Public Policy and the Black Hospital

From Slavery to Segregation to Integration
Mitchell F.Rice, Woodrow Jones, Jr.

The Hill-Burton Act and Black Hospitals

THE HILL-BURTON ACT

The Hospital Survey and Construction Act, commonly known as the Hill-Burton Act, was the federal government’s first major intervention in mainstream medical care. The legislation became federal law on August 13, 1946, under the administration of the U.S. Surgeon General with the assistance of the Federal Hospital Council.  1 The purpose of the Hill-Burton Act was to provide federal funds to states for hospital construction, with the intent of building an improved hospital system nationwide.  2 The legislation was a response to the shortage and maldistribution of hospitals and other health facilities recognized by Congress following the Great Depression and World War II. The legislation was passed during President Harry Truman’s administration. President Truman asked Congress to pass a five-part comprehensive legislative plan to ensure adequate medical services for all Americans. The Hill-Burton Act was passed as a part of this comprehensive plan.  3 The Surgeon General was charged with administering the regulations and approving applications for funds in the form of grants and loans.

There were two aspects of the legislation, a survey phase and a construction phase. Under the survey phase, the federal government provided assistance in surveying existing institutions in each state and developing of a plan for providing the needed additional facilities. Each state was allotted federal funds to meet one-third of its total expenditures for the surveys. The states also had to maintain a system of licensing that would ensure a minimum standard of facility quality and safety. The second aspect of the legislation, which is the focus of this chapter, provided for federal aid in constructing the needed facilities.

Congress initially appropriated $3 million to assist the states in making surveys and developing plans and $75 million each year for five years to assist in the construction of hospitals and health facilities. State planning required that each state inventory their existing hospital facilities to determine the total number of hospital beds. A survey then determined how many additional beds were needed to meet the needs of all the residents in each state.

The Hill-Burton legislation prescribed the following ratios as the minimum for adequate service in urban areas: for general hospitals, four and a half beds per thousand population; for mental hospitals, five beds per thousand; and for chronic hospitals, two beds per thousand.  4 Ratios were also provided for rural areas. Because complete hospital service could not be located in every rural area and small community, states were required under the Act to plan for general hospitals on an area basis through a coordinated hospital system. Each area would be classified according to the role the general hospital should play in a coordinated hospital system. Public and nonprofit facilities that conformed to the federal and state requirements were eligible for Hill-Burton construction grants. The federal share of a hospital project was limited to one-third of the total costs.

In October 1949 the Hill-Burton Act was amended by Congress, increasing the federal government appropriation to $150 million for the next five years. The legislation also increased the federal government’s share for construction to between one-third and two-thirds and established a special priority for beds to be made available to population groups that by race, color, or creed were less adequately served than other groups of the population. However, out of deference to Southern custom the Act contained a “separate but equal” provision that allowed Southern states to build and maintain separate hospital facilities for Blacks or maintain racially separate divisions or wings within one hospital building.

According to Dent, a state met the equitable provision “when the facilities to be built for the group less well provided for heretofore are equal to the proportion of such group in the total population of the area.”  5 This did not mean nonsegregation of patients but only an equalization in bed ratios for each state’s population group. Under the separate-but-equal provision, 14 states—Alabama, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, Missouri, Oklahoma, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia—planned separate hospital facilities.  6 These states submitted a plan showing the White and other population to be served and the number of hospital beds available to White and other populations.

As a part of their applications, the states were required to submit the following statement: “No person/certain persons (cross out one) in the area will be denied admission to the proposed facilities as patients because of race, creed, or color.”  7 If the words, “no person” were crossed out, the State agency was required to indicate on a separate form that, “The requirement of nondiscrimination has been met because this is an area where separate facilities are provided for separate population groups and the State plan otherwise makes equitable provision, on the basis of need, for facilities and services of like quality for each such population group in the area.”  8 As a result of these criteria, in North Carolina 31 racially separate facilities received Hill-Burton grants; four were for Blacks.  9

The Hill-Burton program was continually reauthorized by Congress through 1974. Over its history the program spurred $15.2 billion in project costs, which included about $4.2 billion in grants to about 6,500 hospital projects, about 11,500 total projects, and about 500,000 inpatient beds in nearly 4,000 communities.  10 The program generated about $11.2 billion in non-subsidized construction. About 60 percent of the grants went to private hospitals making the Hill-Burton program a huge subsidy for the hospital industry. About two-thirds of Hill-Burton funds were used for modernization. Table 4.1 shows the amount of Hill-Burton appropriations for each fiscal year from 1948 through 1972.

Interestingly, after the enactment of the Hill-Burton Act, Black physicians, especially those who were members of the National Medical Association, viewed the law with disdain and distrust. The editor of the Journal of the National Medical Association, Dr. John A.Kenney, believed that the Black community would not receive an equitable distribution of Hill-Burton funds because of the separate-but-equal clause.  11 There was also the view that Southern states would not provide two-thirds of the construction costs for Black hospitals and that the separate-but-equal clause would continue to maintain a segregated hospital system.  12

HILL-BURTON AND HOSPITAL SERVICES FOR BLACKS

While it is difficult to determine how many hospitals by the Hill-Burton program provided services and care to Blacks, it is clear that Blacks did benefit to a small extent from the legislation. By April 1, 1949 Dent noted that 218 hospitals had been approved for Hill-Burton construction funds in six Southern states (Mississippi, Alabama, Tennessee, Georgia, Florida, and South Carolina) and Puerto Rico and the Virgin Islands. Of these, four were separate facilities serving Blacks. One each in Montgomery, Mobile, and Birmingham, Alabama and one in Tallahassee, Florida.  13 Further, the total number of hospital beds for Blacks did increase slightly under Hill-Burton, especially in the earlier years of the legislation. Table 4.2 compares the change in the number and percentage of hospital beds between Blacks and Whites from 1946 and 1949 in the states of Alabama, Georgia, and Mississippi. While the number of hospital beds increased in each state for Blacks, the percentage of beds for Blacks in each state was well below their percentage of the population. The percentage of hospital beds for Whites far exceeded their percentage of the population in each of the three states.

McFall also noted increases in the number of acceptable general hospital and mental beds for non-Whites between 1946 and 1950 in two Southern states, Virginia and North Carolina (see Table 4.3). In Virginia the number of acceptable general hospital beds for non-Whites increased from 1,630 to 1,745 and in North Carolina from 1,808 to 2,176.  14 Interestingly, in these two states, the increase in acceptable mental beds for Blacks far exceeded the increase in acceptable general hospital beds for Blacks (see Table 4.3). During this same period in Georgia, the number of generally acceptable beds for Blacks decreased by nearly 400 beds. While in Mississippi, the number of generally acceptable beds for Blacks increased by only 10 beds (see Table 4.4).

Table 4.1  Hill-Burton Appropriations by Fiscal Year, 1948–1972
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Table 4.2  General Hospital Beds by Race in Alabama, Georgia, and Mississippi, May 1949
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Table 4.3  Hospital Facilities by Race in Virginia and North Carolina, 1946 and 1950
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By 1957 Southern states accounted for one-half of 3,514 Hill-Burton projects and by December 31, 1962, Hill-Burton grants had been made to 80 facilities that had been exclusively designated for Whites or Blacks.  15 Thirteen of these projects were for the use of Blacks at a cost of $4,080,308 million.  16 The total Hill-Burton contribution to the 80 projects was about $36.8 million. In Atlanta, Georgia, a wing for Blacks known as the Hughes Spalding Pavilion was added to Grady Memorial Hospital at a cost of $1.85 million. About 60 percent of the funds came from the Hill-Burton Act.  17 The Spalding Pavilion was a five-story air-conditioned hospital with 116 beds, 35 bassinets, kitchen, laundry, and morgue.  18

In Georgia the Hill-Burton program was inaugurated in 1947. By September 1, 1952 twenty-nine new hospitals in Georgia had been opened with Hill-Burton Funds. A study focusing on 17 of the hospitals that had been in operation one year or more indicated that they served Black patients.  19 However, the hospitals did not cl early indicate whether Black patients were served on a segregated or integrated basis. In Atlanta, by the early 1960s, of 4,000 available beds only 680 were available to Blacks, including 430 at the Spalding Pavilion of Grady Memorial.  20 In other words, the one-third of the population in Atlanta that is Black, had available to them one-sixteenth of the hospital beds.  21

In North Carolina, the Hill-Burton program built more racially separate hospital facilities than in any other state. Under the separate-but-equal provision of the North Carolina plan, 31 racially separate hospital facilities received grants; four were for Black facilities.  22 In North Carolina, as in Georgia, the state Hill-Burton Agency reported to the U.S. Surgeon General that the total number of beds in each reporting area of the state was found to be proportionately equal to the division of the population by race. However, the U.S. Public Health Service, which the Surgeon General administered, did not determine the extent to which this proportional equality was in fact provided.  23

BLACK HOSPITALS RECEIVING HILL-BURTON FUNDS

Through a comparison of the Hill-Burton Register for the years 1947–1972 with the list of Black hospitals compiled in Appendix I. A small number of Black hospitals can be discerned as recipients of Hill-Burton funds. Table 4.5 shows the state location and name of the facility, type of construction, beds provided, estimated total cost, federal cost and the date the project was initially approved. Although Table 4.5 is not a complete listing of Black hospitals receiving Hill-Burton funds, it does provide a picture of how federal policy assisted in a very small way in the construction and modernization of Black hospitals. Most of the Hill-Burton funds were used for addition and addition and remodeling of Black hospitals. It seems only a few Black hospitals were constructed as new with Hill-Burton funds. Martin DePorres Hospital (Mobile, Alabama), Florida A & M Hospital (Tallahassee, Florida), Lincoln County Hospital (Fayetteville, Tennessee) and Harlem Hospital (New York City) were among the first Black hospitals to receive Hill-Burton funds. About 4,400 new beds were added to Black hospitals. Table 4.5 shows that approximately $33 million or some one percent of Hill-Burton funds were expended on Black hospitals. Table 4.5 also shows that some 38 separate hospital projects involving Black hospitals, or White hospitals with Black wards, received Hill-Burton funds. Several of these hospitals received multiple Hill-Burton grants.

However, one problem that the Hill-Burton Act did not address was “the exclusion of Negro professional and technical personnel from hospitals which are not exclusively devoted to Negro patients.”  24 The legislation specified that the federal government shall have no control over the personnel in hospitals built with federal funds. The implementation of the Hill-Burton Act was a state responsibility and the state controlled the personnel and the newly constructed hospital or hospital addition.

THE BLACK COMMUNITY’S RESPONSE TO HOSPITAL SEGREGATION AND THE HILL-BURTON ACT

As a response to the continuing problem of hospital segregation, the first Imhotep National Conference on Hospital Integration was held March 8–9, 1957, in Washington, D.C., eleven years after the Hill-Burton Act. The Conference was sponsored by the National Medical Association, the Medico-Chirurgical Society of the District of

Table 4.4  Hospital Beds by Race in Georgia and Mississippi, 1946 and 1950
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Table 4.5  Hill-Burton Funds to Black Hospitals
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Columbia, and the National Association for the Advancement of Colored People (NAACP). The stated purposes of the Conference included the following:

To bring together representatives of all interests among hospitals, the public, the healing professions, and government agencies, which are concerned with this problem.

To provide a complete, comprehensive situation through-out the country as it exists today through first-hand presentations from various regions.  25

Imhotep was chosen as the conference name for two reasons: “First, as a reminder that a dark skin was associated with distinction in medicine before that of any other color, this served to emphasize the dignity of the approach to the problem. Second, because the name meant, ‘He Who Cometh in Peace,’ the sponsoring organization came in peace in a time of emotional tension.”  26

The Conference was attended by 200 delegates from 21 states representing 16 constituent societies of the National Medical Association, the NAACP, and four branches of the National Urban League and various medical and hospital societies. The Conference was primarily devoted to identifying the various forms of hospital discrimination and acquainting the attendees with the forms of discrimination.

Dr. W.Montague Cobb, who was chairman of the NAACP National Health Committe, a member of the Board of Directors, and longtime Editor of the Journal of the National Medical Association, served as chairman of the Conference. One of the Conference’s first actions was to vote unanimously to seek an amendment to the Hill-Burton Act deleting provisions for racial segregation.  27 The Conference also voted unanimously to work “continuously and vigorously, in the spirit of amity” until “racial discrimination has been eliminated from all hospitals in the United States.”  28 Prominent speakers at the Conference included Representative Barratt O’Hara (Illinois), Congresswoman Florence P.Dwyer (New Jersey), Roy Wilkins (NAACP Executive Secretary), Dr. Robert S.Jason (Dean, Howard University College of Medicine), Dr. T.R.M.Howard (President, National Medical Association), and Dr. Edward C. Mazique (President, Medico-Chirurgical Society).  29 Also in attendance at the Conference was Robert M. Cunningham, editor of the widely read periodical The Modern Hospital.  30 Cunningham gave visibility to the Conference by writing an article about it in the April 1957 issue of his publication and by discussing the Conference as keynote speaker at the 1957 meeting of the Southeastern Hospital Conference in Atlanta, Georgia.  31 Cunningham had urged an end to hospital discrimination as early as 1951.  32 His support for hospital integration was most important because Modern Hospital was a major publication in the hospital industry.

The second Conference was held in Chicago on May 23–24, 1958. This meeting focused on techniques used against hospital discrimination in one major city.  33 The third conference, held in Washington, D.C., on May 22–23, 1959, focused on means of dealing with hospital segregation and the attitudes of White professional personnel.  34 At the 1962 Conference, held May 25–26, 1962, in Washington, D.C., President Kennedy sent a special letter of greeting to the attendees advising them that the U.S. Attorney General had intervened in a federal court case to support the argument that the segregation clause (separate-but-equal provision) in the Hill-Burton Act was unconstitutional. Senator Jacobs K.Javits (R-NY), a supporter of hospital integration, was a prominent speaker at the Conference, along with Attorney Jack Greenberg who was Chief Counsel of the NAACP Legal Defense and Educational Fund.  35 The sixth and final Conference was held in 1963 in Atlanta, Georgia. The Imhotep Conference was discontinued after the passage of the Civil Rights Act of 1964. President Kennedy also sent a letter to the 1963 conference pointing out that the efforts of the Imhotep Conference were “perfectly in tune with that of the federal government.”  36

For each conference invitations were sent to those organizations representing the predominantly White professional and hospital power structure, asking them to send representatives. It would seem that Conference leaders believed that having official representation from the White professional and hospital power structures in attendance would bring an end to hospital segregation. These organizations, however, sent only observers (not high-ranking officials) or no one at all. The American Hospital Association, the American Medical Association had observers in attendance at the first conference. Other organizations in attendance were the U.S. Public Health Service, the National Health Council, the National Association of Social Workers, the District of Columbia Hill-Burton Advisory Council, the University of Pittsburgh, the Physicians Forum, National AFL-CIO, Hampton Institute, and others including a number of hospital representatives. The American Medical Association sent an observer to the 1959 conference. The American Nurses Association sent observers to the 1957 and 1963 conferences.  37

Ironically, when the U.S. Department of Health, Education, and Welfare convened a Conference on the Elimination of Hospital Discrimination in July 1964 (supported by President Lyndon Johnson) all the organizations that did not officially attend the Imhotep Conferences were well represented. This included such organizations as the Federal Hospital Council, the American Hospital Association, the American Medical Association, the American Dental Association, and the American Nurses Association. The National Medical Association and the National Dental Association (both Black organizations) were represented at the Conference.  38

At the 1964 conference, to the dismay of the attendees who were expecting an appearance by President Johnson, Associate Special Counsel to the President Hobart Taylor (a Black), represented the President and urged all those in attendance to support what would be explained to them. Taylor’s appearance, perhaps more than his words, was in itself a powerful message to the assembled hospital power structure of the country. Department of Health, Education and Welfare (DHEW) Secretary Anthony J.Celebrezze said that President Johnson expected hospitals to comply with the Civil Rights Act of 1964 and compliance would avoid needless controversy and litigation. This 1964 DHEW Conference was termed the Eighth Imhotep Conference by Dr. W.Montague Cobb who conceived and organized the first Imhotep Conference.  39

THE JUDICIAL CHALLENGE TO HILL-BURTON

Until 1964 the Black hospital was the primary source of hospital care for the Black community. In the early 1960s in Atlanta, only 630 of 4,500 hospital beds were available to Blacks, who comprised 50 percent of the population.  40 In Birmingham, Alabama, where Blacks were 40 percent of the population, only 574 of 1,762 hospital beds were allocated to Blacks. In 1959 in Baltimore, only 7 of 17 hospitals offered accommodations to Blacks.  41 By 1963 70 segregated hospital facilities had received Hill-Burton funding, and many others, while not segregated, engaged in various overt and covert discriminatory practices.  42

In the early 1960s medical civil rights activists and hospital integration proponents began to launch a political and legal attack on hospital segregation. In Congress on September 23, 1961, Senator Jacob Javits (R-NY) introduced Senate Bill 2625 to amend the Hill-Burton Act to prohibit discrimination in any respect whatsoever on account of race, creed, or color in hospital facilities.  43 Senator Javits argued that “nothing could be more pernicious than racial discrimination and segregation in the medical field.” The bill was tabled by a vote of 37 to 33.  44 In the 88th Congress Senator Javits reintroduced a similar bill with support from the American Hospital Association, the American Public Health Association, and the Catholic Hospital Association, who had passed resolutions calling for the elimination of the separate-but-equal clause.  45 On the legal front, a major hospital case was about to unfold.

Simkins v. Moses H.Cone Memorial Hospital

On February 12, 1962, 11 Black citizens, six physicians, three dentists, and two patients, of Greensboro, North Carolina, filed suit against Moses H.Cone Memorial Hospital and the Wesley Long Community Hospital. Both hospitals had received Hill-Burton funds. Cone Hospital received $1,276,950 (grants in 1954 and 1960) and Long Hospital $1,708,150 (grants in 1954 and 1961) (see Table 5.1).  46 For Cone Memorial the grants represented approximately 15 percent of the total combined construction costs. For Long Community the grants represented about 50 percent of the combined total construction costs.  47 Cone Memorial had a policy of denying staff privileges to Black practitioners and admitted Blacks only under limited circumstances. Long Community also denied privileges to Black practitioners and admitted no Black patients. The suit represented the first litigation challenging the constitutionality of the Hill-Burton Act antidiscrimination clause. Three attorneys from the NAACP Legal Defense and Educational Fund including, Chief Counsel Jack Greenberg, represented the plaintiffs, along with an attorney from Durham, North Carolina.  48

The suit charged that the exclusion of Black physicians and dentists from the staff of hospitals, the denial of admission of Black patients, and the separate but equal antidiscrimination clause of the Hill-Burton Act were in violation of the Fourteenth and Fifth amendments of the Constitution. The U.S. District Court disagreed with the plaintiffs on the grounds that private hospitals were not instrumentalities of the states or the federal government. Upon appeal, the Fourth Circuit reversed on the rationale that receipt of Hill-Burton funds represented the “necessary” degree of federal and state involvement and participation. The Supreme Court allowed the decision to stand.  49 The American Public Health Association and the U.S. Department of Justice filed briefs supporting the plaintiffs.

The Department of Health, Education, and Welfare published new regulations on May 19, 1964 in the Federal Register in response to the Simkins ruling. The new regulations stated: “Before a construction application is recommended by a State agency for approval, the State agency shall obtain assurance from the applicant that all portions and services of the entire facility for construction of which, or in connection with which, aid under the Federal Act is sought, will be made available without discrimination on account of race, creed, or color; and that no professional qualified person will be discriminated against on account of race, creed, or color with respect to the privilege of professional practice in the facility”  50 (emphasis added).

THE U.S. COMMISSION ON CIVIL RIGHTS, RACE BIAS, AND HILL-BURTON

In 1963 the U.S. Commission on Civil Rights published its findings on race bias in hospitals.  51 The report was based on public hearings, staff field studies, reports of state of civil rights advisory boards, and a mail survey of 398 hospitals in 34 states; on a regional basis, 130 hospitals surveyed were in Southern states. The remaining hospitals surveyed were in other regions. About 55 percent or 219 hospitals responded to the survey. About 64 hospitals responded from Southern states. The Commission found that 60 hospitals had policies of exclusion or segregation. About 59 of the 60 hospitals were licensed by a political subdivision, 45 were incorporated under state law, 20 hospitals were built or remodeled with federal, state or local government funds, and 36 hospitals received Hill-Burton grants, with 3 obtaining funds under the separate-but-equal provision. The other 33 hospitals, located in 14 Southern and border states, practiced separate living accommodations.  52

In some specific cities, the Commission found the following. In Memphis, Tennessee, a 128 bed city-owned hospital built partially with Hill-Burton funds was the only general accredited facility available to Black paying patients. Three large private church related facilities with a total of 2,082 beds did not admit Blacks. Other small facilities including a Black hospital did admit Black patients.  53 In Nashville, the only hospital facility available to Blacks was Hubbard Hospital (a Black hospital)-at the time a 30 bed facility. No Blacks were admitted to the other four general hospitals (two church related) in the city. One other hospital built partially with a $2 million Hill-Burton grant maintained separate ward facilities for Black adults. In the local city-county hospital, which received both local public and Hill-Burton funds a wing of 28 beds was reserved for Black patients.  54

In Charleston, South Carolina, where six hospitals were located (one church related), only one, a county owned facility, was available to Black patients and Black physicians. The city was about 36 percent Black. One of the segregated facilities was a recipient of Hill-Burton funds, and another facility built largely with Hill-Burton funds admitted Blacks on a segregated basis.  55 In Kansas City, Kansas, of five general hospitals one was used exclusively by Blacks. The Black hospital was the only one for which Hill-Burton funds were not used. Three hospitals admitted Blacks to separate rooms.  56 In Greensboro, North Carolina, two government-owned hospitals providing services to Whites only were recipients of Hill-Burton funds.  57

The Commission also reported that from 1946 to 1963, 89 Hill-Burton grants totaling nearly $40 million were provided to finance construction or remodeling of separate hospital facilities for Whites and Blacks. About 10 percent or $4 million supported facilities for Blacks.  58 Overall, by 1963 the Hill-Burton program was the largest investor in hospitals of all kinds, and the program practically rebuilt the hospital system nationwide. By 1963 the Hill-Burton program was responsible for more than “700,000 general beds, about 500,000 long term beds, 6810 hospital and health centers, 500,000 beds for mental patients and about 64,000 for patients with tuberculosis.”  59 Over the 13-year period between 1948–1961, $1.6 billion in Hill-Burton funds were expended. Max Seham characterized the Hill-Burton program as “a Dr. Jekyll to ‘Whites’ and a cruel Mr. Hyde to the Negroes.”  60

NOTES

1.  Title VI of the Public Health Service Act of August 13, 1946, Public Law Number 79–725, Sections 601, 60 Statute 1041. The Federal Hospital Council was composed of 8 members appointed by the Federal Security Administrator. The one Black member, Dr. Albert W.Dent—President of Dillard University and Director of the University Flint Goodridge Hospital—headed the Council’s Advisory Committee on Nondiscrimination.

2.  The Hill-Burton Act amended the Public Health Service Act of July 1, 1944.

3.  See C.B.Chapman and J.M.Talmadge, “Historical and Political Background of Federal Health Care Legislation.” Law and Contemporary Problems 35 (2) (Spring 1970):334–347; and P.A.Brandon, “The Right of Access of the Medically Underserved to Health Care Services.” Journal of Legal Medicine 2 (3) (September 1981):297–345; 329, notes 113–119.

4.  Van M.Hoge, “The National Hospital Construction Program.” Journal of the National Medical Association 40 (3) (May 1948):102–106.

5.  Albert W.Dent, “Hospital Services and Facilities Available to Negroes in the United States.” Journal of Negro Education (1949):331.

6.  U.S. Commission on Civil Rights, Report of the U.S. Commission on Civil Rights, 1963 (Washington, DC: Government Printing Office): 130.

7.  Ibid., p. 130.

8.  Ibid., p.131.

9.  Ibid., p. 132.

10.  D.Feshbach, “What’s Inside the Black Box: A Case Study of Allocative Politics in the Hill-Burton Program.” International Journal of Health Services 9 (2) (1979):313–339.

11.  John A.Kenney, “Federal Versus State Control.” Journal of the National Medical Association 38 (1946):74.

12.  See “Medical Legislation.” Journal of the National Medical Association 39 (1947):175.

13.  Dent, “Hospital Services and Facilities Available to Negroes in the United States,” p. 331.

14.  T.C.McFall, “Needs for Hospital Facilities and Physicians in Thirteen Southern States.” Journal of the National Medical Association 42 (2) (July 1950):235–236.

15.  Editorial, American Journal of Public Health (1957):1447; and U.S. Commission on Civil Rights, Report of the U.S. Commission on Civil Rights, 1963, p. 131.

16.  U.S. Commission on Civil Rights, Report of the U.S. Commission on Civil Rights, 1963, p. 131.

17.  “For Negroes Only.” Time (June 30, 1952):64. For a detailed discussion of the events and activities that led to the building of the Hughes Spalding Pavilion and subsequent problems see Dietrich C.Reitzes, Negroes and Medicine (Cambridge, MA: Harvard University Press, 1958), pp. 280–290.

18.  “For Negroes Only,” p. 64. Grady Memorial Hospital later received Hill-Burton funds of $462,000 for the construction of a Black nurses’ residence, $13,200 for a psychiatric addition, and $278,929 for a diagnostic and treatment center. See “Texts of the Atlanta and Butner, N.C.Suits.” Journal of the National Medical Association 55 (1) (January 1963):51.

19.  R.C.Williams, “One Year of Operating Experiences of 17 Hospitals Built under Hill-Burton.” Journal of the Medical Association of Georgia (December 1952).

20.  Journal of the National Medical Association, 1962:257.

21.  Ibid.

22.  U.S. Commission on Civil Rights, Report of the U.S. Commission on Civil Rights, 1963, p. 132.

23.  Ibid.

24.  Hoge, “The National Hospital Construction Program,” p. 104.

25.  “The Black American in Medicine.” The Journal of the National Medical Association (Supplement) (December 1981):1197.

26.  Ibid.

27.  “Along the N.A.A.C.P. Battlefront.” The Crisis (April 1957):219–220.

28.  Ibid., p. 219.

29.  Ibid.

30.  “Hospital Discrimination and the Sixth Imhotep Conference.” Journal of the National Medical Association 54 (1) (March 1962):253–255.

31.  Robert M.Cunningham, “National Conference Seeks Acceptance of Negro Doctors and Patients in Hospitals.” The Modern Hospital 88 (4) (April 1957).

32.  Robert M.Cunningham, “Are Hospitals for the Sick—Or Just Some of the Sick.” Modern Hospital 76 (June 1951):51.

33.  “Third Imhotep Conference.” The Crisis (June/July 1959):351–352.

34.  Ibid., p. 352.

35.  “The Black American in Medicine,” p. 1198 and “Notables to Address Sixth Imhotep Conference.” Journal of the National Medical Association 54 (2) (March 1962):256.

36.  Ibid., p. 1198.

37.  Ibid., pp. 1197–1198.

38.  Ibid., pp. 1197–1198.

39.  Ibid., pp. 1197–1198.

40.  Max Seham, “Discrimination against Negroes in Hospitals.” The New England Journal of Medicine 271 (18) (October 29, 1964):940–942

41.  Ibid., p. 941.

42.  K.Wing and M.Rose, “Health Facilities and the Enforcement of Civil Rights.” In Ruth Roemer and George McKray (eds.), Legal Aspects of Health Policy: Issues and Trends (Westport, CT: Greenwood Press, 1980).

43.  “Hospital Discrimination and the Sixth Imhotep Conference,” p. 254.

44.  Seham, “Discrimination against Negroes in Hospitals,” p. 942.

45.  Ibid., p. 942.

46.  “Greensboro, North Carolina Group Files Historic Suit Against Hospital Exclusion.” Journal of the National Medical Association 54 (2) (March 1962):259.

47.  K.Wing, “Title VI and Health Facilities: Forms without Substance.” Hastings Law Journal 30 (1) (September 1978):137–190.

48.  “Greensboro, North Carolina Group Files Historic Suit against Hospital Exclusion,” p. 259. This case has been referred to as “the ‘grandaddy of hospital desegregation suits’ for it did what [B]lack medical reformers had been unable to do for fifteen years: eliminate segregation from hospitals funded by the Hill-Burton Act.” See Edward H.Beardsley, “Good-bye to Jim Crow.” Bulletin of the History of Medicine 60 (1986):378.

49.  See Simkins v.Moses H.Cone Memorial Hospital, 211 F. Supp. 628 (M.D.N.C. 1962); 323 F. 2d. 959 (4th Cir. 1963); cert. denied 376. U.S. 938 (1964).

50.  See U.S. Commission on Civil Rights, Equal Opportunity in Hospitals and Health Facilities: Civil Rights Under the Hill-Burton Program (Washington, D.C.: U.S. Government Printing Office, 1965). See also K.Wing and M.Rose, “Health Facilities and the Enforcement of Civil Rights.” In Ruth Roemer and G.McKray (eds.) Legal Aspects of Health Policy: Issues and Trends (Westport, CT: Greenwood Press, 1980).

51.  U.S. Commission on Civil Rights, Report of the U.S. Commission on Civil Rights, (Washington, D.C.: Government Printing Office, 1963.

52.  Ibid., pp. 134–136.

53.  Ibid., pp. 137.

54.  Ibid., pp. 139.

55.  Ibid., pp. 140.

56.  Ibid., pp. 140.

57.  Ibid., pp. 133.

58.  Ibid., pp. 141–142.

59.  Seham, “Discrimination against Negroes in Hospitals,” p. 942.

60.  Ibid.



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Public Policy and the Black Hospital -- : From Slavery to Segregation to Integration

MLA

"The Hill-Burton Act and Black Hospitals." Public Policy and the Black Hospital : From Slavery to Segregation to Integration. Westport, CT: Greenwood Press, 1994. The African American Experience. Greenwood Publishing Group. 30 Oct 2014. <http://testaae.greenwood.com/doc.aspx?fileID=RBP&chapterID=RBP-811&path=books/greenwood>

Chicago Manual of Style

"The Hill-Burton Act and Black Hospitals." In Public Policy and the Black Hospital : From Slavery to Segregation to Integration, Westport, CT: Greenwood Press, 1994. The African American Experience. Greenwood Publishing Group. http://testaae.greenwood.com/doc.aspx?fileID=RBP&chapterID=RBP-811&path=books/greenwood. (accessed October 30, 2014).