Federal laws came into play in the affairs of state action.

The case is a good example of how federal laws came into play in the affairs of state action.
1.At what level of the judicial court system did this legal opinion occur?
2.What was the opinion of the lower court that was finally overturned in Simkins?
3.Explain at least one the federal laws that was highlighted in Simkins v. Moses H. Cone .
4.How did the federal law play a role in deciding this case?
5.Identify and discuss the Constitutional amendments and issues in the case.
6.Explain why the case was limited in its reach.
7.Identify the federal official and agency that finally extended the cases ruling and how the
cases outcome spread across the Nation.
8.Read the blog “Basic Health Access”; Is the Institutes of Medicine Waking Up?

Part II
Read the articles on Enterprise Risk Management (ERM) and Risk Management in Project
Networks and answer the following:
1.Explain how enterprise risk management is or is not different from basic risk
2.Give one example of each and how to negate the risk.

Legal aspects Module 1

Question 1: The level of judicial court system in which the legal opinion emerged is the US
court of Appeals fourth circuit. The legal decision aimed at eliminating hospital discrimination in
delivering of hospitals and professional levels (Reynolds, 2004).
Question 2: The opinion of the lower court that was later overturned in Simkins was Hill-
Burton requirements that affected equal access to health care facilities. This involved non-
discrimination in the use of federal funds. The proposed Hill-Burton Act was aimed at ensuring
equitable distribution of hospital beds for each population or, “separate but equal.” Although the
Act aimed at improving the healthcare industry but instead, the States engaged in de jure racial
segregation where they used the federal funds to build segregated hospitals. The health policies
back then facilitated racial discrimination for patient admission and for staff privileges based on
their race… thereby violating the 5 th and 14 th amendments of the Constitution (Neuberger &
Shoemaker, n.d.).
Question 3: Several federal laws that were highlighted in Simkins v. Moses H.cone case. For
instance, Simkins sued Wesley Long Community Hospital and Moses H. Cone Memorial
Hospital for failing to integrate physicians and dentists to hospital staff privileges and admission
of patients based on their race. According to Simkins team, this act violated people’s rights
under the ‘Equal Protection Clause of Fourteenth Amendment. In addition, the plaintiffs argued
that the 1946 Hill-Burton Act as and regulations of Public Health regulation of providing
‘separate but equal’ services was unconstitutional and was a violation of Fifth and Fourteenth
Amendment (Reynolds, 2004).
The Fifth Amendment of the US constitution states that no person should be jailed for a crime
unless determined by a grand jury. This aims at ensuring that each citizen is conferred equal
protection in that nobody should be deprived of liberty for life or property without ‘due process’

Legal aspects Module 1

(directed by grand jury). The 14 th Amendment also covers for equal protection similar to the 5 th
Amendment, but the main difference between the two Federal Laws is that the 14 th Amendment
protects American citizen against unreasonable control and discrimination from the government
(Reynolds, 2004).
Question 4: The Federal law played a vital role in when making the judgment. For instance, on
5 th December 1962, the U.S. District Court Fourth Circuit overruled the claim made by Simkins
team because the court argued that the participation in the Hill- Burton program had not made
the hospitals to be non-profit or State’s facilities, thus; they were not included in the provenance
of 5 th and 14 th Amendments. However, the ruling by federal district court was overturned by the
U.S. court of Appeals, Fourth Circuit stating that the two private healthcare facilities were
connected to both the State and Government, and that they were obliged to follow the federal
laws regulation of protecting the public’s right and prohibit racial discrimination as indicated in
the 5 th and 14 th Amendments (Reynolds, 2004).
Question 5: The first issue discussed in this paper is the large scale initiative – Hill Burton
Program- which aimed in facilitating construction of healthcare facilities. The ‘The Hospital
Survey and Construction Act’ was passed in 1946, which led to the authorization of $75 million
annually for 5 years to fund and facilitate hospital construction and additional $3 million for
hospital facilities. During congressional debate of the proposed ‘Hill- Burton Act,’ the National
Association for the Advancement of Colored people (NAACP) requested for amendment of the
Act to ensure that the federal funds were distributed without discrimination. This led to the
integration of the “separate but equal” clause in the Hill-Burton Act. However, this clause was
under legal attack where it was argued that it would violate the 5 th and 14 th Amendment of the US
Constitution (Reynolds, 2004).

Legal aspects Module 1

Attorney Conrad Pearson and his team filed for a suit against the James Walker Memorial
Hospital with complaints that the healthcare facility denied the black health care staff privileges
because of their race, making it a challenge to care for their patients. The case was dismissed
based on arguments that there lacked sufficient evidence that the private healthcare setting was
mandated to fulfill public/state function. The team filed for appeal before the Court of Appeals
Fourth Circuit, but the court affirmed the prior decision made by the District Court. These efforts
resulted in Simkins v Moses H. Cone Memorial Hospital, a case that became the Landmark of
the U.S. Supreme court that led to eradication of segregated healthcare. Few months later, the
Civil Rights Act of 1964 (including Title VI) extended the equality policy to all federal programs.
The Simkins case study was the foundation of universal access to healthcare facilities in the U.S
(Reynolds, 2004).
Question 6: Initially, the Case Study was limited in its reach because it argued that the African
American efforts to protect their constitutional rights. However, the courts failed to challenge
these complaints by supporting the concept of segregation. In most of the Suits, the various
levels of US judicial system argued that racially separated healthcare facilities were equal, and
the segregation was not discrimination. In addition, the court rejected writ of certiorari arguing
that only the healthcare facilities that were proposed to be under the construction in jurisdiction
of the “Fourth Circuit Court” were legally obliged to integrate their service racially (Reynolds,
Question 7: The officials involved include National Association for the Advancement of Colored
People (NAACP) legal defense fund worked closely with state attorneys so as to identify non-
compliant hospitals, and used the cases to put pressure to the Department of Health, Education
and Welfare (HEW) so as to establish a rigorous compliance program under a) Title VI of 1964

Legal aspects Module 1

Civil Rights Act and Hill- Burton program. The Simkins success and Eaton case made the legal
defense fund lawyers to fight against hospital discrimination across the nation; their main aim
was to extend the law so as to reach other hospitals across the country. To increase the public
awareness on ways the public health care facilities that failed to comply with the Federal, State
and National regulations (Reynolds, 2004).
Question 8: Simkins v. Moses H. Cone Mem case study made a big difference in reducing
health disparities. The product of Simkins case is the Civil Rights Act of 1964, which had an
impact on all aspects of American citizens. This was followed by signing of Social Security
Amendments by President Johnson. Despite the struggle to end discrimination in healthcare
facilities, ethnic and racial disparities in reference to access of care and medical covers still
prevail. The large percent of uninsured populations is an example of failing legal systems. This
implies that to address the health disparities issues is not by political will only, but entails
enormous undertakings to identify the “right revolution strategies.” However, there has been
some progress. For instance, most of physician’s privileges are awarded based on individual’s
qualification and not based on color or ethnic group (Curtin, 2011).
Legal aspects Module 1 case: Part 1I
There is a slight difference between basic risk management and the enterprise risk management.
The basic risk management has a narrow view of risk, and is often conducted in bottom up
manner so as to identify the basic risks and to summarize the finds in order to evaluate the risks
in detail (Hall, 2010). An example of basic risk management is assessing patient safety issues
such as breach of privacy, medical errors. The basic risk management is effectively managed by
root Cause Analysis (RCA). The main aim is to identify the potential risks, identify risk
reduction strategies that will effectively mitigate similar events from happening. This includes

Legal aspects Module 1

actions such as adhering to standard operating procedures and guidelines; and adhering to the
existing security procedures so as to ensure that the patient safety is maintained (Hall, 2010).
On the other hand, enterprise risk management has a broader perception of risk. In most cases, it
takes the top down approach. In most cases, the enterprise risk management starts with a
strategic plan and institution’s key objectives. This is followed by the implementation stage and
the evaluation stage. The aim of enterprise risk management is to identify potential risks that
impact’s institution’s ability to achieve its objectives (Pekkinen and Aaltonen, 2015). Enterprise
risk management goes beyond the clinical risks, but aims at enhancing management
effectiveness, better organization’s stability, and increase value for stakeholders, reputation and
board of confidence. For instance in a clinic, the following risks are identified by ERM
including; a) strategic such as joint ventures vs. cost structure; b) external risks such as economic
risks and competition, c) financial risks including investments, d) Operational risks such as
patient safety/ clinical quality, e) performance management and f) information security /
regulatory compliance. As described above, addressing these risks includes planning, perform
risk assessment, implementation of intervention, and modifications of the interventions
(Bromiley, et al., 2015).

Legal aspects Module 1


Bromiley, Philip, et al. (2015). “Enterprise Risk Management: Review, Critique, and Research
Directions.” Long Range Planning 48.4.
Curtin, M.A. (2011). Quality Improvement, Patient Safety & Efficiency in Outpatient Practice.
Chapter 4, pages 41 to 57.
Hall.S. (2010). The Role of Risk Management in Healthcare Operations.
Neuberger, B. & Shoemaker, C.B. (n.d.). The legal basis of public health. Retrieved from Legal
basis of public health.pdf
Pekkinen, L. and Aaltonen, K. (2015). Risk Management in Project Networks: An Information
Processing View. Technology and Investment, 6, 52-62.
Simkins v. Moses H. Cone Mem. Hosp. 323 F.2d 959 (4th Cir. 1963) and the opinion of
Sobeloff, Chief Judge.
Reynolds, P. P. (2004). Professional and Hospital DISCRIMINATION and the US Court of
Appeals Fourth Circuit 1956–1967. American Journal of Public Health, 94(5), 710–720.

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