'Take me to the G': Black St. Louisans' struggle for access to quality health care
This article first appeared in the St. Louis Beacon. - Dr. Jerome Williams Sr. still feels an emotional lift when he thinks about a Monday morning 72 years ago. In 1937, he had gathered with other Boy Scouts on the city's north side that morning. Standing erect, he waited to take his place in line for a parade; and in spite of the cold of a day in late February, he was moved by the sight of hundreds of people -- doctors and lawyers, teachers and preachers, dignitaries and ordinary people -- gathering in the vicinity of Whittier Street and Kennerly Avenue.
"It was one of the proudest moments in the history of black St. Louis," says Williams, now 84. "People were everywhere, sort of like the day when (then-presidential candidate Barack) Obama came to St. Louis to speak at the Arch. It was that kind of event."
What swelled the hearts of the crowd along Whittier Street was witnessing the dedication of a first-class hospital to care for blacks who had grown tired of inferior treatment in the basements of private hospitals; in dirty, segregated wards at the city's main hospital; and in old, hazardous, hand-me-down buildings that had been abandoned by whites relocating to new medical facilities.
These experiences, along with the joyous dedication of Phillips, symbolized the divisive history of race and health care in St. Louis. Before Phillips, blacks had access to two segregated medical facilities -- People's Hospital and St. Mary's Infirmary -- along with the segregated public hospitals: City Hospital No. 1, at 1515 Lafayette, and City Hospital No. 2, which Phillips would eventually replace.
While City Hospital No. 1 admitted black patients to segregated wards, it denied professional training to black doctors. That situation led African-American leaders to push for a special public hospital for black patients and physicians.
That's how the first City Hospital No. 2 came into being. The city bought the old Barnes Hospital at Garrison and Lawton avenues and renamed it City No. 2. A couple years later, black doctors complained that the hospital was an overcrowded fire hazard that jeopardized the patients' lives.
Overcrowding was so severe at the 177-bed hospital that often two beds would be tied together at night to accommodate three or more patients, says Dr. Frank O. Richards, a retired black surgeon. The late black attorney David M. Grant, along with a doctor and a reporter for the now defunct St. Louis Star, exposed conditions at the hospital, added Richards.
"Grant secretly photographed the conditions, and pictures also were taken at the St. Louis Zoo to show that conditions at the hospital were no better," Richards said. He adds that the turning point came when a black physician, Dr. Bernice A. Yancey, was electrocuted by a defective X-ray machine.
Richards, one of the authors of the book "A Century of Black Surgeons," writes that these incidents made it clear that City Hospital No. 2 "could no longer accommodate (patients) in a manner befitting the dignity of human beings, nor could it provide for the safety of those who were there to work and to learn."
The conditions at City Hospital No. 2 spurred on the efforts to build Phillips, the culmination of a dream of a black attorney for whom the hospital was named.
Homer G. Phillips led the campaign for a bond issue, which set aside more than $1 million toward constructing the 685-bed hospital complex. (The hospital eventually cost more than $3 million.)
The deal nearly collapsed. According to the St. Louis Globe-Democrat, some whites argued that the money actually was supposed to be used to build a "colored annex" to City Hospital No. 1 instead of a separate new hospital. But Phillips prevailed, insisting that blacks have a free-standing facility.
Phillips did not live to see the hospital's completion. On the morning of June 18, 1931, Phillips was shot dead, reportedly by one of two black men, while he waited for a streetcar to take him to his law offices at 23 North Jefferson Ave. Although rumors persist that he was assassinated because he had made enemies as a lawyer or had led a successful drive for a black hospital, nobody was ever convicted of the crime.
Take Me to the 'G'
In no time, Homer G. Phillips hospital became a busy place, admitting more than 10,000 patients for a total of 210,940 days of hospital care between 1938 and 1939, and accounting for 1,277 live births between 1939-1940, according to Richards. The level of service spoke to the need for a hospital to serve black residents and train doctors, even if the place was segregated, many doctors say.
Throughout its existence, Phillips would remain largely segregated, even though some white doctors took advantage of its excellent training, particularly in caring for trauma patients.
"The training at Phillips was superb, not only because it was academic but also because it was practical," Dr. Williams recalls. "There was no better place to learn about treating trauma patients. If anybody got seriously hurt, they'd say, 'take me to the G.' "
In spite of the training, Phillips was always perceived as the hospital for blacks even after public-health facilities in St. Louis were integrated following the Supreme Court's Brown v. Board of Education ruling.
But segregated or not, Phillips hospital represented a transformational event in local black history. It emerged as a gateway to medical training for hundreds of black doctors from across the country and abroad. It became an anchor in the neighborhood known as the Ville, fueling an economic engine that brought health and wealth, jobs and financial security to hundreds of people who worked in the hospital complex and in small businesses in the Ville and its surroundings.
The decline -- and rebirth -- of Phillips
In 1979, then-Mayor James Conway decided the city could no longer afford two public hospitals. While acknowledging the importance of the hospital to black St. Louis, Conway closed Phillips, calling the facility "a monument to racism, built according to the attitudes prevalent at the time. We're trying to get away from those attitudes."
Some politicians accused the mayor of bias, saying Phillips should have remained open because it was the newer of the city's two public hospitals. But, in deciding which facility to close, observers said Conway also took into account the fact that City No. 1 could handle more patients and was more centrally located.
When the hospital was shut down, "we were devastated," Richards says of the black medical establishment. The biggest concern, he says, involved the future of training of minority doctors, already in short supply, to practice in underserved communities. Many doctors on Phillips' medical staff were absorbed by other hospitals, here and around the country, adds Richards.
Although black leaders condemned Conway for shutting down the hospital, Phillips already had begun to decline due to three national policies touching on race and health. The first was the Supreme Court decision against segregation in public facilities. That development led then-Mayor Raymond R. Tucker and the Board of Aldermen to abolish racial segregation in city hospitals.
"In the old days, if you were black, the ambulance automatically took you to Phillips, and if you were white, you were automatically taken to City No. 1," recalled Williams, who grew up to become a physician at Phillips. "The racial policies of taking only whites only to City No. 1 changed after Mayor Tucker changed the admission policy."
Even so, few whites were treated at Phillips, but more blacks began to seek treatment at City No. 1.
Also contributing to Phillips' demise were the Hill-Burton Act and the creation of Medicaid and Medicare health insurance programs for the poor and the elderly. Hill-Burton required that health facilities financed with federal dollars could not discriminate by race. That law prompted major private hospitals to open their doors to black patients. The federal Medicaid and Medicare programs also gave more blacks access to health insurance, making these paying patients more attractive to white doctors and hospitals. Meanwhile medical schools began to open their doors to black doctors, robbing Phillips of its steady pool of medical residents.
Oddly, the story of Phillips hospital has a happy ending. Like a tough patient, the building has survived and is once again serving blacks, some of whom might have been born there. Much of the hospital has been renovated into a 220-unit facility for seniors. It opened in 2003.
Meanwhile, by 1985, city officials also decided that the city couldn't afford to run City Hospital No. 1 either. It was replaced with a smaller hospital, Regional Medical Center, operated by a private board under contract with St. Louis and St. Louis County, which had closed its one public hospital. Regional, on the site of the old St. Luke's Hospital at 5535 Delmar in the West End, closed in 1997. That experiment morphed into St. Louis ConnectCare at the same location. It shut down in 2002, and the building is now an urgent care center, which closes daily at 7 p.m.
The population has declined on the north side since Phillips hospital shut down. The people who remain tend to be poorer and with more serious health problems. In place of a full-service hospital, in addition to ConnectCare, the area is served by six federal health centers:
- Grace Hill Water Tower Health Center, 4308 N. Grand
- Grace Hill Murphy-O'Fallon Health Center, 1717 Biddle St.
- Myrtle Davis Comprehensive Health Center, 5471 Martin Luther King Dr.
- Florence Hill Health Center, 5541 Riverview Dr.
- Homer G. Phillips Health Center, 2425 Whittier St.
- People's Health Center, 5701 Delmar
In addition, there are the independent Community Health-in-Partnership Services center, a veterans' hospital and three mental health centers. No wonder, some say, many poor blacks routinely get their care in emergency rooms at private hospitals in the Central West End, south St. Louis and in north St. Louis County.
Dr. Consuelo H. Wilkins, an associate professor of medicine and psychiatry at Washington University Medical School and health-care editor for the St. Louis American, says that ER treatment is the costliest way to deal with health problems. While the treatment might deal with immediate symptoms, it does nothing to address health problems behind the symptoms. Doctors frequently talk about this revolving door through which patients seek ER treatment but don't see a primary-care physician afterward -- because most may not have primary-care doctors.
Last week, Charles Brown, the energetic assistant director of the St. Louis Mercantile Library on the campus of the University of Missouri- St. Louis, was carefully handling delicate photos and clippings about Phillips Hospital when he paused a second and thought about his own birth at Phillips 53 years ago.
Then he thought about something else. His family actually lived closer to City No. 1 in those days.
"Yet they took me way across town to be born," Brown says, smiling and shaking his head.
Such was the irony of race and health care for blacks during the '50s.
History of public hospitals
1846 - City Hospital No. 1 opens
1919 - City Hospital No. 2 opens in the old Barnes Hospital building
1937 - Homer G. Phillips Hospital opens to replace old City Hospital No. 2
1979 - Homer G. Phillips Hospital closes
1986 - Regional Medical Center opens to replace City Hospital No. 1
1997 - Regional Medical Center closes