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Protecting the Health of Black Communities and Fighting for a More Equitable Health Care System

In recognition of Black History Month, this edition of TMI briefs highlights the challenges faced by Black Americans in health care and several of the legal battles fought by the NAACP Legal Defense and Educational Fund, Inc. (LDF) throughout the 20th century to ensure Black citizens have access to fair, quality health care.
In every sector of American life, Black Americans have played pivotal roles. The same is true of our health care system. From the first successful operation on a human heart to the development of a surgical treatment for “Blue-Baby” Syndrome, the contributions of Black Americans have been invaluable to the enrichment of the health care system in the United States.[1] Nevertheless, many of these contributions were made while their originators were denied the full enjoyment of their right to health care on account of their race. Perhaps, no story more typifies this cruel irony than the legend of Dr. Charles R. Drew, a pioneer in blood transfusion research. At the time of his death in 1950, he was the chief of surgery at the Freedmen’s Hospital at Howard University.[2] He died following an automobile accident in North Carolina and his death fueled rumors that he was turned away from Alamance County General Hospital because he was Black. Contrary to popular belief, this legend was an inaccurate representation of Dr. Drew’s final moments as he was not denied admission to a hospital.[3] However, for the scores of Black Americans who had been turned away from hospitals, who had been subjugated to inferior facilities, and had suffered the shame of delivering their children in the offices of veterinarians, it was an altogether believable account. In fact, exactly eight months after Dr. Drew died, a young Black college student named Maltheus Avery was also in an automobile accident in Alamance County, North Carolina.[4] He was refused treatment at Duke University Hospital because their “Black beds” were full and died an hour after being transferred to a nearby hospital designated for Black people. This was the reality for so many Black Americans and Black physicians alike.

Federal policies and programs were integral to maintaining this racial caste system in health care that developed based on the “separate-but-equal” doctrine upheld by the Supreme Court in Plessy v. Ferguson in 1896.  This doctrine would not be overturned until Brown v. Board in 1954, and then only in the field of education. The Hill-Burton Act, a federal law passed in 1946, funded $75 million annually for five years for grants to construct hospitals and $3 million annually for states to conduct surveys of the facilities.[5] This landmark legislation did not come without stipulations related to Black Americans. There was intense debate regarding nondiscrimination in the use of federal funds and whether segregated hospitals would be eligible for funding. The compromise that was struck codified into law “separate-but-equal” language in the disbursement of these funds, based on a guarantee of an equitable number of hospital beds for each population group.[6] Stipulations such as these would be the basis for landmark cases brought by LDF in coming years.

Excerpt from LDF Annual Report 1963; LDF Archives. Click to enlarge.

Perhaps the most important of these was Simkins v. Moses H. Cone Memorial Hospital. Filed on February 13, 1962, it sought to desegregate two prominent Greensboro, North Carolina hospitals—Moses H. Cone Hospital and the Wesley Long Community Hospital. The former occasionally permitted Black patients while the latter did not admit them under any circumstances.[7] The lead plaintiff, George Simkins, Jr. was a dentist in the Greensboro area. Frustrated with the overcrowded conditions and poor facilities at Black hospitals for his patients, he reached out to LDF for assistance in breaking down racial barriers at Moses H. Cone Memorial and Wesley Long Hospitals.[8] LDF attorneys Conrad Pearson and Michael Meltsner argued that the state was involved in the operation of these private hospitals because of their acceptance of Hill-Burton funds.  
Due to the ruling in Brown v. Board, the state’s involvement would call into question the use of separate-but-equal facilities under the Equal Protection Clause of the Fourteenth Amendment. After a District Court ruling that held that the hospitals were private, the case was heard by the Fourth Circuit Court of Appeals. The Fourth Circuit held the “‘separate-but-equal’ provisions of the Hill-Burton Act unconstitutional and ruled that the Federal and State Governments were significantly involved in the operation of the hospitals. Therefore, the hospitals were required to offer services on a nondiscriminatory basis.”[9] The ruling in this case was monumental, as hospitals faced losing federal funding if they discriminated against Black staff and patients. In fact, LDF’s 1963 Annual Report commented that it “may be as far-reaching in the health field as the 1954 decision has been in education.”[10]
The ruling in Simkins v. Moses H. Cone Memorial Hospital laid the framework for Title VI of the Civil Rights Act of 1964, which banned discrimination on the basis of race, color, or national origin by any entity receiving Federal financial assistance. It drastically shifted legal doctrine related to health care, and enabled LDF to take bold action to redress discrimination in hospitals. By July of 1965, LDF and the NAACP together had filed 110 new complaints charging hospitals with racial discrimination.[11]

Excerpt from 1965 press release; LDF Archives

While these complaints helped improve conditions for Black patients, many Black medical staff persons continued to be discriminated against under a pretext of competency. Again, the Fourth Circuit Court of Appeals would play an important role in shaping the future of health care in the United States. Dr. George Cypress was a Black board-certified pediatrician who had been repeatedly denied clinical privileges at Riverside Hospital in Newport News, VA.[12] He was the only Black pediatrician at the hospital and the only pediatrician denied clinical privileges. In Cypress v. Newport News General and Non-Sectarian Hospital Association, the doctor’s complaint alleged discriminatory denial of staff privileges and discrimination in the assignment of patient rooms. As with Simkins v. Moses Cone Memorial Hospital, the District Court dismissed the complaint on March 14, 1966, as the Court found that the secret ballots which were used to give physicians clinical privileges rendered it too difficult to determine whether race was a determining factor.[13] LDF appealed the case to the Fourth Circuit, which reversed the decision of the District Court. It held that the “hospital cannot remain silent in face of evidence that Negro physicians are qualified.”[14] Not only this, but it rejected the secret ballot procedure on the grounds that it was inherently racial due to there being an all-white staff and the fact that the hospital had already factored race into its hospital administration through its efforts to separate patients by color. Furthermore, it held that room assignments could be made with regard to sex, age, illness and other factors, but that racial distinctions were unlawful. Cypress v. Newport News General and Non-Sectarian Hospital Association was so consequential because it withstood the first challenges to the Medicare hospital integration guidelines under Title VI of the 1964 Civil Rights Act.

LDF press releases from 1965 announce complaints filed against segregated hospitals.

While the Civil Rights Era saw many advances in the field of health care, the attacks on Black people’s right to health care would not stop in the coming decades. LDF would challenge many new efforts to exclude Black people from accessing fair health care. For example, Hatcher v. Methodist Hospital of Gary, Inc. challenged the construction of a federally funded satellite expansion in an all-white suburban town 15 miles south of Gary, Indiana, a city which had a 63% minority population at the time.[15] This diverted critical resources, nurses, and doctors, effectively creating a segregated health care system. In 1978, LDF procured a court-approved settlement that included more than $20 million for the hospital that remained in Gary, long-term plans to roll back discriminatory health care practices, and for the Board of Directors to be restructured such that it reflected the population in Gary.[16] In Campaign to Save the Public Hospitals v. Giuliani, LDF successfully blocked the privatization of three public New York City hospitals, which could have jeopardized health care for hundreds of thousands.[17]
Clearly, the resistance to an equitable health care system has been sustained long past the 1960s. The rippling effects of this are being seen in the COVID-19 pandemic, as African Americans are dying from complications at rates disproportionately higher than other ethnic and racial groups.[18] Without the efforts of these litigants, it could have been even worse. The importance of that work is evident and highlights the need to continue to interrogate inequality in health care. During this Black History Month, LDF and the Thurgood Marshall Institute honor the efforts of these litigants from the past to advance a more just health care system.
[1] Black History Month: A Medical Perspective: Chronology of Achievements, Duke Univ., Med. Ctr Library & Archives, https://guides.mclibrary.duke.edu/blackhistorymonth/chronology (last updated Feb. 14, 2021).
[2] The Death of Dr. Charles Drew, N.C. Museum of History, https://www.ncmuseumofhistory.org/death-dr-charles-drew (last visited Feb. 24, 2020).
[3] Id.
[4] Charles B. Drew, Stranger Than Fact, N.Y. Times (Apr. 7, 1996), https://www.nytimes.com/1996/04/07/books/
stranger-than-fact.html.
[5] P. Preston Reynolds, Professional and Hospital DISCRIMINATION and the US Court of Appeals Fourth Circuit 1956–1967, 94 Am. J. Pub. Health, 710–20, 710 (2004), https://ajph.aphapublications.org/doi/10.2105/ajph.94.5.710?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed&.
[6] Id. at 711.
[7] LDF, 1963 Annual Report 4(1963) [hereinafter LDF 1963 Annual Report]; see also LDF, Docket Report 23 (Dec. 1963) [hereinafter LDF 1963 Docket].
[8] Reynolds, supra note 5, at 13.
[9] LDF 1963 Docket, supra note 7, at 23.
[10] LDF 1963 Annual Report, supra note 7, at 4(1963).
[11] Press Release, LDF, Legal Defense Fund Files 12 Complaints Charging Discrimination in Hospitals: New Complaints Bring Total of 110 Filed to Date (July 15, 1965).
[12] Cypress v. Newport News General & Nonsectarian Hosp. Ass’n, 375 F.2d 648, 651 (4th Cir. 1967).
[13] Cypress v. Newport News Gen. & Non-Sectarian Hosp. Ass’n, 251 F. Supp. 667 (E.D. Va. 1966), judgment reversed by Cypress v. Newport News Gen. & Nonsectarian Hosp. Ass’n, 375 F.2d 648 (4th Cir. 1967).
[14] LDF, Docket Report 1967 48 (June 1967).
[15] LDF, Docket Report 1977 108 (Dec. 1977).
[16] LDF, 1978-79 Annual Report 13 (Dec. 1978).
[17] LDF, 1998 Annual Report 17 (1998).
[18] James Louis-Jean et al., Coronavirus (COVID-19) and Racial Disparities: a Perspective Analysis, J. Racial & Ethnic Health Disparities, (2020), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537778/.