Oakland.

The Warriors’ co-owners — one whose success was spawned in Silicon Valley, the other’s in Hollywood — are eager to tap into the riches and reputation of boom-time San Francisco, even with its vast inequality and homeless problems.

Some say those problems have created a spillover effect in Oakland, where there are intense worries over gentrification, housing costs and the erosion of the city’s identity.


Stephen Curry, on a mural in Oakland, has powered the team to three of the last four N.B.A. titles.CreditJim Wilson/The New York Times

West Oakland, for example, a historically black neighborhood between downtown and the Bay Bridge, was once the home of Russell, and of baseball legends like Frank Robinson and Curt Flood, who attended high school together in the 1950s. It’s increasingly abuzz with tech workers, many commuting to the skyscraper forest swallowing up the Warriors across the bay.

The franchise arrived in the Bay Area in 1962, from Philadelphia, and claimed San Francisco for its name. The Warriors resided mostly at the Cow Palace in Daly City, just over San Francisco’s southern city limit.

They played some games at Oakland’s new arena during the 1967-68 season. They moved across the bay full-time a few years later (with one notable return during the 1975 N.B.A. finals, forced by the Ice Follies) and changed the name of the franchise from “San Francisco” to the more collective “Golden State.”

That still gnaws in Oakland. They were never the Oakland Warriors.

Draymond Green, the Warriors’ forward, came to tour the new building this spring with Welts, the team president, and about a dozen members of the news media. Green was about 30 minutes late — traffic from the East Bay.

Welts and Green stood in the bowl of the new arena, gazing up at the empty air where the giant scoreboard will hang. It took imagination to see where the court will be, where the benches and baskets will be.

Welts pointed out that the Chase Center capacity will be 18,064, about 1,000 seats smaller than Oracle Arena. The ceiling is lower than in a lot of new arenas, he said, to help give Chase Center the acoustics and intimacy of Oracle Arena.

In some ways, many ways, the Warriors want fans to feel as if they never left. But injecting a new building with the old atmosphere is an impossible trick for a sports team.

The Warriors, playing both offense and defense, spent the season promoting the move while trying to be respectful of their past. Kerr, the coach, has used the final season in Oakland as daily motivation — “finishing the right way and doing it for Oakland,” he says.

Then — poof — the Warriors will reappear in September, 10 miles or 1,000 miles away.

What will Oakland lose when the Warriors move to San Francisco?

Answer that with a question: What will it gain?

It gets the good old days, the best of days, and the sweet nostalgia unique to cities and arenas left behind. No one takes that away.

And it gets the satisfaction that it handed over something at its apex, something cool and substantial that San Francisco did not create, and probably never could have, and might not ever capture.


The Warriors move leaves the question: Can something move and remain the same?CreditJim Wilson/The New York Times

The Secret to Keeping Black Men Healthy? Maybe Black Doctors

Black men have the lowest life expectancy of any ethnic group in the United States. Much of the gap is explained by greater rates of chronic illnesses such as diabetes and heart disease, which afflict poor and poorly educated black men in particular.

But why is that? Lack of insurance? Lack of access to health care?

Now, a group of researchers in California has demonstrated that another powerful force may be at work: a lack of black physicians.

In the study, black men seeing black male doctors were much more likely to agree to certain preventive measures than were black men seeing doctors who were white or Asian.

Although 13 percent of the population is black in the United States, just 4 percent of doctors are black.

The study, published in June by the National Bureau for Economic Research, involved 702 black men in Oakland, Calif., who came to a clinic for a free health screening. They were randomly assigned to a black male doctor or one who was white or Asian.

Neither the men nor the doctors knew that the purpose of the study was to ask if a doctor’s race mattered when he or she advised these patients. As it turned out, the racial effects were not subtle.

Diabetes screening was part of the health check, and 63 percent of the black men assigned to a black doctor agreed to the screening. But just 43 percent of those assigned to a doctor who was white or Asian consented to be screened.

Some 62 percent of black men with a black doctor agreed to cholesterol tests, compared to 36 percent assigned to a doctor who was not black.

“If their first reaction is, ‘No, I’m not interested in that,’ you must explore why they said no and address those concerns.”

Dr. ChaRandle Jordan

Previous studies have been observational — mostly searching earlier data for trends, a substantially weaker form of evidence — and their results mixed.

“It changed the way I think,” said Jonathan Skinner, a health care economist at Dartmouth College, about the new results. “This study convinced me that the effects are real.”

The researchers employed minority premedical students to recruit participants by visiting 20 barbershops and two flea markets in Oakland, offering black men vouchers for a free health screening.

The screening was at a clinic set up by the investigators and staffed by 14 black and nonblack doctors. The men were offered preventive measures like flu shots and screenings for blood pressure, cholesterol and diabetes.

The men who came to the clinic offered equal praise for their black, white and Asian doctors. But the patients were far more likely to consent to preventive care — screenings and vaccinations — when their doctor was also black.

If black patients were to agree to this preventive care at these rates in the real world, the gap in cardiovascular mortality between black men and the rest of the population could be reduced by 20 percent, the researchers estimated.

“I don’t think I have ever had such a strong result, so unambiguous,” said Dr. Marcella Alsan, an associate professor of medicine at Stanford University and an author of the study.

Why would black doctors have such an effect? Perhaps they used more nonverbal cues to communicate empathy, said Dr. Amber E. Barnato, a professor of medicine and health care delivery at Dartmouth College.

In another small study, she used black and white actors to study white doctors’ interactions with patients at the end of life. Although the doctors said similar things to both black and white actors posing as patients, they stood closer to the white patients, made more eye contact, and touched them more often.

In the new study, Dr. Alsan and her colleagues did not record patient visits. But some hints of the differences could be seen in comments the patients and doctors wrote in evaluations of their experiences.


Dr. Marcella Alsan, an associate professor of medicine at Stanford University, authored the study. “I don’t think I have ever had such a strong result, so unambiguous,” she said.CreditBrian L. Frank for The New York Times

The white and Asian doctors often wrote comments like “weight loss,” “tb test” and “anxiety” — cryptic notations that referred to medical recommendations.

The black doctors often left more personal notes, like “needs food, shelter, clothing, job, ‘flu shot makes you sick,’ he got one.” And “subject yelled at me but then agreed to get flu shot because I recommended it.” And “made patient laugh.”

Black men who saw white doctors wrote comments like, “It was a great and fast experience, doctor was great as well.” And “very informative, very appreciated.”

Those who saw black doctors wrote comments like, “The entire day made me feel very comfortable and relaxed” and “cool doctor” — comments that described an emotional response.

Bridging this racial divide is a fraught matter, noted Dr. Skinner.

“It doesn’t seem so controversial if a woman requests a woman physician,” he said. “If a black patient asks for a black doctor, it’s understandable, especially given this study. But what if a white patient asks for a white doctor?”

A white doctor in this study, who asked that his name be withheld because he has black patients, said he felt his interactions with those who came to the clinic were “normal, comfortable health care visits.” Still, he was not surprised to hear the study’s results.

“Anyone going to see a doctor will be nervous,” he said. “If you face discrimination regularly in life, you will go into a clinic with even more apprehensions. If you see a physician who is African-American, you will feel some relief.”

One of the black doctors who participated in the study, Dr. ChaRandle Jordan, noted that low-income black patients in Oakland tend to be guarded in the doctor’s office.

“When you go into the room, you have to ask them about themselves, establish a rapport with them,” he said. “If their first reaction is, ‘No, I’m not interested in that,’ you must explore why they said no and address those concerns.”

“They might say, ‘Each time my mother had it, she would get the flu,’” he said of patients considering flu shots. “You say, ‘How about you try it this time? I bet you won’t get the flu or it will be less severe.’ You are joking a little bit.”

“It’s something they don’t teach you in medical school — taking that extra step because you appreciate there have been barriers in the past,” Dr. Jordan added.

White doctors can reach out just as well, Dr. Jordan said, adding that a lot depends on how familiar a doctor is with black patients.

Could white doctors have more success with black patients if they carefully watched what black doctors do? “Maybe, maybe not,” said David Cutler, a professor of applied economics at Harvard University.

But now that the researchers showed that a doctor’s race can really matter to his or her patients, he said, the medical profession should take heed.

“The magnitude of the effect is so huge, how can you ignore it?” Dr. Cutler asked.

This E.R. Treats Opioid Addiction on Demand. That’s Very Rare

Dr. Andrew Herring of Highland Hospital in Oakland, Calif., left, gave a dose of buprenorphine, a drug that eases the symptoms of opioid withdrawal, to a homeless man who collected cans to pay for bus fare to get to the hospital.CreditBrian L. Frank for The New York Times

OAKLAND, Calif. — Every year, thousands of people addicted to opioids show up at hospital emergency rooms in withdrawal so agonizing it leaves them moaning and writhing on the floor. Usually, they’re given medicines that help with vomiting or diarrhea and sent on their way, maybe with a few numbers to call about treatment.

When Rhonda Hauswirth arrived at the Highland Hospital E.R. here, retching and shaking violently after a day and a half without heroin, something very different happened. She was offered a dose of buprenorphine on the spot. One of three medications approved in the United States to treat opioid addiction, it works by easing withdrawal symptoms and cravings. The tablet dissolved under her tongue while she slumped in a plastic chair, her long red hair obscuring her ashen face.

Soon, the shakes stopped. “I could focus a little more. I could see straight,” said Ms. Hauswirth, 40. “I’d never heard of anyone going to an emergency room to do that.”

Highland, a clattering big-city hospital where security wands constantly beep as new patients get scanned for weapons, is among a small group of institutions that have started initiating opioid addiction treatment in the E.R. Their aim is to plug a gaping hole in a medical system that consistently fails to provide treatment on demand, or any evidence-based treatment at all, even as more than two million Americans suffer from opioid addiction. According to the latest estimates, overdoses involving opioids killed nearly 50,000 people last year.

By providing buprenorphine around the clock to people in crisis — people who may never otherwise seek medical care — these E.R.s are doing their best to ensure a rare opportunity isn’t lost.


When Rhonda Hauswirth arrived at Highland’s E.R. with severe withdrawal symptoms, she was offered a dose of buprenorphine on the spot — a vital first step, Dr. Herring believes, toward recovery.CreditBrian L. Frank for The New York Times

“With a single E.R. visit we can provide 24 to 48 hours of withdrawal suppression, as well as suppression of cravings,” said Dr. Andrew Herring, an emergency medicine specialist at Highland who runs the buprenorphine program. “It can be this revelatory moment for people — even in the depth of crisis, in the middle of the night. It shows them there’s a pathway back to feeling normal.”

It usually takes many more steps to get someone started on addiction medicine — if they can find it at all, or have the wherewithal to try. Locating a doctor who prescribes buprenorphine and takes insurance can be impossible in large swaths of the country, and the wait for an initial appointment can stretch for weeks, during which people can easily relapse and overdose.

[Read about the national shortage of doctors who can prescribe buprenorphine.]

A 2015 study out of Yale-New Haven Hospital found that addicted patients who were given buprenorphine in the emergency room were twice as likely to be in treatment a month later as those who were simply handed an informational pamphlet with phone numbers.

After Dr. Herring read the Yale study, he persuaded the California Health Care Foundation to give a small grant to Highland and seven other hospitals in Northern California last year, in both urban and rural areas, to experiment with dispensing buprenorphine in their E.R.s. Now the state is spending nearly $700,000 more to expand the concept statewide as part of a broader, $78 million effort to set up a so-called hub-and-spoke system meant to provide more access to buprenorphine and two other addiction medications, methadone and naltrexone.

Under that system, an emergency room would serve as a portal, starting people on buprenorphine and referring them to a large-scale addiction treatment clinic (the hub), to get adjusted to the medication, and to a primary care practice (the spoke) for ongoing care. Dr. Herring is serving as the principal investigator for the project, known as E.D. Bridge. The $78 million is most of California’s share of an initial $1 billion in federal grants that Congress approved for states to spend on addiction treatment and prevention under the 21st Century Cures Act, enacted in 2016.

“At first it seemed so alien and far-fetched,” Dr. Herring said, noting that doctors are often nervous about buprenorphine, which is more commonly known by the brand name Suboxone. They need training and a special license from the federal Drug Enforcement Administration to prescribe it for addiction (it’s also used to treat pain), although E.R. doctors don’t need the license to provide doses of the medication to patients in withdrawal.

But lately, Dr. Gail D’Onofrio, the lead author of the Yale study, has been fielding calls every week from E.R. doctors interested in her hospital’s model.

Since the study was published, a few dozen hospital emergency departments, including in Boston, New York, Philadelphia, Brunswick, Me., Camden, N.J., and Syracuse, have also started offering buprenorphine.

“I think we’re at the stage now where emergency docs are saying, ‘I’ve got to do something,’ ” Dr. D’Onofrio said. “They’re beyond thinking they can just be a revolving door.”

As Dr. Herring’s shift began one Tuesday, a 30-year-old woman in a white baseball cap entered the E.R. She said she had been using heroin for the past three years, but had been taking opioids since a doctor prescribed her the painkiller Norco after a softball injury when she was 12. She had overdosed twice and had never stopped using for more than two months at a time. Most recently, she told the doctor, she had been snorting fentanyl from a dealer who gave it to her for free in exchange for meth provided by her friend.


Angelica had overdosed twice and had never gone more than two months without using before she arrived at the E.R.CreditBrian L. Frank for The New York Times

She was talking fast about how she hadn’t been able to sleep for days. She had just moved into a sober-living house in Berkeley, about 20 minutes away, and withdrawal was kicking in. The manager of the house had sent her to Highland.

“My heart was just pounding,” the young woman, who asked to be identified only by her first name, Angelica, told Dr. Herring. “My stomach hurt from everything going straight through me. My body just won’t turn off.”

Dr. Herring nodded. “It’s called wired and tired,” he said. A nurse brought her a buprenorphine tablet as they went over her history, and Dr. Herring told her to come to his addiction clinic in two days for a follow-up visit and more medication.

While the care provided in emergency rooms is particularly expensive, supporters of programs like E.D. Bridge say E.R.s are the best place for stabilizing any dangerously out-of-control condition, including addiction.

“We don’t think twice about someone having a heart attack, getting stabilized in the emergency department, and then getting ongoing care from the cardiologist,” said Dr. Kelly Pfeifer, director of high-value care at the California Health Care Foundation. “And the risk of death within a year after an overdose is greater than it is for a heart attack.”

She added that since E.R. visits like Angelica’s are usually brief and uncomplicated, they aren’t as expensive as many other types of E.R. care.

Here in Oakland, a city of 416,000, opioid addiction cuts across lines of race and ethnicity. Highland has provided buprenorphine to roughly equal numbers of blacks and whites, with Latinos, Asians and other ethnic groups filling out the rest. Many of those patients are homeless and most are on Medicaid, the government health insurance program for the poor that, crucially for Dr. Herring’s program, California expanded under the Affordable Care Act. Buprenorphine can cost more than $500 a month, putting it out of reach for many of the uninsured.

Since February 2017, Highland’s E.R. has offered buprenorphine to more than 375 emergency room patients. Two-thirds of them accepted it, along with an initial appointment for ongoing treatment at the hospital’s addiction clinic.

Many were in withdrawal. Some had infections from injecting opioids. Others were seeking help for an unrelated medical problem, like a broken arm, but disclosed that they were addicted to heroin or opioid painkillers.

Dozens have continued taking buprenorphine, a weak opioid that activates the same receptors in the brain that other opioids do, but doesn’t cause a high if taken as prescribed. Even if they reject the idea of starting treatment, those who try buprenorphine in the E.R. may be more likely to do so in the future, Dr. Herring said.


Dr. Herring with a patient. Since February 2017, two-thirds of the E.R. patients to come through Highland for buprenorphine accepted it and at least one appointment for ongoing treatment.CreditBrian L. Frank for The New York Times

“You’ve given them a chance to test-drive it,” he said. “They’ll still remember in a month, in a year.”

At Highland, patients who get an initial dose of buprenorphine also usually get a prescription for Suboxone, which comes in strips that dissolve in the mouth and is harder to abuse, to last until they can get to an addiction clinic that Dr. Herring runs on Thursdays. There, he assesses their progress and often adjusts their dose on a weekly or biweekly basis until they can find a more permanent provider.

Dr. Herring has reached out aggressively to detox centers, where people often spend a few days withdrawing from heroin, and residential treatment programs. Although many such programs haven’t allowed residents to be on buprenorphine or methadone, California has started requiring them to.

Signs posted throughout the E.R.’s waiting area — “Need Help With Pain Pills or Heroin? We want to help you get off opioids” — have helped spread the word. That’s how a man named Abai found his way to Dr. Herring; his sister had come to the E.R. with a respiratory infection, seen the signs and told him about the program.

Abai, who is 35 and asked that his middle name be used to protect his privacy, had been released from federal prison six weeks earlier, and was trying hard not to return to heroin and other drugs that he had used incessantly before his 18-month sentence. He had been buying buprenorphine off the street, but now he had a job offer and wanted a more stable source of treatment.

“It keeps me away from doing any hard drugs and that’s really critical for me,” he said. “Being on federal probation, they have zero tolerance.”

About an hour later, after Dr. Herring briefly met with him, a nurse called Abai’s name and put a buprenorphine tablet under his tongue. He left after promising to come to Dr. Herring’s clinic the next morning.

An urban public teaching hospital like Highland, with lots of mission-driven doctors and a commitment to serving the poor, can do this — particularly in the Bay Area, where attitudes about addiction are among the most progressive in the country. But can every hospital? Given the choice, would they?

“You do hit sort of a culture clash,” said Arianna Sampson, a physician assistant at Marshall Medical Center in Placerville, Calif., about two hours northeast of Oakland in rural El Dorado County. Ms. Sampson worked with Dr. Herring to start an E.D. Bridge program there last year, and her emergency room has provided initial doses of buprenorphine to 41 patients since last August. But Ms. Sampson has had to work to overcome stigma about buprenorphine — that it’s just one opioid replacing another — in the community, she said.

The Placerville program refers patients to a local community health center that prescribes buprenorphine, where many have become regular patients.


Ms. Hauswirth picking up a buprenorphine prescription. “It’s a war within my body,” she said, adding that she hadn’t used in 90 days.CreditBrian L. Frank for The New York Times

Although Highland’s E.R. treats a fair number of opioid overdose victims — about 150 last year- — they aren’t usually candidates for starting buprenorphine on the spot, Dr. Herring said. Many have just been revived with naloxone, an injectable drug that reverses overdoses, and there isn’t enough data yet about the safety of giving them buprenorphine so soon afterward.

“Figuring out how to do that safely and effectively has to be one of our greatest priorities,” Dr. Herring said.

The efforts to help don’t always work. One afternoon in May, a homeless woman named Jessica came to the Highland E.R. with a festering abscess on her arm, the result of a heroin injection gone bad. She was thin, with a whispery voice. Waiting for help, she asked a nurse what month it was.

[Read about how San Francisco’s health department is offering buprenorphine prescriptions to opioid-addicted homeless people on the streets.]

The staff had flagged her as a patient for Dr. Herring, and he learned she had been using for seven years. Because she had injected heroin just before coming to the E.R., she was not a candidate for an immediate dose of buprenorphine; people have to be in at least mild withdrawal to start taking it, otherwise it can throw them into full-fledged withdrawal. Christian Hailozian, the E.D. Bridge program coordinator, sat down next to her with a checklist of questions.


Christa Blackwell, a friend of Ms. Hauswirth’s and a patient of Dr. Herring’s, who reported she was doing well with her medication. “Keep taking it like a vitamin,” Dr. Herring told her.CreditBrian L. Frank for The New York Times

“So you live just by yourself, in your car?” he asked. “No friends or family with you?”

She nodded.

“Do you have a phone number I can reach you at? You don’t have a phone?”

“O.K. ma’am, we’re going to let the doctors treat your arm right now,” he went on. “But we’d really like you to come back tomorrow. O.K.? It would be really good to try and reduce the amount of heroin you’re doing and try to start on these meds. You’re going to have to put yourself in a little bit of withdrawal.”

Jessica was preoccupied with her swollen arm, staring past Mr. Hailozian. After her abscess was drained, she left in a hurry, scuffing across the floor in pink slippers.

That day was a long one for Dr. Herring, who met with Abai and Jessica in between a steady flow of emergencies, including a harrowing one involving a toddler who had stopped breathing. He worked until midnight.

The next morning, he arrived at the hospital early and hustled to the basement office where he holds his weekly clinic for patients who started buprenorphine in the E.R. Angelica and Abai were already waiting, as were a young homeless couple carrying all their belongings. Ms. Hauswirth was there, too, with a friend from her detox center, Christa Blackwell.

Ms. Hauswirth wasn’t feeling well. She had never let herself experience withdrawal before, scrambling to find heroin or pills before it kicked in. Although she was now taking 16 milligrams of buprenorphine daily, a healthy dose, she was still feeling sick by the end of each day.

“It’s a war within my body,” she told Dr. Herring.

He added a nighttime dose of eight milligrams to her regimen; she had used very heavily for several years and needed more help than some.

Ms. Blackwell, 42, was livelier, telling Dr. Herring that she was doing well on 16 milligrams of buprenorphine daily.

But Dr. Herring had a warning for her: “People can feel like they’re cured. So just keep taking it, like a vitamin.”

“You’ve torched everything, and the medication is letting it grow back, and it’s going to be beautiful,” he added. “But it’s going to take some time.”