Simkins v. Moses H. Cone Memorial Hospital
323 F.2d 959 (1963)
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Rule of Law:
A private hospital that receives substantial federal funding under the Hill-Burton Act, and thereby becomes an integral part of a comprehensive state plan for health services, is engaged in 'state action' and is subject to the Fifth and Fourteenth Amendment prohibitions against racial discrimination. The statutory provision within the Hill-Burton Act authorizing 'separate-but-equal' facilities is unconstitutional.
Facts:
- The Moses H. Cone Memorial Hospital and Wesley Long Community Hospital were private, non-profit hospitals in Greensboro, North Carolina.
- A group of licensed Negro physicians and dentists in Greensboro were denied staff privileges at both hospitals due to their race.
- Negro patients were either completely excluded from Wesley Long Community Hospital or admitted to Moses H. Cone Memorial Hospital only under special, discriminatory conditions.
- Both hospitals applied for and received substantial federal construction funds distributed through a North Carolina state agency under the Hill-Burton Act.
- Cone Hospital received over $1.2 million in federal funds (approx. 15% of its project costs) and Long Hospital received over $1.9 million (approx. 50% of its project costs).
- In their applications for federal funds, both hospitals explicitly stated their intent to deny admission to certain persons based on race, as was permitted by the 'separate-but-equal' provision of the Hill-Burton Act at the time.
- The hospitals' participation in the Hill-Burton program subjected them to an elaborate system of state and federal regulations, including integration into a state-wide plan for hospital construction and services approved by the Surgeon General.
Procedural Posture:
- Negro physicians, dentists, and patients (plaintiffs) filed suit against Moses H. Cone Memorial Hospital and Wesley Long Community Hospital (defendants) in the U.S. District Court for the Middle District of North Carolina, seeking declaratory and injunctive relief.
- The United States intervened as a plaintiff to challenge the constitutionality of a portion of the Hill-Burton Act.
- The defendants moved to dismiss the complaint for lack of jurisdiction, arguing there was no 'state action.'
- The plaintiffs and the United States moved for summary judgment.
- The District Court granted the defendants' motion to dismiss and denied the plaintiffs' and the United States' motions for summary judgment.
- The plaintiffs and the United States (appellants) appealed the dismissal to the U.S. Court of Appeals for the Fourth Circuit.
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Issue:
Does a private, non-profit hospital's participation in the Hill-Burton federal and state funding program constitute 'state action' under the Fifth and Fourteenth Amendments, thereby prohibiting racial discrimination, and is the 'separate-but-equal' provision of the Hill-Burton Act unconstitutional?
Opinions:
Majority - Sobeloff, C.J.
Yes, the hospitals' participation constitutes state action, and the separate-but-equal provision of the statute is unconstitutional. The key inquiry is not whether the hospitals became government instrumentalities, but whether the government became so significantly involved in their conduct that their actions can be attributed to the state. Citing Burton v. Wilmington Parking Authority, the court found the requisite state involvement by 'sifting facts and weighing circumstances,' which included the massive infusion of public funds and the fact that the hospitals operated as 'integral parts of comprehensive joint or intermeshing state and federal plans.' Because the state and federal governments participated in and affirmatively sanctioned the discriminatory conduct through the Hill-Burton Act's separate-but-equal provision, the hospitals' actions are subject to constitutional constraints. Therefore, the portion of 42 U.S.C.A. § 291e(f) that authorizes separate-but-equal facilities is unconstitutional under the Fifth and Fourteenth Amendments and must be invalidated.
Dissenting - Haynsworth, J.
No, the hospitals' actions do not constitute state action, and the court should not reach the constitutional question. The hospitals were long-standing private charitable institutions, and the receipt of federal grants-in-aid does not convert their operations into a governmental function. The Hill-Burton Act was intended to provide financial assistance, not to establish a regulatory scheme that would give the government control over the hospitals' subsequent operations. The 'state plan' is merely a survey of needs to allocate funds, not an assumption of a state function to provide hospital care. The majority's holding is unprecedented, distorts the purpose of the Hill-Burton Act, and misapplies the precedent of Burton, which involved a lessee in a publicly owned building. This decision wrongly overrules the circuit's own precedent in Eaton v. Board of Managers.
Analysis:
This decision significantly expanded the 'state action' doctrine by holding that heavy governmental subsidization and integration into a comprehensive state plan can subject a private entity to constitutional requirements. The case cast doubt on prior, more restrictive precedents like Eaton and extended the reasoning of Burton beyond landlord-lessee relationships. By striking down the 'separate-but-equal' clause of the Hill-Burton Act, the court removed the federal legal sanction for segregation in a vast network of hospitals, becoming a landmark decision in the desegregation of healthcare facilities across the United States. This ruling had a profound practical impact, opening access for minority physicians and patients to hospitals that had previously been segregated.
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