The level of the judicial court system in which this legal opinion occurred
The level of the judicial court system emerged from the US Court of Appeals Fourth Circuit (Reynolds 710). Cases involving a hospital in North Carolina and the other hospital in Virginia were determined in these proceedings. Several court cases that involved National Association for the Advancement of Colored People Legal Defense and Education Fund between 1956 and 1967 provided the foundation for the removal of the widespread discrimination in hospitals and professional associations (Reynolds 710).
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Until the mid 1960s, there was overt hospital discrimination in the US. Moreover, these discriminatory practices were legally sanctioned in many states. According to Reynolds, discrimination was demonstrated in several ways, including “denial of staff privileges to minority physicians and dentists, refusal to admit minority applicants to nursing and residency training programs, and failure to provide medical, surgical, pediatric, and obstetric services to minority patients” (710). Attempts to end to hospital discrimination involved the participation of several stakeholders such as “professional organizations; the federal government; public health, hospital, and civil rights organizations” (Reynolds 710). There was also a direct attack on hospital policies on discrimination. As a result, the two landmark rulings involving the above-mentioned hospitals set new precedents for hospital discrimination.
The opinion of the lower court that was finally overturned in Simkins
On appeal of the case, the Fourth Circuit Court overturned years of legal decisions that supported a complex system of discriminatory hospital care. This was the first landmark ruling (Simkins v Moses H. Cone Memorial Hospital – 1963). It altered the use of the federal government’s public funds to expand and maintain segregated hospital care. The role of Chief Justice Simon E. Sobeloff remained instrumental in this landmark ruling. The Supreme Court used its power granted in the US Constitution (Introduction to the United States Legal System Structure of Government par. 2).
The lawyers actively sought for state action or the involvement of the federal government with regard to activities of a private hospital. They wanted a protection against discrimination based on the provisions of the 5th and 14th Amendments of the US Constitution (par. 2). The federal government had to decide whether to render an opinion on state action or the relief on discrimination.
Consequently, in a historic move, the assistant Attorney General offered a long brief in which the position of the Black medical professionals and patients was supported. The federal government argued that the use of the federal funds in a discriminatory way was not constitutions and therefore Black professionals and patients could get medical services and privileges they sought.
Based on the Simkins’ ruling, other court cases cited this ruling to strengthen their arguments against hospital discrimination in the US.
The federal laws that were highlighted in Simkins v. Moses H. Cone
The Hospital Survey and Construction Act (or the Hill–Burton Act) 1946 was critical in this case. The Act aimed to offer federal grants to advance construction and physical plants of the US hospital systems. States were free to distribute money to expand existing hospitals or construct new ones. This applied to both government-owned facilities and voluntary not-for-profit hospitals.
Under the Hill-Burton Act, any hospitals under the program were not allowed to discriminate based on race, color, national origin, or creed, but ‘separate but equal’ clause in the Act allowed hospitals to discriminate. It was the ‘separate but equal’ clause, which would come under attack during the case of Simkins. The lawyers argued that the clause violated the 5th and 14th Amendments of the US Constitution, which had prohibited against racial discrimination.
Although President Johnson ratified the Title VI of the Civil Rights Act of 1964 three months later, it was instrumental in this case. It sought to broaden the concept of equality to all federal programs because voluntary compliance was difficult to achieve. This marked the foundation for the universal access to healthcare in the US.
The role of the federal law in deciding this case
The federal law provided the basis for argument in this case. The federal government interpreted the law to support the position of Black professionals and patients. The government concurred that it was unconstitutional to use federal funds in a discriminatory way. Hence, Black physicians, dentists and patients were granted similar privileges and services based on their statuses.
In interpretation of the federal law, the judges recognized the extensive use of public funds to support comprehensive governmental plans. In this regard, the extent of the both national and state governments’ participation in hospital construction was relevant and therefore, the case did not rest on the issue of equality or lack of it.
The US Supreme Court set a precedent for subsequent cases. For instance, the case of Simkins was regarded as a landmark case and became a point of reference for more than 260 cases between the year 1963 and 2001. It played a critical role in other legal decisions and showed tremendous shift in legal opinion toward hospital discrimination. The federal law again was applied in the case of Eaton, which initially the District Court had dismissed based on factual situation and a lack of changes in the law.
The federal law, therefore, played critical roles in promoting racial integration and compliance among hospitals.
The Constitutional amendments and issues in the case
Initially, the goal was to ensure voluntary compliance with hospitals. This, however, would later prove difficult as discrimination persisted. The filibuster had marred the Civil Rights Act 1964. New regulations were formulated for the Title VI that outlawed the distribution of funds to hospitals or any other state agencies that discriminated minority groups. The President assented to these changes and they became a model for other agencies.
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There was poor voluntary compliance because Black physicians and patients still experienced racial discrimination. In 1965, the Medicare Act was enacted to ensure that the US senior citizens would gain access to hospitals irrespective of their races. The Medicare Act aimed to promote racial integration. However, racial policies and practices were still rampant in many hospitals and lawmakers used their influences to amend the appropriations bill to allow segregation arguably on medical grounds. In counter arguments, it was noted that the appropriations bill was not under the jurisdiction of hospitals. Second, several agencies and other stakeholders had approved Medicare hospital certification guidelines and segregation therefore undermined it. Third, the amendment 207 undermined the provisions of the Civil Rights Act and thus had the potential to reverse gains achieved in eliminating racial discrimination in healthcare. Finally, it had large legal loopholes to promote racial segregation.
The Court of Appeals Fourth Circuit judges asserted that race was simply not a factor to influence “the admission, assignment, classification, or treatment of patients” (Reynolds 710).
The case was limited in its reach
While Simkins was heralded as a landmark ruling and it became a point of reference for many hospital discrimination cases, it was limited in its reach because the US Supreme Court did not grant writ of certiorari. As a result, only facilities, which were proposed or under construction in certain jurisdiction of the Fourth Circuit Court (Maryland, Virginia, West Virginia, North Carolina, and South Carolina) were required by the law to ensure nondiscrimination.
In addition, the new Hill-Burton laws were not applicable to facilities that had already utilized federal funds. It is imperative to note that Hill-Burton construction projects were under the clause of ‘separate but equal’, all-White or all-Black. Although several other institutions had given assurance on nondiscrimination, Black professionals and hospitals continued to experience discrimination in hospitals.
The surgeon general, however, published that hospitals were required to offer services without discrimination because of race, creed or color.
The federal official and agency that finally extended the cases’ ruling and the spread of cases’ outcome across the Nation
The role of the surgeon general in extending the case outcome was noted in the publication. The publication required all hospitals to provide assurances that services will be made available without discrimination because of race, creed, or color to both patients and Black professionals.
Chief Justice Sobeloff and other judges of the Fourth Circuit Court shifted the legal opinion on racial discrimination in hospitals. On several occasions, the Supreme Court reversed the decisions of the District Courts on rulings regarding racial discrimination and segregation.
The NAACP Legal Defense Fund was also instrumental in promoting the outcomes of the cases. For instance, the fund worked with its lawyers to identify hospitals that did not observe compliance and submitted their cases to courts. In addition, it wanted other agencies such as “the Department of Health, Education and Welfare (HEW) to develop a rigorous compliance program, first under the Hill–Burton program and then under Title VI of the 1964 Civil Rights Act” (Reynolds 710). The fund aimed to extend the law to all hospitals in the US, introduce public debates on activities of hospitals other healthcare providers and ensure that they complied with the both federal and state laws and regulations. Lawyers also considered the tax-exempt status of some facilities (Showalter 7).
Later influences were noted in court cases such as Dr. Hawkins and Dr. Cypress’ applications and an attempt by Senator John C. Stennis to promote patient segregation, which the House of Representatives defeated.
The case makes or fails to make a big difference in decreasing health inequities
Clearly, the case of Simkins had a critical positive influence on hospital discrimination for over two decades. It provided opportunities for hospital integration based on the Hill-Burton Act and the provisions under the Civil Rights Act and the Medicare hospital certification program.
While the case resulted in significant improvements, Robert C. Bowman seems to suggest that the current healthcare design has left some Americans behind (Bowman par. 1). The Institutes of Medicine (IOM) has a critical role to play in healthcare design.
The case resulted in widespread changes, but American healthcare systems and designs continue to undergo many changes and ignore other quotas (Teitelbaum s27). While the IOM has promoted notable changes, its design has also failed to account for some sections of healthcare stakeholders such as physicians and health insurance companies. At the same time, the primary care has not reached some sections of the population.
The IOM and other healthcare stakeholders must solve primary care, address healthcare access and long-term investments.
Bowman, Robert C. “Is the Institutes of Medicine Waking Up?” Basic Health Access. 2013. Web.
Introduction to the United States Legal System Structure of Government. n.d. Web.
Reynolds, P. Preston. “Professional and Hospital DISCRIMINATION and the US Court of Appeals Fourth Circuit 1956–1967.” American Journal of Public Health 94.5 (2004): 710–720. Print.
Showalter, J. Stuart. The Law of Healthcare Administration, 6th ed. Chicago, IL: Health Administration Press, 2011. Print.
Teitelbaum, J Burke. “Health care and civil rights: an introduction.” Ethnicity & Disease 15.2 Suppl 2 (2005): S27-30. Print.