Rooting Out Racism in Medicine

Opinion-Editorial

New York Times Newspaper
New York, NY

August 14, 2008



Historians tend to focus on mob violence and lynching when they write about the racial atrocities of the Jim Crow South. But not all killings were carried out by men in white sheets armed with guns and nooses.

Indeed, it’s obvious when you think about it that many more African-Americans died as a result of racist medical treatment in the South than at the hands of all the lynch mobs, bombers, and night riders combined.

The American Medical Association glossed over this issue last month when it issued a formal apology for the racist policies it tolerated — and tacitly endorsed — in the century-long period that ended in the late 1960’s.

(The AMA discusses the issue in fuller form here and here.)

In failing to tell the bloody side of the story, the AMA diminished the power of what was perhaps the most important public statement of its history.

In the segregated South, black Americans who experienced medical emergencies faced the ever-present danger that they would die after being given substandard treatment — or no treatment at all — at segregated hospitals.

One of the more famous deaths, the news of which swept through the black community in 1931, was that of the Fisk University Dean of Women, Juliette Derricotte. She was injured in a car accident in Dalton, Georgia, where the local hospital did not accept black patients. She expired after being transported to a hospital in Chattanooga.

In that same year, the light-skinned father of the civil rights leader Walter White was struck by a car in Atlanta. Mistaken for a white man, he was taken to the white ward at Grady Hospital. He was exposed as a Negro when a darker-skinned relative arrived at the hospital; the staff hustled him across the street to the squalid colored ward, where he, too, eventually died.

Walter White, writing after Ms. Derricotte’s death, summed up the situation as follows: “[T]he barbarity of race segregation in the South is shown in all its brutal ugliness by the willingness to let cultured respected and leading colored women die for lack of hospital facilities which are available to white persons no matter how low in the social scale.”

Of the situation at Grady Hospital, the historian Ronald H. Bayor writes: “When a health emergency occurred and Grady was called for an ambulance, the first question was about the race of the injured. If a black ambulance was not available (they numbered few), one designated for whites would not be sent.”

Because there were always fewer black beds than were needed at white hospitals that treated black people, African-Americans faced the possibility that they would be turned away. Those who gained entry were placed in colored-only wards — sometimes located in basements or boiler rooms — where they often received inferior care, and faced a greater risk of dying because doctors and staff members regarded them as less than fully human.

As the black physician Asa Yancey put it: “the staff responded a few minutes later [with a black patient], and that response probably would continue with the entire treatment.’’ For these reasons, Dr. Yancey said, African-Americans at Jim Crow hospitals had a higher mortality rate than whites at the same hospitals — and a higher death rate than black patients who were fortunate enough to land in black teaching hospitals.

Black physicians, who had formed the National Medical Association, fought against these horrors and urged the AMA to do the same. But the AMA remained shamefully mute at crucial junctures in the struggle for medical fairness.

It failed, for example, to fight against the Hill-Burton Act, the federal law that allowed the states to use federal funds in the construction of hospitals that would be segregated by race. It remained silent during the debates on the Civil Rights Act of 1964.

It also pioneered the “states’ rights” approach, allowing state and county chapters to keep out black physicians when and where they chose to. The same doctors who controlled membership in the AMA chapters prevented black doctors from getting hospital privileges and specialty training.

By holding down the numbers of black physicians, particularly in the specialties, the Southern system ensured that black patients would continue to get inferior care and made it less likely that young black men and women would aspire to the profession. These policies are partly to blame for the shortage of black physicians that plagues the country to this day.

The AMA could have done a much better job of describing the damage its policies have wrought. Nonetheless, the group’s immediate past president, Dr. Ronald Davis, deserves enormous credit for tackling this explosive issue. The apology should be the first step in the process of correcting a whole host of longstanding wrongs.

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