Racial segregation in medicine in the American South

Racial segregation in medicine in the American South determined not only where patients could seek treatment but also which institutions could offer care to them, and on what terms. The history traced through Southern Baptist Hospital and Jannie Burgess links an institution’s religious and charitable mission to a long record of racial exclusion, then follows the uneven changes brought by federal pressure and civil-rights requirements. In the account of Hurricane Katrina, Burgess’s life also meets a second system of classification: Memorial Medical Center’s decision to evacuate patients with Do Not Resuscitate orders last. The book connects these histories without claiming that the evacuation rule was racially motivated; instead, it shows how a patient’s race, illness, age, and dependence on care form part of the history through which an ostensibly neutral rule is understood.

The hospital’s founding and its limits

Southern Baptist Hospital opened in 1926 with a mission of relieving pain, prolonging life, and relieving suffering. Its founding drew support from a broad public: almost eight hundred New Orleanians contributed to the purchase of land, and people of religions other than Baptist supported the project. The institution’s stated charitable purpose, however, did not mean that care was available on equal terms. Poor families seeking charity treatment had to provide a church letter attesting to their need and promising a donation. The category of eligible charity patients was initially narrow, focusing mainly on widows, orphans, and older people; a poor man seeking treatment for his wife might instead be offered credit and told that charity could undermine his dignity.

The hospital’s charitable work was also linked to the Southern Baptist Convention’s public standing. Its pamphlets used accounts of charity patients, particularly children, to seek donations and promote the hospital’s missionary role. The book places this activity within the Convention’s history of support for slavery, Jim Crow laws, and racial segregation. That context matters: the hospital’s language of service existed alongside an institutional and denominational order in which Black New Orleanians did not enjoy equal access to medical care.

Exclusion and federal pressure

Jannie Burgess’s career makes the contradiction tangible. Born only a few months after Southern Baptist Hospital opened, she later trained and worked as a nurse, taking up the profession to support her children after jobs that included taxi dispatcher and secretary to a mortician. In mid-twentieth-century New Orleans, her light-brown skin placed her on the working side of a racial boundary: she could care for patients in many private hospitals but could not receive care in them. More than four decades passed before she could be a patient at the hospital that had opened in the year of her birth.

Southern Baptist Hospital was among the last Southern hospitals to accept integration. In the mid-1960s, as Medicare and other federal hospital programs made reimbursement conditional on nondiscrimination, the hospital refused to participate. A 1966 statement presented resistance as a defense against government interference, and supportive letters from New Orleanians praised the institution for standing against federal pressure. The book records this response as part of the surrounding climate, not as evidence that all residents held the same view.

The position changed in stages. In 1968, the hospital began quietly accepting African American patients, in line with new nondiscrimination statements adopted by the Southern Baptist Convention. The following year, it set aside its opposition to Medicare, explaining that participation would ease the financial burden on older patients. Federal authorities declared the hospital compliant with the Civil Rights Act of 1964 in 1969. The change had an immediate institutional consequence: the number of patients over sixty-five nearly tripled during the first two weeks of Medicare participation. The sequence shows civil-rights pressure, denominational change, and financial incentives converging; it does not reduce integration to a single cause.

Unequal treatment after formal integration

The end of formal exclusion did not erase disputes over racial equality inside the institution. Between 1979 and 1980, at least six employees filed race-discrimination charges against the hospital with the Equal Employment Opportunity Commission. In at least two cases, the agency found no cause to believe the allegations were true. African American engineer Issac E. Frezel sued Southern Baptist Hospitals, Inc., alleging that he had been placed on probation for unauthorized shift changes, passed over for promotion, and eventually fired while a white coworker involved in the same offense was not disciplined. The hospital denied that anything illegal had occurred, and the case settled out of court for an undisclosed sum. These allegations and their settlement document continuing contest over workplace treatment, while leaving the outcome and terms of the settlement unknown.

Burgess’s own response to mistreatment was endurance: when patients treated her poorly in her nursing work, she gritted her teeth, smiled, and continued. After retiring, she moved into senior housing at Flint-Goodridge Apartments, on the site of the former Flint-Goodridge Hospital in New Orleans. That earlier hospital had been the city’s only private hospital where Black patients could receive care and their doctors could pursue residency training. The location thus carries a history of both exclusion from private institutions and the creation of a separate place where Black patients and physicians could obtain care and training.

Burgess at Memorial during Katrina

After surgery and chemotherapy had held her uterine cancer in check, Burgess lived well for two years. In early August 2005, severe weakness brought her to Memorial Medical Center, where doctors found a bowel blockage and, during surgery, cancer in her liver that could not be removed. She did not want to live on machines and declined dialysis if her failing kidneys made it necessary. After discussing her preferences with Burgess, her sister, and her niece, her doctor shifted the goal of care toward comfort and ordered small doses of morphine as needed for pain. Her history of being excluded from hospital care therefore precedes a later decision about the limits she set for her own treatment; the two are related in the narrative, but one is not offered as an explanation for the other.

Burgess’s daughter, Linette Burgess Guidi, had lived overseas for more than two decades. Their relationship had been strained by differences that included Linette’s role as the New Orleans Playboy Club’s first Black Bunny and her mother’s disapproval, but their visit at Memorial carried a sense of reconciliation. As relatives prepared to leave the city, Linette told her mother she loved her, thanked her for raising her, and said she would return on Wednesday. The promise of a return met the uncertainty of the approaching evacuation.

When Memorial’s doctors established that patients with DNR orders would be evacuated last, Burgess was one of four such patients in the intensive care unit. A DNR order meant that a patient whose breathing or heartbeat stopped should not be resuscitated; it did not, in itself, mean that the patient should be left behind. The book explains that the evacuation policy arose from a mistaken understanding of what DNR orders meant and of the legal status of patients who had them. Elsewhere in Memorial, a patient’s daughter asked to cancel her mother’s DNR after realizing that the order was being treated as a reason not to rescue her. The episode illustrates the difference between refusing resuscitation and refusing evacuation, though it does not establish the race of that patient or a racial motive for the policy.

Disaster categories and racial history

The account places these decisions against a broader record of unequal access without collapsing distinct events into a single explanation. During the crisis, a family with small children who arrived by boat was turned away. Karen Wynn believed the hospital had reached its capacity and did not perceive racism in the refusal, even though nearly all those turned away were African American and Wynn was too. Physician Bryant King was offended in large part because the refused people had dark skin, but did not make race the explicit basis of his protest. The scene preserves the difference between staff members’ interpretations while showing how a general claim of limited capacity operated in a city where race had long shaped access to institutions and care.

The book also contrasts the public Charity Hospital’s evacuation with that of Memorial. Charity faced severe infrastructure failures, had roughly twice as many patients across its two campuses, and had fewer staff relative to patients; fewer than ten patients died there. Staff described continuing care for patients in their rooms until the end and cited morale-building practices, including frequent meetings and a flashlight talent show. These details offer a comparison in institutional response, not proof that racial composition alone explains the different outcomes.

Taken together, Burgess’s life, Southern Baptist Hospital’s delayed integration, later employment-discrimination allegations, and Memorial’s disaster triage make segregation more than a closed chapter in the book’s history. They show how access to care and authority over care are shaped across time: by admission policies and federal rules, by workplace decisions, and by the emergency labels used to sort patients. The narrative’s restraint about motive is significant. It identifies racial history as essential context for understanding who was vulnerable and how institutional decisions were experienced, while distinguishing that context from evidence that any particular Katrina-era decision was made because of race.