REVIEW
A White Dean and Black Physicians at the Epicenter of the Civil Rights Movement Richard D. deShazo, MD,a Robert Smith, MD,b Leigh Baldwin Skipworth, BAa a Departments of Medicine and Pediatrics, The University of Mississippi Medical Center, Jackson; bCentral Mississippi Health Services, Jackson.
ABSTRACT Robert Q. Marston, MD, a gregarious Rhodes and Markel Scholar, native Virginian, and well-connected National Institutes of Health-trained medical scientist found himself the new dean and hospital director of a promising academic medical center at age 38. It was 1961 and the University of Mississippi Medical Center (UMMC) in Jackson was, unknown to him, about to be at the geographic center of the struggle for African American civil rights. That struggle would entangle UMMC in a national search for social justice and change the course of American history and American medicine. Shortly after his arrival, the new dean received and refused a written request from the Secretary of the Mississippi Chapter of the National Medical Association (NMA) to make educational venues at the segregated medical center available to black physicians. The same year, UMMC became the primary medical provider for sick and injured Freedom Riders, sit-in and demonstration participants, and others who breached the racial divide defined by the state’s feared Sovereignty Commission. That divide was violently enforced by collaboration among law enforcement, Citizens’ Councils, and the Ku Klux Klan. The crescendo of the civil rights struggle that attended Marston’s arrival included a deadly riot following James Meredith’s integration of the Ole Miss campus in Oxford in 1962, the death of National Association for the Advancement of Colored People (NAACP) Field Secretary Medgar Evers at UMMC in 1963, a national controversy over UMMC’s role in the autopsies of 3 civil rights workers murdered in Neshoba County, an attempt at limited compliance to Title VI of the Civil Rights Act of 1964, and a federal civil rights complaint against UMMC by the NAACP Legal and Educational Fund in 1965. That complaint noted that UMMC was out of compliance with the Civil Rights Act of 1964 and seriously threatened its federal funding and academic operations. Marston developed a compliance strategy that included the hiring of the first black faculty member, a request for an immediate federal civil rights inspection, and secretive overnight integration of the hospitals and clinics. A key to his strategy was engagement of support from the black community, with whom he had previously developed no relationship. Marston asked NAACP Field Director Charles Evers for support, and met with 5 black Mississippi physicians. Among the 5 was Robert Smith, MD, a founding member of the Medical Committee for Human Rights, the NMA officer whose request for NMA membership-access to the medical center was ignored. He was unaware of their local and national civil rights roles and active dialogue with the federal government on implementation of Title VI. The desire of the black physicians to see UMMC become an equal opportunity health resource resulted in their quiet assistance that aided UMMC compliance initiatives and played a major role in the successful outcome of the 1965 investigation of the charges of Title VI violations. This success established Marston as a national figure in academic medicine and contributed to his selection for positions as Director of The National Institutes of Health and President of the University of Florida. As commemorations of the 50th anniversary of Freedom Summer of 1964 proceed, UMMC has become arguably the most racially integrated academic health center in the United States. Ó 2014 Elsevier Inc. All rights reserved. The American Journal of Medicine (2014) 127, 469-478 KEYWORDS: Academic medical center; Black physicians; Civil rights; Freedom Summer
Funding: None. Conflicts of Interest: None. Authorship: All authors had access to the data and a role in writing the manuscript. 0002-9343/$ -see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.amjmed.2014.03.021
Requests for reprints should be addressed to Richard D. deShazo, MD, Departments of Medicine and Pediatrics, The University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216. E-mail address: [email protected]
470
The American Journal of Medicine, Vol 127, No 6, June 2014
The struggle for civil rights by African Americans in the Associate at the National Institutes of Health (NIH). At the time South climaxed between 1955 and 1968 and changed the of his recruitment, he was Assistant Dean for Student Affairs course of American history and American medicine and Associate Professor of Medicine at the Medical College (Figure 1). It is bookended by the Montgomery, Alabama of Virginia. He had no other administrative experience.2 bus boycott led by Martin Luther King, Jr., and his asSoon after his arrival, UMMC found itself at the epicenter sassination in 1968, and continues today. The involvement of the American civil rights movement, unable to escape the of physicians in the movement for politics, violence, and change of the social justice in health and the time. Marston successfully navigaCLINICAL SIGNIFICANCE resulting impact on medicine is a ted UMMC through this period of th story fitting 2014, the 50th annichaos. Remarkable was his skill in The occasion of the 50 anniversary of pacification of the segregationists versary of Freedom Summer in Freedom Summer 1964 in Mississippi, an surrounding him, his initial failure Mississippi. The newly catalogued event that changed the course of history to embrace Mississippi black phyrecords of Maurine Twiss, who and medicine in the US, provides an sicians who reached out to him, and served as the University of Misopportunity to revisit the role of physithe role these physicians played in sissippi Medical Center (UMMC) cians in the movement for social justice. his success. Public Relations Director from August 1955 to 1978, provide insight on events there during that LANDMARK LEGISLATION AFFECTING period (Figure 2). Some of these records were source do1 SEGREGATION IN HEALTH CARE cuments for her book, Pressure from All Sides. The state’s fledgling academic health center, UMMC, The Hill-Burton Act of 1946 financed 40% of new hospital opened in 1955 (Figure 3). A new, 38-year-old dean, Robert beds in the US between 1946 and 1976.3,4 Many of these Marston, MD, arrived in 1961 (Figure 4). Marston, a Rhodes beds were in new hospitals like UMMC. Language in the and Markel Scholar, was a Virginia Military Institute and legislation ensured the preservation of segregated health care Medical College of Virginia graduate who had been a Clinical until the Simkins v. Moses Cone court decision 17 years later.
Figure 1 The violent nature of resistance to the civil rights movement in Mississippi is demonstrated in these 2 photographs. (A; left) This interaction between police and 5-yearold Anthony Quinn occurred during a 1965 demonstration against police brutality at the Jackson City Hall. (B; right) June Finer, MD, Medical Committee for Human Rights (MCHR) Southern Region Coordinator, comforts Anthony after an American flag was jerked from his hands. Dr Finer was arrested and taken to jail for inspection of her medical bag (shown) for prescription medications, as the state medical licensure agency refused to grant licensure to MCHR physicians. She had none. These pictures were published in The New York Times in July 1965 and were widely discussed. (Matt Herron/TakeStock).
deShazo et al
Medicine and Civil Rights
Figure 2 Maurine Twiss, Director of the Office of Public Affairs at the University of Mississippi Medical Center (UMMC) during Marston’s tenure. She kept extensive typed notes of activities at UMMC related to civil rights. (Twiss Archives, UMMC Rowland Medical Library).
There the court ruled that Hill-Burton hospitals could neither refuse to admit black patients, segregate them, or deny hospital privileges to black physicians.5 Like older civil rights rulings, Simkins proved anemic in promoting integration. The Brown v. Board of Education ruling that followed in 1954 outlawed separate-but-equal segregation in public education but also was slow to be implemented.6 It ignited a violent wave of racial politics and militancy against desegregation in the South.
471
Figure 4 Robert Q. Marston, MD, Dean of the School of Medicine and Director of the University of Mississippi Medical Center (UMMC) in 1961. (Twiss Archives, UMMC Rowland Medical Library).
working against integration, including White Citizens’ Councils and the Ku Klux Klan (KKK).7 The Civil Rights Act of 1964 with Title VI that specifically outlawed segregation in government-sponsored programs brought civil rights activities to a boil in Mississippi state institutions.8 The Federal Bureau of Investigation (FBI) titled Mississippi cases of the period “Miburn,” Mississippi Burning, because of the widespread burning of black churches and homes and the assaults and murder of civil rights advocates.9
RESISTANCE TO DESEGREGATION In Mississippi, the Brown decision resulted in the immediate establishment of segregationist Governor J.P. Coleman’s Sovereignty Commission to spy on and intimidate any citizen favoring civil rights and to collaborate with organizations
Figure 3 The University of Mississippi Medical Center (UMMC) shortly after its opening in 1955. (Twiss Archives, UMMC Rowland Medical Library).
UMMC BETWEEN A ROCK AND A HARD PLACE Increasingly, the totally segregated UMMC was involved in the social turmoil surrounding civil rights during the time of Marston’s deanship (Figure 5). Statewide voter registration efforts and challenges to segregation in interstate transportation brought Freedom Rides into Jackson, the state capital, beginning in 1961 and resulted in incarceration of hundreds of civil rights activists.10 UMMC cared for many sick and injured civil rights workers for rural and metropolitan areas in its emergency units.11 The admission of James Meredith as the first black student at the University of Mississippi (Ole Miss) campus in Oxford in 1962 resulted in a riot, deaths, and occupation of the city by US military troops.12 Marston met with UMMC medical students and house staff, many of whom were Ole Miss graduates, to keep them in Jackson and away from the turmoil in Oxford.1 (page 85) One response to the integration of Ole Miss and increasing attempts at voter registration in the state was the assassination of National Association for the Advancement of Colored People (NAACP) Field Director and Mississippi native, Medgar Evers, in June 1963. He was shot with a high-powered
472
The American Journal of Medicine, Vol 127, No 6, June 2014
Figure 5
Abbreviated chronology of events in this paper.
rifle by a killer lying in wait outside his home in Jackson. Evers died at UMMC despite resuscitation attempts.13 Albert A. Britton, Jr., MD, a black physician in Jackson and friend of Medgar Evers, was present at UMMC during efforts to save him in the emergency room and gave high praise to UMMC staff for their medical care and the professional courtesy he received (personal interview of E. King by Richard deShazo, MD, Jackson, MS, February 19, 2014).
MEDICAL SUPPORT FOR FREEDOM SUMMER The Council of Federated Organizations (COFO),14 a confederation of the 4 civil rights organizations most active in
Mississippi at the time, developed a carefully planned, organized, and executed Mississippi Summer Project that came to be known as Freedom Summer of 1964. Over 900 carefully selected, mostly white, students from prestigious east and west coast colleges and universities arrived in waves in Mississippi in June and were joined by other volunteers, including teachers, labor organizers, social workers, attorneys, and others from all over the US. During the planning for Freedom Summer, Mississippi native Robert “Bob” Smith, MD, realized that the small number of black physicians in the state, many of whom were in the process of moving elsewhere or retiring out of fear for their lives and livelihoods, would be inadequate to provide medical care for
deShazo et al
Medicine and Civil Rights
such a large group of volunteers (Figure 6). Care from the white physician community was unlikely, as many had been angered by an insulting letter from 2 east coast physician volunteers (Figure 7).15 (page 41) Many black and white physicians would not risk the attention of the Sovereignty Commission to provide care to outside “agitators.” Smith, acting as an officer of the Mississippi affiliate of the National Medical Association, asked Marston shortly after his arrival for black physician access to UMMC educational programs, but Smith was rebuffed (personal interview of Robert B. Smith, MD, by Richard deShazo, MD, Jackson, MS, January 30, 2014). Thus, he considered it unlikely that UMMC would provide physicians for Freedom Summer outside of the UMMC campus. Smith was a founding member of the progressive physicians group, the Medical Committee for Human Rights (MCHR). In 1963, he had unsuccessfully presented a petition to and picketed the American Medical Association to demand desegregation of state medical societies and membership for black physicians.15 (page 16) Smith contacted MCHR physician colleagues in New York and requested
Figure 6 Robert Smith, MD, Mississippi native, family practitioner, founding member of the Medical Committee for Human Rights and longtime national civil rights leader. (Robert Smith, MD).
473 that the organization take on statewide medical support for the volunteers as a project. The MCHR arrived in the state 1 month later with physicians, nurses, and psychologists for deployment throughout the state.16 On June 21, 1964, a Freedom Summer volunteer, Andrew Goodman, joined another white New York native, Michael (Mickey) Schwerner, and black Mississippi native, James Chaney, both COFO members, in Meridian, Mississippi for a day trip to nearby Neshoba County to visit the members of a church that had been burned by the KKK.15 (pp. 69-70) On their way home, the KKK and local law enforcement members murdered all 3 and buried them in an earthen dam nearby. Their bodies were found by the FBI 6 weeks later and taken to UMMC, thus, keeping UMMC in the eye of the civil rights storm9 (Figure 8).
MURDER AND PROFESSIONAL DISGRACE IN GERMANY AND MISSISSIPPI? A Neshoba County judge ordered that the autopsies for the 3 men be performed at UMMC by a community pathologist, Dr Featherston, rather than by University pathologists, 2 of whom were present to assist agents from FBI crime laboratories.1 (page 108) Schwerner’s family asked that MCHR physicians Charles Goodrich, MD, and Alfred Kogan, MD, already in Jackson, be present for the autopsies. The Neshoba County attorney refused the request. Spokespersons for COFO reported to the press that UMMC had refused to allow MCHR physicians to observe the autopsies, a charge widely quoted in the press.17 The autopsy was made more suspicious, as the FBI allowed the Neshoba County Sherriff and his deputy, both suspects in the murders, to observe the autopsies.18 Afterward, FBI agents told the local press that all 3 had been shot to death. Dr M. David Spain, a well-known New York forensic pathologist and civil rights activist, appeared at UMMC the following day and was allowed by UMMC pathologists to view the body of James Chaney. He concluded that Chaney had been both beaten and shot and suggested there had been a cover-up of the beating by the pathologists present at the first autopsy.19 This was followed by an article in the Yale Journal of Biology and Medicine that condemned UMMC and commented that, “Nazi Germany may seem far away, but we can find occasions nearer home and close in time which bear on the status of the physician as a member of society.”20 The nationwide discussion of these articles caused Marston to fear that the years of work by Arthur Guyton, MD, and others to build a great medical center for Mississippi could be lost to false accusations.1 (pages 110-111) Marston worked hard to defend UMMC and faculty accused in this matter. For instance, in a letter to the editor of the Yale Journal, he wrote, “Our department of pathology was unfairly charged with unprofessional conduct in the lay press last year by Dr David M. Spain,” and now, “Dr Louis Lasagna repeats Dr Spain’s charges as ‘examples of professional disgrace in Germany and Mississippi’.”21 Marston noted that J. Edgar Hoover confirmed in writing that he, not UMMC, refused to
474
The American Journal of Medicine, Vol 127, No 6, June 2014
Figure 7 The Brenner and Coles letter was mailed to physicians in Mississippi in June of 1964 by Harvard psychologist Robert Cole and Massachusetts Institute of Technology physician Joseph Brenner. They participated in the orientation of Freedom Summer volunteers at Oxford, Ohio. (Re-illustrated from reference #17).
release the original autopsy report (Figure 9). The whole affair “cast a shadow over the Medical Center which loomed there for a long time.”1 (pp. 110-111) Review of the un-redacted and still unpublished original autopsy report shows that Dr Featherston noted “fractured and broken bones were present in the jaw, upper limbs, and left shoulder area” of James Chaney.9 There was no cover-up.
A NEW FEDERAL COMPLIANCE QUESTIONNAIRE Marston was required to sign a new Civil Rights Act-related federal compliance document to receive federal funds in 1964 and requested an opinion on the document from the University attorney. The attorney replied that a “yes” to any question about the presence of racially segregated employee facilities would place UMMC out of compliance. A financial statement for 1963-1964, prepared for discussions around this matter, shows that the school had received $2,192,299 in
federal funds during the period, with an additional $334,323 due. Those funds were essential to survival. But compliance was not a simple task.22 The Sovereignty Commission had UMMC under constant scrutiny. Memories were fresh of the legislature’s “expression of concern” in 1956 about “creeping racial integration” at UMMC, followed by a legislative investigation in 1962 when black and white children were found watching television together in the hospital.23 Marston sought an opinion from the Sovereignty Commission (and governor) as well and provided financial information to the Commission through the UMMC comptroller. The Commission, concerned that the legislature might be asked to replace any funds lost, recommended “voluntary compliance” without the option to “fully desegregate.”24 Because of concern that the white facilities management personnel would refuse, Twiss and Marston (carrying the opinion from the University attorney in his hand) personally
deShazo et al
Medicine and Civil Rights
475
Figure 8 Missing poster showing the 3 civil rights workers whose bodies were later found in Neshoba County, Mississippi in August 1964. (Federal Bureau of Investigation, June 1964).
removed “colored” and “white” signs throughout UMMC one night in the summer of 1964. In discussions with the UMMC architect, Marston learned that UMMC had been originally designed and constructed to be an integrated facility.25 The wall that separated “colored” from “white” areas in the hospital cafeteria soon disappeared in the middle of the night and the new federal compliance document was signed.1 (page 123) There were no questions that would require the desegregation of patient and visitor areas, prohibited by Title VI, so that was not done.
THE THREAT OF LOSS OF FEDERAL GRANTS AND CONTRACTS In 1964 and onward, Hill-Burton hospitals in Mississippi were visited by MCHR physicians and nurses who noted
and reported Title VI violations to federal agencies, the NAACP, and others.17 (page 34) On March 5, 1965, the Associated Press ran a story that the NAACP Legal and Educational Defense Fund had filed civil rights complaints against 29 hospitals in 8 southern states with the US Department of Health and Human Services (HHS), and the UMMC University Hospital was on the list. In mid-April, Marston learned that NIH payments on grants and contracts were to be held for any institution charged with noncompliance until they were inspected. Marston’s attempts to get the specifics of the complaint from contacts he had in Washington failed, until a checklist to be used in hospital investigations was leaked to him in March of 1965.26 The list suggested that complaints against UMMC were likely to be related to remaining segregation in the institution.
476
The American Journal of Medicine, Vol 127, No 6, June 2014
Figure 9 J. Edgar Hoover’s July 1965 response to a letter from Dr Marston requesting release of the Featherston autopsy reports on 3 civil rights workers. (Twiss Archives, University of Mississippi Medical Center Rowland Medical Library).
Marston decided to be proactive. He sought and received the advice and presence at UMMC of Ole Miss Chancellor, J.D. Williams, in the implementation of a plan. On March 11, an African American PhD was offered the first faculty position for an African American, over resistance from the state college board. Next, he asked the black community for support, a reach, because he had little contact with them in his first 3 years as dean. Knowing that the NAACP was the source of the charges, he sent a letter to Charles Evers, who had replaced his brother, Medgar Evers, as Mississippi Field Director for the NAACP and asked for support and dialogue.27 He also asked for a meeting with Mississippi black physician leaders whom he had never met. They included Drs Albert B. Britton, Jr, William Miller, Robert Smith, James Anderson from Jackson, and Dr Cyril Walwyn from Yazoo City, Mississippi. Dr Marston met with them on April 13,
and much to his surprise, realized they knew the details of the NAACP complaint, the federal scrutiny of UMMC, that a site visit was coming, and much more.1 (page 138) They also mentioned the locations of “colored” signs on campus that had not been removed, and that the cafeteria was still “segregated,” as whites sat with whites and blacks with blacks. They suggested that the former “colored” and white lunch lines in the cafeteria be consolidated into a single one, but Marston left them in place.1 (page 138) Later, Marston realized that these black physicians were at the center of local and national civil rights activities, including historic leadership positions in the NAACP and present leadership in Freedom Summer, COFO, and the MCHR. He did not know that Smith had recently been asked to be an Assistant Secretary in the Equal Opportunity Division of HHS, but turned it down. Britton was Chair of
deShazo et al
Medicine and Civil Rights
the Mississippi Advisory Committee to the US Civil Rights Commission. Some, including Britton and Smith, had regular meetings with HHS at their Atlanta and Washington offices, where progress toward compliance to civil rights legislation was reviewed. Most of these physicians also had close contacts with rank-and-file Mississippi blacks, including the 899 black UMMC employees, through their medical practices. Marston asked them for advice and assistance. They offered help and information on community concerns about discriminatory practices at UMMC. The Twiss files contained numerous notes of telephone calls and letters between Marston and Britton, who eventually asked Marston to join the local Head Start Steering Committee.28 Marston was quietly inducted into the National Medical Association.1 (page 141),28 Twiss wrote that, “No matter how profound their belief in the civil rights movement, how determined they were to remove inequities, they did not want to damage the state’s medical center.”1 (page 142) What they did want was equal access of black physicians and patients to the resources of UMMC and equal opportunity employment for black employees. The evidence shows they risked their lives for that goal (personal interview of Robert B. Smith, MD, by Richard deShazo, MD, Jackson, MS, December 26, 2013). The assistance of these black physicians toward UMMC’s compliance with Title VI and their communications to federal civil rights enforcement agencies on behalf of UMMC has not been fully appreciated. The day after his meeting with black physicians, Marston issued a written order to his reluctant Hospital Director to completely and immediately integrate lest the funds be lost.29 There were white faculty at UMMC who were supportive of Marston’s decision, but available records show that his decisions were made with little faculty input. Funding deadlines with the NIH were at hand. Marston contacted James M. Quigley, Assistant Secretary of the Department of Health Education and Welfare in Washington. He explained the implications of even a temporary loss of funding and argued that an immediate site visit to disprove the allegations (still unknown to him) was only fair. Quigley agreed and the inspection was scheduled for 3 days later. The inspection team that arrived on Friday, April 16, 1965 included 2 senior administrators, Sherry Arnstein from Quigley’s office at the Department of Health, Education, and Welfare, and William Burleigh, assistant chief of the Division of Hospitals and Medical Facilities for the US Public Health Service. Before the visit, Mrs Arnstein told colleagues that if she found UMMC in compliance, she would begin her report with, “Christ has risen.” While the inspection proceeded, Dr Marston simultaneously addressed the faculty and staff in the presence of Arnstein and Burleigh on the subject, “Medical Center Policy on Civil Rights Implementation.”25 The bottom line was, “The time is now” to integrate because we have to do so to survive financially. No comments about social justice were made. The 2 investigators left, nothing transpired, and another investigator appeared on June 7 to inspect the cafeteria. Just
477 as the black physicians reported to Marston, he was concerned that whites still sat with whites and blacks with blacks, and both used separate lunch lines. In response, UMMC closed one of the lunch lines to force “mingling.”1 (page 150) When a hold was placed on the funding of one grant, Marston sent a telegram to Quigley on June 9, saying holding grant money from UMMC was “meaningless.” Quigley, impressed with Marston’s efforts and persistence, said he would release the money. Several years later, Mrs Arnstein told Marston at an American Association of Medical Colleges meeting that she started her inspection report to Quigley with, “Christ has risen.” Life went on, with no further inspections during Marston’s tenure, but he knew more would follow. In the interim, as they sat side by side on a plane ride from Washington to Jackson, Marston commented to Smith that the continuous civil rights problems at the Medical Center were “risky to the career of a Rhodes Scholar” and he was “looking at other opportunities.” In 1966, Marston, who had impressed many with his leadership at UMMC, became Associate Director of the NIH, where he established the Regional Medical Program. He was promoted to NIH Director and subsequently became a successful President of the University of Florida at Gainesville in 1974. Meanwhile, Mississippi practicing physicians and civil rights veterans Drs Robert Smith, James Anderson, Charles Humphrey, and Aaron Shirley partnered with Drs Count Gibson, Jack Geiger, and other MCHR veterans of Freedom Summer to propose and develop the Federally Qualified Health Center (FQHC) program, a major accomplishment of President Lyndon B. Johnson’s War on Poverty. The first rural FQHC opened in the Mississippi Delta in 1967.30 UMMC has a formal ongoing relationship with 21 Mississippi FQHCs, a Center for Health Disparities and Rural Health, a successful recruitment program for minority students, an Association of American Medical Colleges-recognized holistic-admission process, and a faculty that willingly participate in the search for justice in health.31 The martyrdom of Medgar Evers, Mickey Schwerner, James Chaney, and others, the Civil Rights Act of 1964, the Voting Rights Act of 1965, the skills of a Dean, and the courage of a small group of “good doctors” helped make that possible.
ACKNOWLEDGEMENT The authors appreciate the assistance of Janis Quinn, BA, with reviews of archival materials. Jerry Mitchell provided the unredacted autopsy report of James Chaney.
References 1. Twiss MC, Currier RD. Pressure from All Sides—The University of Mississippi Medical Center in the 60s. Jackson, MS: The University of Mississippi Medical Center; 2004. 2. McGuigan JW. Robert Quarles Marston, M.D. 1923-1999. Trans Am Clin Climatol Assoc. 2005;116:Ix-Ixiii. 3. Olakanmi O. Report on Historical Links Between the American Medical Association and the “Hill-Burton Act” (pp. 1-12). Available at: www. ama-assn.org/doc/ethics/hillburton.pdf. Accessed January 20, 2014.
478 4. Hill-Burton Act, 42 USC S 291 e(f) (1946). Available at: http://www. ecfr.gov/cgi-bin/retrieveECFR?gp¼1&SID¼5001d169544ff7cb8345697 84f2bede7&ty¼HTML&h¼L&n¼42y2.0.1.2.13&r¼PART. Accessed February 17, 2014. 5. Simkins v Moses H. Cone Memorial Hospital 323 F2d 959 (4th Cir), cert denied, 376 US 938(1964). Available at: https://www.casetext.com/ case/simkins-v-moses-h-cone-memorial-hospital. Accessed February 17, 2014. 6. Brown v. Board of Education, 347 US. 483(1954). Available at: http:// scholar.google.com/scholar_case?case¼12120372216939101759&q¼ Brownþv.þBoardþofþEducation,þ347þUS.þ483þ(1954).&hl¼en& as_sdt¼6,25&as_vis¼1. Accessed February 17, 2014. 7. Silver JW. Chapter 2: The voices of militancy. In: Mississippi: The Closed Society. New York: Harvest Books; 1963:40-43. 8. Civil Rights Act of 1964, Pub L. 88-352. Available at: http:// library.clerk.house.gov/reference-files/PPL_CivilRightsAct_1964.pdf. Accessed February 17, 2014. 9. US Department of Justice, Federal Bureau of Investigation. Bernard L. Akin et al. vs Victims, File 44-25706, 12/9/1964. Available at: http:// vault.fbi.gov/Mississippi%20Burning%20(MIBURN)%20Case/Missis sippi%20Burning%20(MIBURN)%20Case%20Part%208%20of%209. Accessed February 10, 2014. 10. Arsenault R. Freedom’s coming and it won’t be long. In: Freedom Riders: 1961 and the Struggle for Racial Justice. New York: Oxford University Press; 2006:259-303. 11. The Student Nonviolent Coordinating Committee. A Chronology of Violence and Intimidation in Mississippi Since 1961. Available at: http:// www.crmvet.org/docs/sncc_ms_violence.pdf. Accessed February 17, 2014. 12. Bryant N. Black Man Who Was Crazy Enough to Apply to Ole Miss. J Blacks High Educ 2006;(53):60-71. 13. Dalton ML. The first lung transplantation. Ann Thorac Surg. 1995;60: 1437-1438. 14. Payne C. I’ve Got the Light of Freedom: The Organizing Tradition and the Mississippi Freedom Struggle. Berkeley, CA: University of California Press; 1995. 15. Dittmer, John. The Good Doctors: The Medical Committee for Human Rights and the Struggle for Social Justice in Health Care. New York: Bloomsbury; 2010. 16. McAdam D. Freedom high: the summer of ‘64. In: Freedom Summer. New York: Oxford University Press; 1988:154-155. 17. Twiss M. Note to file. Jackson, MS: UMMC Rowland Medical Library Archives; Twiss File; August 5, 1964.
The American Journal of Medicine, Vol 127, No 6, June 2014 18. Cochran J Jr, O’Tousa A. Federal Bureau of Investigation Autopsy Report of Dr. William Preston Featherston, August 12, 1964. File JN 44-1, page 1-6. Unredacted copy obtained courtesy of Jerry Mitchell, Clarion Ledger Newspaper, Jackson, Mississippi using Freedom of Information Act. 19. Spain D. Mississippi autopsy. Ramparts Magazine; 1964:43-49. Available at: http://dickatlee.com/issues/mississippi/mississippi_eye witness/mississippi_autopsy.html. Dr. Spain’s reports in the press and a subsequent paper in the Yale Journal of Biology and Medicine in January 1965. 20. Lasagna L. The mind and morality of the doctor. II. Physician and the macrocosm. Yale J Biol Med. 1965;37:361-378. 21. Marston RQ. Correspondence from the University of Mississippi Medical Center. Yale J Biol Med. 1965;38:47-48. 22. Financial Statement of Federal Funds Received by UMMC 1963-1964. Jackson, MS: UMMC Rowland Medical Library Archives; Twiss File. 23. Ole Miss hospital integration cited. Legislator says children in pediatrics ward mixed. Clarion Ledger newspaper. Jackson, MS: January 19, 1962. 24. Johnson E Jr. Letter to Paul B. Johnson, Governor. Available at: http:// mdah.state.ms.us/arrec/digital_archives/sovcom/result.php?image¼images/ png/cd05/038599.png&otherstuff¼3j72j0j13j1j1j1j38005j. Accessed April 1, 2014. 25. Marston RQ. Medical Center Policy on Civil Rights Implementation. Jackson, MS: UMMC Rowland Medical Library Archives; Twiss File; April 16, 1965. 26. Twiss M. Typed transcription of phone call from contact at HEW. Jackson, MS: UMMC Rowland Medical Library Archives; Twiss File; March 12, 1965. 27. Marston RQ. Letter to Charles Evers. Jackson, MS: UMMC Rowland Medical Library Archives; Twiss File; April 17, 1965. 28. Marston RQ. Typed record of May 28, 1965 phone conversation with A.B. Britton, Jr., MD, who offered an invitation to join MS Project Head Start Steering Committee and received an update on minority applications to the School of Nursing and Medicine. Jackson, MS: UMMC Rowland Medical Library Archives; Twiss File. 29. Marston RQ. Letter to David Wilson, MD. Jackson, MS: UMMC Rowland Medical Library Archives; Twiss File; April 13, 1965. 30. Lefkovitz B. Chapter 2. MS: Where it all began. Community Health Centers: A Movement and the People Who Made it Happen. New Brunswick, NJ: Rutgers University Press; 2007:35-42. 31. Quinn J. Promises Kept. Jackson, MS: The University of Mississippi Medical Center; 2005:176-177. June 13, 2001. Post Script.
A White Dean and Black Physicians at the Epicenter of the Civil Rights Movement Richard D. deShazo, MD,a Robert Smith, MD,b Leigh Baldwin Skipworth, BAa a Departments of Medicine and Pediatrics, The University of Mississippi Medical Center, Jackson; bCentral Mississippi Health Services, Jackson.
ABSTRACT Robert Q. Marston, MD, a gregarious Rhodes and Markel Scholar, native Virginian, and well-connected National Institutes of Health-trained medical scientist found himself the new dean and hospital director of a promising academic medical center at age 38. It was 1961 and the University of Mississippi Medical Center (UMMC) in Jackson was, unknown to him, about to be at the geographic center of the struggle for African American civil rights. That struggle would entangle UMMC in a national search for social justice and change the course of American history and American medicine. Shortly after his arrival, the new dean received and refused a written request from the Secretary of the Mississippi Chapter of the National Medical Association (NMA) to make educational venues at the segregated medical center available to black physicians. The same year, UMMC became the primary medical provider for sick and injured Freedom Riders, sit-in and demonstration participants, and others who breached the racial divide defined by the state’s feared Sovereignty Commission. That divide was violently enforced by collaboration among law enforcement, Citizens’ Councils, and the Ku Klux Klan. The crescendo of the civil rights struggle that attended Marston’s arrival included a deadly riot following James Meredith’s integration of the Ole Miss campus in Oxford in 1962, the death of National Association for the Advancement of Colored People (NAACP) Field Secretary Medgar Evers at UMMC in 1963, a national controversy over UMMC’s role in the autopsies of 3 civil rights workers murdered in Neshoba County, an attempt at limited compliance to Title VI of the Civil Rights Act of 1964, and a federal civil rights complaint against UMMC by the NAACP Legal and Educational Fund in 1965. That complaint noted that UMMC was out of compliance with the Civil Rights Act of 1964 and seriously threatened its federal funding and academic operations. Marston developed a compliance strategy that included the hiring of the first black faculty member, a request for an immediate federal civil rights inspection, and secretive overnight integration of the hospitals and clinics. A key to his strategy was engagement of support from the black community, with whom he had previously developed no relationship. Marston asked NAACP Field Director Charles Evers for support, and met with 5 black Mississippi physicians. Among the 5 was Robert Smith, MD, a founding member of the Medical Committee for Human Rights, the NMA officer whose request for NMA membership-access to the medical center was ignored. He was unaware of their local and national civil rights roles and active dialogue with the federal government on implementation of Title VI. The desire of the black physicians to see UMMC become an equal opportunity health resource resulted in their quiet assistance that aided UMMC compliance initiatives and played a major role in the successful outcome of the 1965 investigation of the charges of Title VI violations. This success established Marston as a national figure in academic medicine and contributed to his selection for positions as Director of The National Institutes of Health and President of the University of Florida. As commemorations of the 50th anniversary of Freedom Summer of 1964 proceed, UMMC has become arguably the most racially integrated academic health center in the United States. Ó 2014 Elsevier Inc. All rights reserved. The American Journal of Medicine (2014) 127, 469-478 KEYWORDS: Academic medical center; Black physicians; Civil rights; Freedom Summer
Funding: None. Conflicts of Interest: None. Authorship: All authors had access to the data and a role in writing the manuscript. 0002-9343/$ -see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.amjmed.2014.03.021
Requests for reprints should be addressed to Richard D. deShazo, MD, Departments of Medicine and Pediatrics, The University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216. E-mail address: [email protected]
470
The American Journal of Medicine, Vol 127, No 6, June 2014
The struggle for civil rights by African Americans in the Associate at the National Institutes of Health (NIH). At the time South climaxed between 1955 and 1968 and changed the of his recruitment, he was Assistant Dean for Student Affairs course of American history and American medicine and Associate Professor of Medicine at the Medical College (Figure 1). It is bookended by the Montgomery, Alabama of Virginia. He had no other administrative experience.2 bus boycott led by Martin Luther King, Jr., and his asSoon after his arrival, UMMC found itself at the epicenter sassination in 1968, and continues today. The involvement of the American civil rights movement, unable to escape the of physicians in the movement for politics, violence, and change of the social justice in health and the time. Marston successfully navigaCLINICAL SIGNIFICANCE resulting impact on medicine is a ted UMMC through this period of th story fitting 2014, the 50th annichaos. Remarkable was his skill in The occasion of the 50 anniversary of pacification of the segregationists versary of Freedom Summer in Freedom Summer 1964 in Mississippi, an surrounding him, his initial failure Mississippi. The newly catalogued event that changed the course of history to embrace Mississippi black phyrecords of Maurine Twiss, who and medicine in the US, provides an sicians who reached out to him, and served as the University of Misopportunity to revisit the role of physithe role these physicians played in sissippi Medical Center (UMMC) cians in the movement for social justice. his success. Public Relations Director from August 1955 to 1978, provide insight on events there during that LANDMARK LEGISLATION AFFECTING period (Figure 2). Some of these records were source do1 SEGREGATION IN HEALTH CARE cuments for her book, Pressure from All Sides. The state’s fledgling academic health center, UMMC, The Hill-Burton Act of 1946 financed 40% of new hospital opened in 1955 (Figure 3). A new, 38-year-old dean, Robert beds in the US between 1946 and 1976.3,4 Many of these Marston, MD, arrived in 1961 (Figure 4). Marston, a Rhodes beds were in new hospitals like UMMC. Language in the and Markel Scholar, was a Virginia Military Institute and legislation ensured the preservation of segregated health care Medical College of Virginia graduate who had been a Clinical until the Simkins v. Moses Cone court decision 17 years later.
Figure 1 The violent nature of resistance to the civil rights movement in Mississippi is demonstrated in these 2 photographs. (A; left) This interaction between police and 5-yearold Anthony Quinn occurred during a 1965 demonstration against police brutality at the Jackson City Hall. (B; right) June Finer, MD, Medical Committee for Human Rights (MCHR) Southern Region Coordinator, comforts Anthony after an American flag was jerked from his hands. Dr Finer was arrested and taken to jail for inspection of her medical bag (shown) for prescription medications, as the state medical licensure agency refused to grant licensure to MCHR physicians. She had none. These pictures were published in The New York Times in July 1965 and were widely discussed. (Matt Herron/TakeStock).
deShazo et al
Medicine and Civil Rights
Figure 2 Maurine Twiss, Director of the Office of Public Affairs at the University of Mississippi Medical Center (UMMC) during Marston’s tenure. She kept extensive typed notes of activities at UMMC related to civil rights. (Twiss Archives, UMMC Rowland Medical Library).
There the court ruled that Hill-Burton hospitals could neither refuse to admit black patients, segregate them, or deny hospital privileges to black physicians.5 Like older civil rights rulings, Simkins proved anemic in promoting integration. The Brown v. Board of Education ruling that followed in 1954 outlawed separate-but-equal segregation in public education but also was slow to be implemented.6 It ignited a violent wave of racial politics and militancy against desegregation in the South.
471
Figure 4 Robert Q. Marston, MD, Dean of the School of Medicine and Director of the University of Mississippi Medical Center (UMMC) in 1961. (Twiss Archives, UMMC Rowland Medical Library).
working against integration, including White Citizens’ Councils and the Ku Klux Klan (KKK).7 The Civil Rights Act of 1964 with Title VI that specifically outlawed segregation in government-sponsored programs brought civil rights activities to a boil in Mississippi state institutions.8 The Federal Bureau of Investigation (FBI) titled Mississippi cases of the period “Miburn,” Mississippi Burning, because of the widespread burning of black churches and homes and the assaults and murder of civil rights advocates.9
RESISTANCE TO DESEGREGATION In Mississippi, the Brown decision resulted in the immediate establishment of segregationist Governor J.P. Coleman’s Sovereignty Commission to spy on and intimidate any citizen favoring civil rights and to collaborate with organizations
Figure 3 The University of Mississippi Medical Center (UMMC) shortly after its opening in 1955. (Twiss Archives, UMMC Rowland Medical Library).
UMMC BETWEEN A ROCK AND A HARD PLACE Increasingly, the totally segregated UMMC was involved in the social turmoil surrounding civil rights during the time of Marston’s deanship (Figure 5). Statewide voter registration efforts and challenges to segregation in interstate transportation brought Freedom Rides into Jackson, the state capital, beginning in 1961 and resulted in incarceration of hundreds of civil rights activists.10 UMMC cared for many sick and injured civil rights workers for rural and metropolitan areas in its emergency units.11 The admission of James Meredith as the first black student at the University of Mississippi (Ole Miss) campus in Oxford in 1962 resulted in a riot, deaths, and occupation of the city by US military troops.12 Marston met with UMMC medical students and house staff, many of whom were Ole Miss graduates, to keep them in Jackson and away from the turmoil in Oxford.1 (page 85) One response to the integration of Ole Miss and increasing attempts at voter registration in the state was the assassination of National Association for the Advancement of Colored People (NAACP) Field Director and Mississippi native, Medgar Evers, in June 1963. He was shot with a high-powered
472
The American Journal of Medicine, Vol 127, No 6, June 2014
Figure 5
Abbreviated chronology of events in this paper.
rifle by a killer lying in wait outside his home in Jackson. Evers died at UMMC despite resuscitation attempts.13 Albert A. Britton, Jr., MD, a black physician in Jackson and friend of Medgar Evers, was present at UMMC during efforts to save him in the emergency room and gave high praise to UMMC staff for their medical care and the professional courtesy he received (personal interview of E. King by Richard deShazo, MD, Jackson, MS, February 19, 2014).
MEDICAL SUPPORT FOR FREEDOM SUMMER The Council of Federated Organizations (COFO),14 a confederation of the 4 civil rights organizations most active in
Mississippi at the time, developed a carefully planned, organized, and executed Mississippi Summer Project that came to be known as Freedom Summer of 1964. Over 900 carefully selected, mostly white, students from prestigious east and west coast colleges and universities arrived in waves in Mississippi in June and were joined by other volunteers, including teachers, labor organizers, social workers, attorneys, and others from all over the US. During the planning for Freedom Summer, Mississippi native Robert “Bob” Smith, MD, realized that the small number of black physicians in the state, many of whom were in the process of moving elsewhere or retiring out of fear for their lives and livelihoods, would be inadequate to provide medical care for
deShazo et al
Medicine and Civil Rights
such a large group of volunteers (Figure 6). Care from the white physician community was unlikely, as many had been angered by an insulting letter from 2 east coast physician volunteers (Figure 7).15 (page 41) Many black and white physicians would not risk the attention of the Sovereignty Commission to provide care to outside “agitators.” Smith, acting as an officer of the Mississippi affiliate of the National Medical Association, asked Marston shortly after his arrival for black physician access to UMMC educational programs, but Smith was rebuffed (personal interview of Robert B. Smith, MD, by Richard deShazo, MD, Jackson, MS, January 30, 2014). Thus, he considered it unlikely that UMMC would provide physicians for Freedom Summer outside of the UMMC campus. Smith was a founding member of the progressive physicians group, the Medical Committee for Human Rights (MCHR). In 1963, he had unsuccessfully presented a petition to and picketed the American Medical Association to demand desegregation of state medical societies and membership for black physicians.15 (page 16) Smith contacted MCHR physician colleagues in New York and requested
Figure 6 Robert Smith, MD, Mississippi native, family practitioner, founding member of the Medical Committee for Human Rights and longtime national civil rights leader. (Robert Smith, MD).
473 that the organization take on statewide medical support for the volunteers as a project. The MCHR arrived in the state 1 month later with physicians, nurses, and psychologists for deployment throughout the state.16 On June 21, 1964, a Freedom Summer volunteer, Andrew Goodman, joined another white New York native, Michael (Mickey) Schwerner, and black Mississippi native, James Chaney, both COFO members, in Meridian, Mississippi for a day trip to nearby Neshoba County to visit the members of a church that had been burned by the KKK.15 (pp. 69-70) On their way home, the KKK and local law enforcement members murdered all 3 and buried them in an earthen dam nearby. Their bodies were found by the FBI 6 weeks later and taken to UMMC, thus, keeping UMMC in the eye of the civil rights storm9 (Figure 8).
MURDER AND PROFESSIONAL DISGRACE IN GERMANY AND MISSISSIPPI? A Neshoba County judge ordered that the autopsies for the 3 men be performed at UMMC by a community pathologist, Dr Featherston, rather than by University pathologists, 2 of whom were present to assist agents from FBI crime laboratories.1 (page 108) Schwerner’s family asked that MCHR physicians Charles Goodrich, MD, and Alfred Kogan, MD, already in Jackson, be present for the autopsies. The Neshoba County attorney refused the request. Spokespersons for COFO reported to the press that UMMC had refused to allow MCHR physicians to observe the autopsies, a charge widely quoted in the press.17 The autopsy was made more suspicious, as the FBI allowed the Neshoba County Sherriff and his deputy, both suspects in the murders, to observe the autopsies.18 Afterward, FBI agents told the local press that all 3 had been shot to death. Dr M. David Spain, a well-known New York forensic pathologist and civil rights activist, appeared at UMMC the following day and was allowed by UMMC pathologists to view the body of James Chaney. He concluded that Chaney had been both beaten and shot and suggested there had been a cover-up of the beating by the pathologists present at the first autopsy.19 This was followed by an article in the Yale Journal of Biology and Medicine that condemned UMMC and commented that, “Nazi Germany may seem far away, but we can find occasions nearer home and close in time which bear on the status of the physician as a member of society.”20 The nationwide discussion of these articles caused Marston to fear that the years of work by Arthur Guyton, MD, and others to build a great medical center for Mississippi could be lost to false accusations.1 (pages 110-111) Marston worked hard to defend UMMC and faculty accused in this matter. For instance, in a letter to the editor of the Yale Journal, he wrote, “Our department of pathology was unfairly charged with unprofessional conduct in the lay press last year by Dr David M. Spain,” and now, “Dr Louis Lasagna repeats Dr Spain’s charges as ‘examples of professional disgrace in Germany and Mississippi’.”21 Marston noted that J. Edgar Hoover confirmed in writing that he, not UMMC, refused to
474
The American Journal of Medicine, Vol 127, No 6, June 2014
Figure 7 The Brenner and Coles letter was mailed to physicians in Mississippi in June of 1964 by Harvard psychologist Robert Cole and Massachusetts Institute of Technology physician Joseph Brenner. They participated in the orientation of Freedom Summer volunteers at Oxford, Ohio. (Re-illustrated from reference #17).
release the original autopsy report (Figure 9). The whole affair “cast a shadow over the Medical Center which loomed there for a long time.”1 (pp. 110-111) Review of the un-redacted and still unpublished original autopsy report shows that Dr Featherston noted “fractured and broken bones were present in the jaw, upper limbs, and left shoulder area” of James Chaney.9 There was no cover-up.
A NEW FEDERAL COMPLIANCE QUESTIONNAIRE Marston was required to sign a new Civil Rights Act-related federal compliance document to receive federal funds in 1964 and requested an opinion on the document from the University attorney. The attorney replied that a “yes” to any question about the presence of racially segregated employee facilities would place UMMC out of compliance. A financial statement for 1963-1964, prepared for discussions around this matter, shows that the school had received $2,192,299 in
federal funds during the period, with an additional $334,323 due. Those funds were essential to survival. But compliance was not a simple task.22 The Sovereignty Commission had UMMC under constant scrutiny. Memories were fresh of the legislature’s “expression of concern” in 1956 about “creeping racial integration” at UMMC, followed by a legislative investigation in 1962 when black and white children were found watching television together in the hospital.23 Marston sought an opinion from the Sovereignty Commission (and governor) as well and provided financial information to the Commission through the UMMC comptroller. The Commission, concerned that the legislature might be asked to replace any funds lost, recommended “voluntary compliance” without the option to “fully desegregate.”24 Because of concern that the white facilities management personnel would refuse, Twiss and Marston (carrying the opinion from the University attorney in his hand) personally
deShazo et al
Medicine and Civil Rights
475
Figure 8 Missing poster showing the 3 civil rights workers whose bodies were later found in Neshoba County, Mississippi in August 1964. (Federal Bureau of Investigation, June 1964).
removed “colored” and “white” signs throughout UMMC one night in the summer of 1964. In discussions with the UMMC architect, Marston learned that UMMC had been originally designed and constructed to be an integrated facility.25 The wall that separated “colored” from “white” areas in the hospital cafeteria soon disappeared in the middle of the night and the new federal compliance document was signed.1 (page 123) There were no questions that would require the desegregation of patient and visitor areas, prohibited by Title VI, so that was not done.
THE THREAT OF LOSS OF FEDERAL GRANTS AND CONTRACTS In 1964 and onward, Hill-Burton hospitals in Mississippi were visited by MCHR physicians and nurses who noted
and reported Title VI violations to federal agencies, the NAACP, and others.17 (page 34) On March 5, 1965, the Associated Press ran a story that the NAACP Legal and Educational Defense Fund had filed civil rights complaints against 29 hospitals in 8 southern states with the US Department of Health and Human Services (HHS), and the UMMC University Hospital was on the list. In mid-April, Marston learned that NIH payments on grants and contracts were to be held for any institution charged with noncompliance until they were inspected. Marston’s attempts to get the specifics of the complaint from contacts he had in Washington failed, until a checklist to be used in hospital investigations was leaked to him in March of 1965.26 The list suggested that complaints against UMMC were likely to be related to remaining segregation in the institution.
476
The American Journal of Medicine, Vol 127, No 6, June 2014
Figure 9 J. Edgar Hoover’s July 1965 response to a letter from Dr Marston requesting release of the Featherston autopsy reports on 3 civil rights workers. (Twiss Archives, University of Mississippi Medical Center Rowland Medical Library).
Marston decided to be proactive. He sought and received the advice and presence at UMMC of Ole Miss Chancellor, J.D. Williams, in the implementation of a plan. On March 11, an African American PhD was offered the first faculty position for an African American, over resistance from the state college board. Next, he asked the black community for support, a reach, because he had little contact with them in his first 3 years as dean. Knowing that the NAACP was the source of the charges, he sent a letter to Charles Evers, who had replaced his brother, Medgar Evers, as Mississippi Field Director for the NAACP and asked for support and dialogue.27 He also asked for a meeting with Mississippi black physician leaders whom he had never met. They included Drs Albert B. Britton, Jr, William Miller, Robert Smith, James Anderson from Jackson, and Dr Cyril Walwyn from Yazoo City, Mississippi. Dr Marston met with them on April 13,
and much to his surprise, realized they knew the details of the NAACP complaint, the federal scrutiny of UMMC, that a site visit was coming, and much more.1 (page 138) They also mentioned the locations of “colored” signs on campus that had not been removed, and that the cafeteria was still “segregated,” as whites sat with whites and blacks with blacks. They suggested that the former “colored” and white lunch lines in the cafeteria be consolidated into a single one, but Marston left them in place.1 (page 138) Later, Marston realized that these black physicians were at the center of local and national civil rights activities, including historic leadership positions in the NAACP and present leadership in Freedom Summer, COFO, and the MCHR. He did not know that Smith had recently been asked to be an Assistant Secretary in the Equal Opportunity Division of HHS, but turned it down. Britton was Chair of
deShazo et al
Medicine and Civil Rights
the Mississippi Advisory Committee to the US Civil Rights Commission. Some, including Britton and Smith, had regular meetings with HHS at their Atlanta and Washington offices, where progress toward compliance to civil rights legislation was reviewed. Most of these physicians also had close contacts with rank-and-file Mississippi blacks, including the 899 black UMMC employees, through their medical practices. Marston asked them for advice and assistance. They offered help and information on community concerns about discriminatory practices at UMMC. The Twiss files contained numerous notes of telephone calls and letters between Marston and Britton, who eventually asked Marston to join the local Head Start Steering Committee.28 Marston was quietly inducted into the National Medical Association.1 (page 141),28 Twiss wrote that, “No matter how profound their belief in the civil rights movement, how determined they were to remove inequities, they did not want to damage the state’s medical center.”1 (page 142) What they did want was equal access of black physicians and patients to the resources of UMMC and equal opportunity employment for black employees. The evidence shows they risked their lives for that goal (personal interview of Robert B. Smith, MD, by Richard deShazo, MD, Jackson, MS, December 26, 2013). The assistance of these black physicians toward UMMC’s compliance with Title VI and their communications to federal civil rights enforcement agencies on behalf of UMMC has not been fully appreciated. The day after his meeting with black physicians, Marston issued a written order to his reluctant Hospital Director to completely and immediately integrate lest the funds be lost.29 There were white faculty at UMMC who were supportive of Marston’s decision, but available records show that his decisions were made with little faculty input. Funding deadlines with the NIH were at hand. Marston contacted James M. Quigley, Assistant Secretary of the Department of Health Education and Welfare in Washington. He explained the implications of even a temporary loss of funding and argued that an immediate site visit to disprove the allegations (still unknown to him) was only fair. Quigley agreed and the inspection was scheduled for 3 days later. The inspection team that arrived on Friday, April 16, 1965 included 2 senior administrators, Sherry Arnstein from Quigley’s office at the Department of Health, Education, and Welfare, and William Burleigh, assistant chief of the Division of Hospitals and Medical Facilities for the US Public Health Service. Before the visit, Mrs Arnstein told colleagues that if she found UMMC in compliance, she would begin her report with, “Christ has risen.” While the inspection proceeded, Dr Marston simultaneously addressed the faculty and staff in the presence of Arnstein and Burleigh on the subject, “Medical Center Policy on Civil Rights Implementation.”25 The bottom line was, “The time is now” to integrate because we have to do so to survive financially. No comments about social justice were made. The 2 investigators left, nothing transpired, and another investigator appeared on June 7 to inspect the cafeteria. Just
477 as the black physicians reported to Marston, he was concerned that whites still sat with whites and blacks with blacks, and both used separate lunch lines. In response, UMMC closed one of the lunch lines to force “mingling.”1 (page 150) When a hold was placed on the funding of one grant, Marston sent a telegram to Quigley on June 9, saying holding grant money from UMMC was “meaningless.” Quigley, impressed with Marston’s efforts and persistence, said he would release the money. Several years later, Mrs Arnstein told Marston at an American Association of Medical Colleges meeting that she started her inspection report to Quigley with, “Christ has risen.” Life went on, with no further inspections during Marston’s tenure, but he knew more would follow. In the interim, as they sat side by side on a plane ride from Washington to Jackson, Marston commented to Smith that the continuous civil rights problems at the Medical Center were “risky to the career of a Rhodes Scholar” and he was “looking at other opportunities.” In 1966, Marston, who had impressed many with his leadership at UMMC, became Associate Director of the NIH, where he established the Regional Medical Program. He was promoted to NIH Director and subsequently became a successful President of the University of Florida at Gainesville in 1974. Meanwhile, Mississippi practicing physicians and civil rights veterans Drs Robert Smith, James Anderson, Charles Humphrey, and Aaron Shirley partnered with Drs Count Gibson, Jack Geiger, and other MCHR veterans of Freedom Summer to propose and develop the Federally Qualified Health Center (FQHC) program, a major accomplishment of President Lyndon B. Johnson’s War on Poverty. The first rural FQHC opened in the Mississippi Delta in 1967.30 UMMC has a formal ongoing relationship with 21 Mississippi FQHCs, a Center for Health Disparities and Rural Health, a successful recruitment program for minority students, an Association of American Medical Colleges-recognized holistic-admission process, and a faculty that willingly participate in the search for justice in health.31 The martyrdom of Medgar Evers, Mickey Schwerner, James Chaney, and others, the Civil Rights Act of 1964, the Voting Rights Act of 1965, the skills of a Dean, and the courage of a small group of “good doctors” helped make that possible.
ACKNOWLEDGEMENT The authors appreciate the assistance of Janis Quinn, BA, with reviews of archival materials. Jerry Mitchell provided the unredacted autopsy report of James Chaney.
References 1. Twiss MC, Currier RD. Pressure from All Sides—The University of Mississippi Medical Center in the 60s. Jackson, MS: The University of Mississippi Medical Center; 2004. 2. McGuigan JW. Robert Quarles Marston, M.D. 1923-1999. Trans Am Clin Climatol Assoc. 2005;116:Ix-Ixiii. 3. Olakanmi O. Report on Historical Links Between the American Medical Association and the “Hill-Burton Act” (pp. 1-12). Available at: www. ama-assn.org/doc/ethics/hillburton.pdf. Accessed January 20, 2014.
478 4. Hill-Burton Act, 42 USC S 291 e(f) (1946). Available at: http://www. ecfr.gov/cgi-bin/retrieveECFR?gp¼1&SID¼5001d169544ff7cb8345697 84f2bede7&ty¼HTML&h¼L&n¼42y2.0.1.2.13&r¼PART. Accessed February 17, 2014. 5. Simkins v Moses H. Cone Memorial Hospital 323 F2d 959 (4th Cir), cert denied, 376 US 938(1964). Available at: https://www.casetext.com/ case/simkins-v-moses-h-cone-memorial-hospital. Accessed February 17, 2014. 6. Brown v. Board of Education, 347 US. 483(1954). Available at: http:// scholar.google.com/scholar_case?case¼12120372216939101759&q¼ Brownþv.þBoardþofþEducation,þ347þUS.þ483þ(1954).&hl¼en& as_sdt¼6,25&as_vis¼1. Accessed February 17, 2014. 7. Silver JW. Chapter 2: The voices of militancy. In: Mississippi: The Closed Society. New York: Harvest Books; 1963:40-43. 8. Civil Rights Act of 1964, Pub L. 88-352. Available at: http:// library.clerk.house.gov/reference-files/PPL_CivilRightsAct_1964.pdf. Accessed February 17, 2014. 9. US Department of Justice, Federal Bureau of Investigation. Bernard L. Akin et al. vs Victims, File 44-25706, 12/9/1964. Available at: http:// vault.fbi.gov/Mississippi%20Burning%20(MIBURN)%20Case/Missis sippi%20Burning%20(MIBURN)%20Case%20Part%208%20of%209. Accessed February 10, 2014. 10. Arsenault R. Freedom’s coming and it won’t be long. In: Freedom Riders: 1961 and the Struggle for Racial Justice. New York: Oxford University Press; 2006:259-303. 11. The Student Nonviolent Coordinating Committee. A Chronology of Violence and Intimidation in Mississippi Since 1961. Available at: http:// www.crmvet.org/docs/sncc_ms_violence.pdf. Accessed February 17, 2014. 12. Bryant N. Black Man Who Was Crazy Enough to Apply to Ole Miss. J Blacks High Educ 2006;(53):60-71. 13. Dalton ML. The first lung transplantation. Ann Thorac Surg. 1995;60: 1437-1438. 14. Payne C. I’ve Got the Light of Freedom: The Organizing Tradition and the Mississippi Freedom Struggle. Berkeley, CA: University of California Press; 1995. 15. Dittmer, John. The Good Doctors: The Medical Committee for Human Rights and the Struggle for Social Justice in Health Care. New York: Bloomsbury; 2010. 16. McAdam D. Freedom high: the summer of ‘64. In: Freedom Summer. New York: Oxford University Press; 1988:154-155. 17. Twiss M. Note to file. Jackson, MS: UMMC Rowland Medical Library Archives; Twiss File; August 5, 1964.
The American Journal of Medicine, Vol 127, No 6, June 2014 18. Cochran J Jr, O’Tousa A. Federal Bureau of Investigation Autopsy Report of Dr. William Preston Featherston, August 12, 1964. File JN 44-1, page 1-6. Unredacted copy obtained courtesy of Jerry Mitchell, Clarion Ledger Newspaper, Jackson, Mississippi using Freedom of Information Act. 19. Spain D. Mississippi autopsy. Ramparts Magazine; 1964:43-49. Available at: http://dickatlee.com/issues/mississippi/mississippi_eye witness/mississippi_autopsy.html. Dr. Spain’s reports in the press and a subsequent paper in the Yale Journal of Biology and Medicine in January 1965. 20. Lasagna L. The mind and morality of the doctor. II. Physician and the macrocosm. Yale J Biol Med. 1965;37:361-378. 21. Marston RQ. Correspondence from the University of Mississippi Medical Center. Yale J Biol Med. 1965;38:47-48. 22. Financial Statement of Federal Funds Received by UMMC 1963-1964. Jackson, MS: UMMC Rowland Medical Library Archives; Twiss File. 23. Ole Miss hospital integration cited. Legislator says children in pediatrics ward mixed. Clarion Ledger newspaper. Jackson, MS: January 19, 1962. 24. Johnson E Jr. Letter to Paul B. Johnson, Governor. Available at: http:// mdah.state.ms.us/arrec/digital_archives/sovcom/result.php?image¼images/ png/cd05/038599.png&otherstuff¼3j72j0j13j1j1j1j38005j. Accessed April 1, 2014. 25. Marston RQ. Medical Center Policy on Civil Rights Implementation. Jackson, MS: UMMC Rowland Medical Library Archives; Twiss File; April 16, 1965. 26. Twiss M. Typed transcription of phone call from contact at HEW. Jackson, MS: UMMC Rowland Medical Library Archives; Twiss File; March 12, 1965. 27. Marston RQ. Letter to Charles Evers. Jackson, MS: UMMC Rowland Medical Library Archives; Twiss File; April 17, 1965. 28. Marston RQ. Typed record of May 28, 1965 phone conversation with A.B. Britton, Jr., MD, who offered an invitation to join MS Project Head Start Steering Committee and received an update on minority applications to the School of Nursing and Medicine. Jackson, MS: UMMC Rowland Medical Library Archives; Twiss File. 29. Marston RQ. Letter to David Wilson, MD. Jackson, MS: UMMC Rowland Medical Library Archives; Twiss File; April 13, 1965. 30. Lefkovitz B. Chapter 2. MS: Where it all began. Community Health Centers: A Movement and the People Who Made it Happen. New Brunswick, NJ: Rutgers University Press; 2007:35-42. 31. Quinn J. Promises Kept. Jackson, MS: The University of Mississippi Medical Center; 2005:176-177. June 13, 2001. Post Script.
