“Greene’s actions and words cling to a worldview in which structural and institutional racism and white supremacy prevail,” members of the Virginia Legislative Black Caucus said in a letter, adding that Greene’s words “signal the intentional slowing down of lifesaving policies and actions” for mothers of color.

A spokeswoman for Youngkin said he reached out to Lamont Bagby (D-Henrico), chairman of the Black Caucus, but would not say if the governor plans to meet with lawmakers per their request.

“I was disappointed to hear that Dr. Greene did not effectively communicate our mission,” Youngkin said in a statement, adding that he was “outraged” about the rate of Black maternal mortality.

Del. Marcus B. Simon (D-Fairfax) said Greene’s appointment as commissioner is subject to confirmation by the General Assembly, but he can serve at the will of the governor until the next regular legislative session in January.

In two interviews for a story The Washington Post published online Wednesday, Greene said invoking racism alienates White people. The view aligns with efforts by the Youngkin administration to purge equity initiatives in education through banning the teaching of critical race theory, in a state where about 40 percent of Virginians identify as something other than White.

Tension over role of racism in public health strains Va. agency under Youngkin

Within the health department, one anonymous employee who was not authorized to speak on behalf of the agency, said Greene’s philosophy imperils their work and the people they serve and represents a full turnabout from policies prioritized under the administration of former governor Ralph Northam, a Democrat.

Tensions came to a head in March during a meeting between Greene and Vanessa Walker Harris, director of the Office of Family Health Services, and her team, which left at least one woman in tears and compelled Walker Harris to accuse Greene of gaslighting them.

State Sen. Jennifer L. McClellan (D-Richmond), a member of the Black Caucus, said almost dying during the premature birth of her second child gave her a heightened awareness of the dangers of pregnancy, especially for Black women. Greene’s comments reinforced a mind-set that undermines Black women and denies them quality health care, she said.

“First of all, I was just angry,” she said in an interview Wednesday. “It reminded me a lot of many of the stories I have heard … of Black women who say there’s a problem, and the medical establishment, particularly White male doctors, older, dismiss what they are saying.”

Although national unrest after the police killing of George Floyd two years ago awakened some White people to what Black Americans have known, McClellan said, many of the problems identified in a landmark 1968 report by the National Advisory Commission on Civil Disorders, known as the Kerner Commission, are still true today: generations of inequality and racist policies lead to disproportionate poverty and poor heath for Black people.

“The impact of decades and centuries of racist public policy under Jim Crow did not go away with a magic wand when laws were changed,” McClellan said. “I’m going to do something about it, I invite [the Youngkin administration] to join me in doing something about it or get out of the way.”

McClellan said Greene’s views made her question work done to try to reverse the disparities, including the state’s April 2021 Maternal Health Strategic Plan, which says “structural racism is at the root of maternal health disparities just as it is for many other health disparities.”

The maternal mortality rate for Black women is 2.5 times the rate for White women, according to data analyzed in the plan. Nationwide, college-educated Black women are at 60 percent greater risk of maternal death than a White or Hispanic woman with less education, the report says. Northam aimed to eliminate the racial disparity in maternal mortality by 2025.

“Part of what’s frustrating now is, how many different governors do I have to tell this to? This is the third governor I’ve had to tell it to and I’ve only served under four,” said McClellan whose tenure has coincided with Youngkin, Northam, Terry McAuliffe and Tim Kaine. Only Kaine understood without being told, she said.

She also praised Walker Harris, a Johns Hopkins-educated doctor, as “a consummate professional who is doing what Black women throughout history have done and that is see a problem and working to address it, trying to overcome pushback with grace and dignity.”

Walker Harris was director of the Office of Family Health Services from 2015 to 2020, when Northam appointed her deputy secretary of Health and Human Resources. She replaced Daniel Carey as secretary of the agency in the final months of Northam’s term, and returned to lead the office devoted to women, children and families under Youngkin.

By speaking out, she exposed a philosophical clash between Greene and the mission of the department, far more than a “work spat,” according to an employee who spoke on the condition of anonymity because they are not authorized to speak on behalf of the department. They said they worried that Greene’s comments, which they characterized as racist, could harm the people the agency is charged with serving.

In a 136-word general statement provided in response to nine detailed questions, Youngkin did not mention racism, but said the administration must address “access to medical services and screening, prenatal care, nutrition, and counseling, which play important roles in a mother and child’s health.” A spokeswoman for the health department referred questions to the governor’s office and did not make Greene available for an interview.

Greene in a prior interview days after the mass shooting in Uvalde, Tex., also dismissed gun violence as a Democratic talking point. Richmond Mayor Levar Stoney on Thursday called the remark “offensive and severely out of touch,” given that, on average, 1,065 people die by guns per year in Virginia and Black Virginians are eight times more likely than White people to die by gun homicide, he said, citing data from the Centers for Disease Control and Prevention.

“Hiding from these realities doesn’t make them go away,” he said. “Dr. Greene needs to stop being a coward and do something about them.”

Del. Candi Mundon King (D-Prince William), a member of the General Assembly’s Task Force on Maternal Health Data and Quality Measures, said she questioned in a May meeting why Youngkin’s administration had not included racism among factors for bad health outcomes, and did not receive an adequate response.

Mundon King, the mother of three, including an 11-year-old daughter with sickle cell anemia, said she was “completely outraged” that Greene raised the issue of the genetic disorder — which is related to one’s ancestry, not skin color — and suggested there could be a genetic reason for Black maternal mortality.

“I expect some accountability from the governor as well as the lieutenant governor who is a Black woman,” she said. “This is a reflection of the governor.”