Episode 4: “No Room at the Inn”

UNHEALED: A Story of Race, Memory, and a Teaching Hospital
Episode 4: No Room at the Hospital
Transcript

          Voice-overs: 1950 Newspaper headlines

          Hospital refuses Negro. Dies.

          Youth refused by hospitals dies. Segregation responsible.

          Segregation responsible. Dying auto victims sent to Jim Crow Center.

          Hospital refuses dying A&T student.

Dr. Jeff Baker: Those were just some of the headlines following the death of Maltheus Avery, a young Black student critically injured in an auto accident who was turned away from Duke Hospital on the night of Friday, December 1st, 1950.

Dr. Damon Tweedy: Those headlines show us that what happened to Maltheus Avery became a national story. I'm Damon Tweedy and I'm a psychiatrist at Duke and author of the book, Black Man in a White Coat.

Dr. Jeffrey Baker: And I'm Jeff Baker, a pediatrician, historian, and director of the Ethics Center at Duke. And this is the fourth episode of the podcast UNHEALED, a podcast where we're looking at our past as a first step to understand our present and to try to reimagine what our healthcare system might look like in the future.

Dr. Damon Tweedy: In our last episode, we talked about the impact of Maltheus Avery's death on his family. It was gut wrenching. The events surrounding his death nearly shattered a family who had worked so hard to achieve their own version of the American Dream. But it was also a story of resilience, of brothers who later fought the very system that had turned Maltheus away. Today we're going to talk about the aftermath of Matheus Avery's death beyond his family. His story was reported all around the country. Black newspapers took up the calls and pushed for equal treatment in hospitals, and this press coverage actually inspired an early civil rights organization to launch a national investigation into the tragedies that occurred within segregated hospitals of the day. So Avery's death did not just fade quietly into the night.

Dr. Jeff Baker: So Damon, I think there was a question we first need to talk about, which is this: Why did this story get reported at all? I mean, after all, in the Jim Crow days, there were lots of stories of Black people being turned away from white hospitals in the South, but they almost never made the news.

Dr. Damon Tweedy: You know, I wondered that too when I first heard about this story and read about it. The answer is simple: Maltheus Avery's mom just refused to let the story go away.

Dr. Jeff Baker: Yeah, Hazel, the matriarch of the Avery family. You know, almost 40 years later when she was 87 years old, Hazel talked to the historian Spencie Love about those terrible events. A highway patrolman came to the family home late that Friday and delivered the news in person. Hazel and her husband and daughter rode to Lincoln Hospital literally in the hearse of the local Black funeral home. There she learned that her son had been refused treatment at Duke. She was distraught; she was angry. Nearly 40 years later, she recalled:

          Voice-over, Hazel Avery: I talked to the head nurse and the doctors. I had done everything but cussed them. I ought to have done that. I had heard such incidents happening. I told them they could put him on the floor and treat him. They said they had no room.

Dr. Damon Tweedy: So Hazel Avery went back to Henderson and talked to the town's one Black lawyer. He told her they had no basis to sue. He said they didn't have any other options except to talk to the local papers. So that's what she did.

Dr. Jeff Baker: And it worked. Within days the story was picked up on in Durham, Raleigh and Henderson. The Durham Morning Herald even dispatched a reporter on the Monday after the accident. He took the assignment pretty seriously and talked to doctors and staff at all three of the involved hospitals. He even talked to the ambulance driver. The article that appeared the next morning told the story we've talked about before. He recounted Avery's accident and his journey by ambulance to Alamance General Hospital, to Duke, and finally to Lincoln. It's thanks to this reporter that we know that Avery was only in the Duke Emergency Room for about 10 minutes and that Duke didn't even call to warn Lincoln that a critically-ill patient was on his way. It was a pretty hard-hitting article, and it actually quoted Duke officials as stating that Avery wasn't admitted because there were no beds available on what they called the Negro Ward. They even admitted in their words:

          Voice-over, Durham Morning Herald: …that they are prepared to receive only a small number of Negroes.

Dr. Jeff Baker: So overall I thought it was a fairly decent piece of journalism. But Damon, I wonder what you might think about the newspaper's editorial that came out the next day. The headline was “Some Questions that Should Be Answered,” and here's how it started.

          Voice-over, Durham Morning Herald editorial: Another case in which a person in need of emergency medical treatment has died after being shuffled about from hospital to hospital is in the news.

Dr. Jeff Baker: The writer summarized the facts around the accident, how Avery had been sent by ambulance to Duke for surgery, but then sent on to Lincoln Hospital after just a very brief evaluation.

          Voice-over, Durham Morning Herald editorial: If this man was in need of immediate emergency treatment, are we to believe that no way could be found to give him that treatment at Duke Hospital? Are the nice proper rules and regulations of a hospital to carry precedent over a man's vital need for medical aid? So, what do you think of that, Damon?

Dr. Damon Tweedy: Well, it did seriously question Duke's actions, but despite the heading, “Some Questions that Should Be Answered,” I'm not sure it asked the most important one of all. The article’s questions focused on whether surgery could have saved Avery. It didn't address the reality of turning away a dying patient because of his race. This article didn't name segregation at all, and it closed on a note that kind of softened its critique of Duke and its actions that December night.

          Voice-over, Durham Morning Herald editorial: One must of course keep these incidents in proper perspective. Evidently, they do not happen often, or at least if they do, they don't get before the public. And against such an incident must be balanced the hundreds of cases of injured persons brought to the doors of Duke Hospital and other hospitals who are treated and indeed saved from death.

Dr. Jeff Baker: I've looked at a lot of these newspapers and that's about as hard hitting an editorial as came from any of the white newspapers that covered Avery's death. Some papers in fact ran much shorter stories, and some didn't even mention race at all.

Dr. Damon Tweedy: But Durham's weekly Black newspaper, The Carolina Times, did not shy away at all from getting to the heart of things. The paper's motto was “the truth unbridled,” and that's exactly how they reported on Maltheus’s death. A week after his death, his story was the lead taking up half of the front page. “Hospital Refuses Dying A&T Student” proclaimed the headline in giant letters and it showed, for the first time in any newspaper, a picture of Avery. So The Carolina Times played a big part in this story.

Dr. Jeff Baker: Absolutely. I think anyone who's familiar with the history of civil rights in Durham is going to know about The Carolina Times, and I was really happy to see that a whole book just came out about it. Jerry Gershenhorn, who's a professor at NC Central, has just published what I’d call the definitive history of the newspaper and its really remarkable editor, Louis Austin.

          Professor Jerry Gershenhorn: Louis Austin, in The Carolina Times, I would argue was one of the most important and radical of the southern Black journalists. He was often called a militant. Some mistakenly said he was a communist, which was not true. He actually came from a very kind of religious perspective. He was a staunch Christian and he believed that everybody was equal before God and therefore all Blacks, whites, all Americans, all people throughout the world should have equal rights. And he challenged segregation before many would in the South.

Dr. Jeff Baker: Jerry has written a lot about the role of the American Black press in what he and others have called the long freedom struggle of African Americans.

          Prof. Jerry Gershenhorn: The Black press played a crucial role in the Black freedom struggle. Black press began in 1827 with Freedom’s Journal in New York City. At that time it was focused on fighting for the abolition of slavery. After the end of slavery with the end of the Civil War and the passage of the 13th Amendment in 1865, the Black press played a crucial role— both in the south and the north—in fighting for racial equality against racial segregation or in some cases for equal facilities.

Dr. Jeff Baker: But even in comparison to other Black newspapers, Austin stood out.

          Prof. Jerry Gershenhorn: He used lawsuits. He used boycotts in the 1930s, so he kind of charted many of the methods that were used in the modern civil rights struggle in the 1960s.

Dr. Jeff Baker: So it shouldn't surprise us that The Carolina Times coverage was a good deal harsher, or perhaps more truthful. Avery died after being refused treatment at Duke Hospital, it said, because:

          Voice-over, Louis Austin, The Carolina Times: The carefully-guarded segregation law of North Carolina prohibited him from being placed in any other space than that allotted for his race. Maltheus Avery, student at A&T college who had served his country on a foreign battlefield fighting for democracy that was denied him on his native soil, even in his hour of calamity, probably paid with his life Friday for not being born a member of the superior race. Or maybe Avery was going to die anyway. And there isn't enough brotherly love in North Carolina
to let a Negro die where white folks are supposed to gasp their last.

Dr. Damon Tweedy: Wow. He was on a roll. Louis Austin, the editor, made it clear that the entire system of segregation was to blame. On the Saturday before Christmas, Austin was still fuming when he wrote a second editorial titled "No Room at the Hospital." Let's just not lose sight of the courage it took to so publicly condemn racism in North Carolina in 1950. You know, it's still the days of racist violence against Black people without any consequence. But Austin was determined to inform Durham's black community what was going on around them.

Dr. Jeff Baker: And this was just the beginning. Black papers soon carried the story all over the country. As just one example, one of the country's most prominent Black papers, Baltimore's Afro-American, ran a front page story on it on December 16th with the banner, “Youth Refused by Two Hospitals Dies. Segregation Responsible.” It named segregation in the first line of the article.

          Voice-over, Baltimore Afro-American: The tragedy of racial segregation in this so-called liberal state underscored the funeral of Maltheus R. Avery.

Dr. Jeff Baker: The same newspaper ran a split cartoon a few days before Christmas that showed on one side Mary and Joseph being refused entry to the inn at Bethlehem, and on the other side a Black man on a stretcher being turned away from Duke Hospital. The line under the cartoon said, “Still no room at the inn in some places.”

Dr. Damon Tweedy: So you know that was the same heading Louis Austin had used in another commentary that same day. The meaning was clear, and the message was extremely powerful.

Dr. Jeff Baker: And it was a message that resonated deeply for many readers, including a guy named Jim Dombrowski, who was an activist and anti-segregationist living in New Orleans.

Dr. Damon Tweedy: This guy was a little bit of a character. Tell us a little bit about him, Jeff.

Dr. Jeff Baker: Yeah, he is an interesting character. So I'd never of this guy until I found a whole bunch of letters that he sent to Duke's president in the aftermath of Avery's death. It turns out that he was a graduate from Emory University in the 1920s, turned down a job from Coca-Cola to go to seminary, where he became radicalized. He called himself a Christian socialist and he ends up spending the rest of his life as a labor organizer and an activist. He was a pretty radical guy for his day.

Dr. Damon Tweedy: He was. Dombrowski was executive director of the Southern Conference Educational Fund or SCEF. It's a boring name, but in fact it was an organization of Black and white activists dedicated to ending racial segregation throughout the south. And as the name implied, the SCEF focused on education rather than healthcare—until December 1950.

Dr. Jeff Baker: And that's when Dombrowski read that article in the Baltimore Afro-American that we just mentioned about the death of Maltheus Avery and Duke's refusal to admit him. The article galvanized Dombrowski into action, and soon after the SCEF launched a campaign to expose racial inequalities in healthcare across the south. Dombrowski sent a survey to nearly 2,500 hospitals across the south asking about their policies regarding Black patients. He asked good questions: how many beds did they have for Black and white patients, and what did they do with emergencies when only white beds were open? At the same time, he started collecting stories from newspapers and his extensive network all around the country to show that what had happened to Avery wasn't just an isolated incident. And he compiled a dozen of the most striking stories into a booklet called The Untouchables.
He ended up sending 25,000 copies of The Untouchables around the country.

Dr. Damon Tweedy: Yeah, I've got a copy right here in my hand. It's a 30-page booklet about the size of a legal pad and inside there are 12 stories, each one as hard hitting as the next.

Dr. Jeff Baker: This was the closest thing to a social media campaign that you're going to find in 1950. We know that this booklet reached some pretty powerful people. In fact, First Lady Eleanor Roosevelt mentions The Untouchables in one of her daily journal entries.

          Voice-over, Eleanor Roosevelt: I have just received from the Southern Conference Educational Fund a most interesting pamphlet entitled The Untouchables. It deals with the question of segregation in hospitals and
the difficult situations that arise when hospitals do not accept all sick people, but put limitations on their service.

Dr. Jeff Baker: She goes on to say…

          Voice-over, Eleanor Roosevelt: No one could look through this pamphlet without being deeply troubled that such things as it describes should happen anywhere in the United States. Some of the instances it mentions go back many years, but also detailed are some occurrences of recent years that seem fairly shocking.

Dr. Jeff Baker: And here are just a few of the stories that shocked the First Lady.

          Voice-over, The Untouchables: February, 1951, Akron, Ohio, 40 miles from Cleveland. An 18-year-old with diabetes became seriously ill. His doctor tried to get him into a city hospital, but they would not admit him. Instead, they placed him on a waiting list where he remained for 27 hours. He lapsed into a coma and was taken urgently to the hospital, but was still not admitted because of the hospital's policy not to mix its semi-private rooms. He died in the emergency room five hours later.

          Voice-over, The Untouchables: October, 1951, Memphis, Tennessee. A pregnant Black woman was sent home because of the decree that Negro maternity cases are treated only as outpatients. On the front porch of her home, she gave birth to twins, one of which died of strangulation from the umbilical cord. Help from the hospital arrived three hours later. The hospital administrator had harsh words for her. She disregarded previous instructions by coming to the hospital, he declared. There is no indication of medical negligence.

Dr. Damon Tweedy: Wow, that last story makes me think about the maternal health problems that Black women still experience much more frequently today, and how they have their roots in the past. There's a lot to digest in this booklet, and what's clear is that Maltheus Avery was just one of several stories that revealed the harm that was inflicted by medical racism back then. It also reveals that his death and the coverage that followed in the Black press actually led to concrete action, an organized campaign led by the SCEF to collect evidence that segregated hospitals caused real harm.

Dr. Jeff Baker: Yeah, that that's a big deal and we want to come back to it. But first, let's remember why this story wasn't just forgotten like so many others.

Dr. Damon Tweedy: It’s because Maltheus’s mother wouldn’t let it go away. She made sure that the papers covered the story.

Dr. Jeff Baker: She was one strong woman.

Dr. Damon Tweedy: You know Jeff, this story sort of echoes a much more well-known one. I think a lot of our listeners are familiar with the name Emmett Till. He's that 14-year-old boy who was brutally slain in Mississippi in 1955. Well, his mother made that in some ways into a big national story. She invited the press to his funeral and Jet Magazine published that infamous photo of the open casket.

Dr. Jeff Baker: Yeah, it set off a national reckoning about racial violence in the South. That was five years after Avery's death. So, do you think we can call Avery's death a turning point?

Dr. Damon Tweedy: I think that's probably taking it a little bit too far. It's really more like one of these what-might-have-been kind of moments. The road to integration—it took a very long time. It wasn't until 1963 that the courts ruled against Jim Crow in healthcare.

Dr. Jeff Baker: That's right. Despite this campaign, segregated hospital care remained the law of the land throughout the 1950s, which takes us back to the results of that survey by the SCEF. They speak for themselves. Nearly two thirds of hospital administrators were in favor of segregated care for Black patients. And it also made clear that Black patients, if they were admitted at all, were admitted on a quota system. And it's pretty obvious that there just weren't enough beds to treat Black patients.

Dr. Damon Tweedy: So I think the results kind of tell us what we already know. Racial segregation was the social and political norm of the day. It's fair to say that, you know, many hospitals, the leaders, the healthcare workers, they didn't really question its existence. It was just like a given, you know, like a fact of life.

Dr. Jeff Baker: That's right. As reprehensible as segregation at Duke Hospital strikes us today, it was pretty much the default in the American South in 1950.

Dr. Damon Tweedy: So here's the big question, Jeff. Does that get Duke Hospital morally off the hook? Can we just say, well everyone was racist then, call it a day, and move on?

Dr. Jeff Baker: That's a huge question. We're not going to do that in five minutes. We're going to tackle that one in our very next episode. So we hope all of you will join us in that conversation.

Dr. Damon Tweedy: Yeah, that's going to be a tough one.

Dr. Jeff Baker: It is, but it's a conversation that we've got to have. So thanks again for listening today to UNHEALED. I'm Jeff Baker.

Dr. Damon Tweedy: And I'm Damon Tweedy. Talk to you next time.

Dr. Jeff Baker:
UNHEALED was produced by the Trent Center for Bioethics, Humanities & History of Medicine at Duke School of Medicine. Our producer is Beverley Abel. Keith Weston is mix engineer. Our project manager is Nikki Vangsnes. Marjorie Miller provided project assistance. Music by Blue Dot Sessions in Pond Five. Funding has been provided by the Josiah Charles Trent Memorial Foundation, Mary Duke Biddle Foundation, and Duke Institutional History Project. Our website is unhealed.duke.edu.