Hospital Integration (1955-1980, Section 8)
Despite encouragement from the AMA and the American Hospital Association in the 1950s and early 1960s, most white southern hospitals had resisted desegregation. Full integration of these facilities by both physicians and patients occurred gradually and perhaps more quietly than other civil rights efforts, but it also depended, in part, on lawsuits and federal legislation.
When he returned home to Houston in 1961, Dr. Joseph Clayton Gathe found that most of Houston’s white hospitals did not extend privileges to African-American physicians. Determined to break this color barrier, he repeatedly sought and was denied privileges at St. Joseph’s Hospital for a number of years. Dr. Gathe subsequently and successfully sued the hospital, alleging that its denial of his privileges violated his constitutional rights under the equal protection clause of the Fourteenth Amendment. The first black doctor on staff at St. Joseph, he rose to the position of vice-chief of staff by the end of the 1960s, but discrimination persisted. Traditionally, the hospital board elevated the vice-chief to chief of staff the following year. The board did not promote Dr. Gathe.
Three pieces of federal legislation ultimately proved essential in integrating American hospitals. Title VII of the Civil Rights Act of 1964 prohibited discrimination by covered employers on the basis of religion, sex, race, or national origin. By itself, this law might not have prevented private hospitals from denying privileges to black doctors, in part, because attending physicians usually were not hospital employees.
The following year, however, Congress passed President Lyndon B. Johnson’s Medicare program, a health insurance program for people 65 or older, and Medicaid program, a health insurance program for individuals and families with low incomes and resources jointly funded by the states and the federal government. Medicare and Medicaid were cornerstones of President Johnson’s Great Society. Prior to this time, the health insurance industry in the United States consisted primarily of private companies that provided coverage for some Americans through their places of employment. While President Johnson�s programs expanded coverage, particularly for poor and elderly Americans who otherwise could not afford medical treatment, many other Americans have remained uncovered as the federal government has never passed laws providing for comprehensive national health care.
President Johnson insisted that the law require all hospitals receiving Medicare and Medicaid funds to follow the letter and spirit of the Civil Rights Act. “Ending segregation meant more than merely taking down ‘White’ and ‘Colored’ signs and forcing all-white hospitals to accept African-American patients. The hospital staff of doctors and nurses needed to be desegregated, enabling equal chances for all personnel to receive staff privileges or to qualify for special training.” 1
In 1965, Congress also amended the Hill-Burton Act. Signed into law by President Harry Truman in 1946, the Hill-Burton Act provided federal grants to improve the physical aspects of the nation’s hospitals. Initially, the law allowed for grants to hospitals that followed “separate but equal” policies and maintained segregated facilities. In 1963, the U.S. Supreme Court struck down this provision of the law and, “prohibited further use of public monies for the construction and operation of racially segregated hospitals.” 2 New amendments to the law required compliance with the Civil Rights Act and the Medicare Act and obligated hospitals to provide free or low-cost health care for local residents who could not afford medical services.
With the passage of these laws, most white hospitals in the South quickly and quietly integrated their facilities – almost overnight – for fear of losing federal funding. The physical remnants of Jim Crow began to fall down.
Citations
- Jaap Kooijman, And the Pursuit of National Health: The Incremental Strategy Toward National Health Insurance in the United States of America (Amsterdam and Atlanta, GA: Rodopi By Editions, January 1999).
- Wilbur H. Watson, Against All Odds (New Brunswick, New Jersey: Transaction Publishers, 1999).