Civil Rights and Healthcare: Remembering Simkins v. Cone (1963)

Upon her release from L. Richardson Memorial Hospital’s maternity ward in Greensboro, North Carolina, my grandmother, Ann Wilson Scales, walked a few short steps to her mother’s home with a small baby in hand. She had just given birth to my mother, La Tanya Wilson Sanford, in the city’s Black hospital. It was 1965. Unbeknownst to either of them, a small group of L. Richardson’s physicians, dentists, and patients had waged a quiet war against segregation two years earlier. The city was the site of arguably one of the more consequential yet little-known civil rights battles in American history. No, it was not the beginning of the student sit-in movement initiated by North Carolina A&T students in 1960. Rather, this small contingent fought in district and circuit courts to desegregate U.S. healthcare. At issue was where medical professionals could practice and where patients could access care: in the older, segregated L. Richardson Hospital, or in the newer, more modern (and better funded) Moses H. Cone Memorial Hospital.

In 1962, dentist George Simkins, Jr. unsuccessfully attempted to admit a patient to Moses H. Cone Memorial Hospital, one of two private white hospitals in the city supported by tax dollars. Combining his role as community dentist and President of the Greensboro chapter of the NAACP, Simkins initiated a class-action lawsuit against both Moses Cone and Wesley Long Community Hospitals. The NAACP’s Legal Defense Fund assisted in litigating the test case. Not only were African American patients barred from these institutions, Black physicians were barred from practicing there, even as both institutions received state and federal funds provided by the 1946 Hill-Burton Hospital Survey and Construction Act. Hill-Burton emerged from President Harry Truman’s failed healthcare reform and promised to rebuild and modernize the U.S. healthcare infrastructure. However, this program included a loophole where states that engaged in de jure racial segregation could use the money to build segregated facilities. Cone and Long Hospitals both benefitted from this program and its segregation loophole. This is not to say that segregated hospitals did not exist before the Hill-Burton Program, however; historian Vanessa Gamble chronicles the movement to establish Black hospitals from 1920–1945.

Initially, the district court of North Carolina sided with the defendant hospitals; however, the Fourth Circuit Court of Appeals (and later the United States Supreme Court, which refused to hear the case) deemed that the two hospitals’ policies of racial discrimination for both patient admissions and visiting physician staff privileges violated the fifth and fourteenth amendments of the Constitution.

Last September, the CEO of Cone Health Network, of which Moses Cone Memorial Hospital and Wesley Long Hospitals are now a part, issued a public apology to the last surviving plaintiff of the historic court ruling. Dr. Alvin Blount, 94, graciously accepted the long overdue apology from the health system, initiating local reflections on racial discrimination in healthcare. This is not the first apology issued to acknowledge the long-strained history of race and racism associated with medicine and healthcare. In May 1997, former President Bill Clinton formally apologized for the United States Public Health Service’s “Tuskegee Study of Untreated Syphilis in the Negro Male” (1932–1972). In 2008, the American Medical Association (AMA) officially apologized for its exclusion of Black physicians from membership, an important acknowledgment given that AMA membership became increasingly important for hospital admitting privileges, licensure, and broader steps in professional development. As historian Thomas Ward notes, until the AMA desegregated in 1968, Black physicians were barred from white hospitals and denied opportunities for continuing medical education, thereby justifying their own professional societies and medical schools. All of these apologies were too little, too late, and their legacies continue to influence healthcare to date.

Cone Health commemorated the legacy of the Simkins decision by allocating $250,000 in scholarship funds for students pursuing healthcare professions. Guilford County commemorated the case by placing a marker outside Cone Hospital and a bronze statue of George Simkins on the grounds of the Guilford County Courthouse. These symbolic gestures speak to the case’s broad importance, defining Simkins not only as a significant battle for civil rights in medicine, but also as a touchstone moment in a much larger movement for freedom and liberation. Simkins was decided only months before the Civil Rights Act of 1964 was ratified; the Title VI of this act and Medicare funding forced the desegregation of healthcare facilities almost overnight, as historian David Barton Smith argues. In a short documentary produced by Cone Health, Dr. Blount recalled that the Simkins case “ended ‘separate but equal’ forever.”

Yet, the Simkins decision does not figure prominently in many popular renditions of civil rights history.¹ Contrary to the aforementioned Clinton and AMA apologies, which received national attention, the Simkins apology did not move beyond the local media. In many of these local reflections, the Simkins case was likened to the historic 1954 Brown v. Board ruling. Though both cases ostensibly achieved similar ends, eliminating separate but equal institutions in education and healthcare, respectively, the comparison obscures more than it reveals. Even I am guilty of this shorthand, an easy way to communicate the gravity and significance of this decision. But this shorthand has the unintended effect of perpetuating Simkins’ invisibility.

History plays a role in why Brown lives on in the popular imaginary and Simkins does not. A majority of Americans interacted with both systems as they each cared for the nation’s most vulnerable: children and the infirm. Desegregating American education, however, was a very public battle, as images and video captured the Little Rock Nine or Dorothy Counts (who integrated my high school, Harding University High School in Charlotte, North Carolina) confronting inflamed white mobs. Brown was not simply waged in court; debates around school segregation seeped into American homes and into popular discourse. On the other hand, Dr. Blount remembered that the Simkins plaintiffs wanted to engage in a quiet challenge to segregated healthcare.² Although their fiscal independence allowed some physicians, like T. R. M. Howard, to jump to the fore of a broader movement, others sought to challenge their exclusion from the medical establishment in a more dignified manner.

While the Supreme Court heard Brown, it did not take the Simkins case. Until the Civil Rights Act months later, the lower Circuit Court’s ruling stood as jurisprudence only in the Fourth Circuit’s Mid-Atlantic region. Moreover, the two cases had distinct legal questions at their heart; Brown questioned the separate but equal doctrine established in 1896, while Simkins questioned whether public funding of private institutions counted as “state action.” Undoubtedly, Brown was an essential step leading to the Simkins decision. Without its challenge to the separate but equal doctrine, Simkins may have failed. Finally, the speed by which institutions in the fields of education and healthcare were desegregated differed dramatically. In the words of Chief Justice Earl Warren, school desegregation was ordered with “all deliberate speed,” while the Simkins case, combined with the Civil Rights Act and Medicare legislation, helped to desegregate many hospitals rather quickly. Political scientist and historian David Smith’s The Power to Heal: Civil Rights Medicare, and the Struggle to Transform America’s Healthcare System (2016) recovers this connection and situates health policy implementation in the broader movement for equality, employment, and rights.

Though the Simkins case is lauded for bringing about a swift end to segregation in healthcare, among other things, it led to the decline of Black community hospitals. While some, like Grady Memorial in Atlanta, successfully negotiated the new terrain of race relations, federal monies, power, and increased opportunities for Black medical students and doctors elsewhere, others like Homer G. Phillips Hospital of St. Louis and L. Richardson Hospital shuddered under the burden of increasing medical costs, lack of staff, and changing ideas around the importance of these institutions. In effect, Black hospitals were an anachronism in the post-Simkins era. Where some Black patients could, like my grandmother, walk to and from their community hospitals, such an action is almost inconceivable today given the large, distant campuses of many contemporary urban hospitals and medical centers.

Cone Health’s apology, though overdue, came at just the right moment. Dr. Alvin Blount passed away earlier this year, only months after his former legal foe recognized and applauded his pioneering work. The silences around the Simkins decision demonstrate that more work still needs to be done on our understanding of the history and legacy of Black liberation. Specifically, the nexus between civil rights and health remains fertile ground for scholarly inquiry. We must heed the warning of W. Montague Cobb, physician, anthropologist, editor, activist, and intellectual, “lest we forget.”

Ezelle Sanford III is a fourth-year graduate student at Princeton University in the Department of History, Program in the History of Science. He is currently a Visiting Scholar in the Center for Humanities at Washington University in St. Louis working on his dissertation project, “A Source of Pride, a Vision of Progress: The Homer G. Phillips Hospital of St. Louis, MO.”