A new highway marker outside Cone Hospital commemorates a lawsuit filed by nine black physicians that resulted in a court decision striking down discrimination in hospitals across the nation.

A lawsuit filed by nine black physicians and dentists, along with two patients, against what is now Cone Health led to the desegregation of hospitals across the country in 1964.

Dr. George C. Simkins Jr., the black dentist and local NAACP president, had previously led a successful effort in the mid-1950s to desegregate the Gillespie Park golf course in southeast Greensboro. Less than a decade later, Simkins’ quiet assault on policies that barred blacks from practicing medicine and black patients from receiving care at the city’s two largest and most modern hospitals — which took place as students carried out mass demonstrations to desegregate lunch counters, cafeterias and theaters — has received less attention.

That oversight was corrected on Tuesday with the unveiling of a new highway marker outside Cone Hospital by the state Departments of Cultural Resources that reads simply: “Simkins v. Cone: Landmark federal court of appeals decision 1963 involving Cone Hospital led to racial integration of hospitals in the US.”

Prior to a federal court ruling in Simkins’ favor, Wesley Long Hospital had completely excluded black doctors and patients, while Cone required that black patients first be admitted to L. Richardson Memorial Hospital, the city’s black hospital. With the exception of “extreme emergencies,” black patients could only request transfer to Cone once they had received a physical exam and diagnostic procedures at Richardson. Another “humiliating condition” required that their black physicians discharge them first before they could receive care at the more modern white hospital. Black patients were required to make do with Richardson, which was built in 1927, while their white candidates had access to the state-of-the-art Cone Hospital, which opened in 1953.

The effort to desegregate Moses Cone Memorial Hospital and Wesley Long Hospital began about two months after NC A&T College students launched the sit-ins at Woolworth’s on Feb. 1, 1960. As Jo Spivey reported at the time for the Greensboro Record, Simkins said he had written letters to administrators at Cone Hospital and Wesley Long Hospital asking that the patients of black physicians be admitted to the two hospitals and had received no response. Spivey quoted Simkins as saying that the Greensboro NAACP believed that “it is morally wrong and legally indefensible that those federal funds may be constitutionally granted to these hospitals in such a way as to deny to one-fourth of Greensboro’s population, just because of race, access to the healing arts and the privileges and opportunities which these federal funds make possible.”

Dr. Alvin Blount, who is now 94, is the last surviving member of the plaintiffs group. Blount served in the Korean War — an experience that would not allow him to accede to the indignities of segregation when he returned to civilian life and began his practice in Greensboro.

“I was just coming from an institution, the Army, which had almost everything you wanted to work with,” he said in a short documentary posted on YouTube by Cone Health in September. “I learned there that men can work together, regardless of race, color or creed.”

The case hinged on whether the private hospitals’ use of federal construction funds made them instruments of the state, and thus subject to 14th Amendment guarantee of equal protection under the law. But the black doctors sought more than the right to practice medicine and have their patients treated at the two Greensboro hospitals; they asked the courts to file an injunction declaring unconstitutional a section of the 1946 Hill-Burton Act that authorized construction of hospitals with federal funds on a “separate but equal” basis. Sponsored by Sen. Lister Hill, a Democrat from Alabama, and Sen. Richard Burton, a Republican from Ohio, the law authorized a massive federal spending bill to subsidize a hospital construction boom to meet pent-up demand after the Great Depression and World War II.

The court dismissed the case on the basis that they didn’t have authority to hold the hospitals to constitutional requirements because while the hospitals were clearly engaging in racial discrimination the plaintiffs hadn’t proven that they were instruments of the state. But when Simkins, Bount and their fellow physicians appealed, they received welcome support from the federal government when Attorney General Robert F. Kennedy filed a friend-of-the-court brief on their behalf..

Almost a year later, on Nov. 1, 1963, the Fourth Circuit Court of Appeals overturned the lower court decision in split 3-2 ruling. In contrast to the district court, the Fourth Circuit concluded that the hospitals’ acceptance of federal funds did reach the necessary “degree of state participating and involvement” to make it subject to Constitutional guarantees.

“The massive use of public funds and extensive state-federal sharing in the common plan are all relevant factors,” the court ruled. “We deal here with the appropriation of millions of dollars of public monies pursuant to comprehensive governmental plans. But we emphasize that this is not merely a controversy over a sum of money. Viewed from the plaintiffs’ standpoint it is an effort by a group of citizens to escape the consequences of discrimination in a concern touching health and life itself. As the case affects the defendants it raises the question of whether they may escape constitutional responsibilities for the equal treatment of citizens, arising from participating in a joint federal and state program allocating aid to hospital facilities throughout the state.”

Addressing the sham of the “separate but equal” doctrine, which had already been struck down by the Supreme Court in its 1954 Brown v. Board decision, the court cited a report by the North Carolina Committee to the United States Commission on Civil Rights. The report found that medical facilities available to non-whites in the state were both more limited and inferior to those open to whites. The ruling also cited a finding by the committee that segregated medical facilities were at least partially responsible for the infant mortality rate for African Americans being double that of whites, while black women died giving childbirth at a rate five times their white counterparts.

Cone Hospital had received $1.3 million and Wesley Long Hospital had received $1.9 million from the federal government, covering about 15 percent of total construction expenses, with most of the funds being disbursed after the Brown v. Board decision. A so-called “Non-Discrimination Report” filed by the NC Medical Care Commission in 1962 to account for the federal funds spelled out what segregation meant: Richardson had 91 acceptable beds for non-white patients, while the two facilities largely off limits to blacks — Cone Hospital and Wesley Long Hospital — had 482 beds and 220 beds respectively.

The legal victory resulted in Cone Hospital inviting four black physicians to join its medical staff in late 1963. Months later, the Supreme Court’s refusal to hear an appeal made the Fourth Circuit opinion the law of the land, effectively ending segregation by hospitals. The Civil Rights Act, signed by President Lyndon Johnson in July 1964, further confirmed the decision by making it illegal for private organizations to discriminate in public accommodations.

Earlier this year, Dr. Blount sat down with Cone Health CEO Terry Akin and Dr. James Wyatt, the president of the hospital’s medical and dental staff, to talk about the struggle to desegregate healthcare in Greensboro.

“If you would allow me, I really consider it an honor — and an overdue honor,” Akin told Blount, “I’d like to say on behalf of Cone Health to you, on behalf of your colleagues, on behalf of the citizens, who were denied access for that period of time, I would like to apologize on behalf of Cone Health for the segregation and the discrimination that you experienced.”

Blount responded slowly and deliberately.

“With deepest appreciation for your efforts to apologize,” he said, “it’s accepted for the fact that for always we’ll be together.”

Akin reiterated his apology on Tuesday, and announced that Cone Health has committed $250,000 in seed money for an annual scholarship fund.

“We know there’s more work to be done,” he said. “In the coming months and years we will continue to challenge ourselves and each other to become an organization that mirrors the communities we serve and that achieves equal health outcomes for all of those for whom we are privileged to care.”

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