Beside the Troubled Waters: A Black Doctor Remembers Life, Medicine, and Civil Rights in an Alabama Town

Beside The Troubled Waters

A Black Doctor Remembers Life, Medicine, and Civil Rights in an Alabama Town

SONNIE WELLINGTON HEREFORD III AND JACK D. ELLIS

THE UNIVERSITY OF ALABAMA PRESS

Tuscaloosa

Copyright © 2011

The University of Alabama Press

Tuscaloosa, Alabama 35487-0380

All rights reserved

Manufactured in the United States of America

Typeface: ACaslon

∞

The paper on which this book is printed meets the minimum requirements of American National Standard for Information Sciences-Permanence of Paper for Printed Library Materials, ANSI Z39.48-1984.

Library of Congress Cataloging-in-Publication Data

Hereford, Sonnie W.

Beside the troubled waters : a black doctor remembers life, medicine, and civil rights in an Alabama town / Sonnie Wellington Hereford III and Jack D. Ellis.

p.; cm.

Other title: Black doctor remembers life, medicine, and civil rights in an Alabama town Includes bibliographical references and index.

ISBN 978-0-8173-1721-8 (cloth : alk. paper) — ISBN 978-0-8173-8506-4 (electronic) 1. Hereford, Sonnie W. 2. African American physicians—Alabama—Biography. I. Ellis, Jack D. II. Title. III. Title: Black doctor remembers life, medicine, and civil rights in an Alabama town.

[DNLM: 1. Hereford, Sonnie W. 2. Physicians—Alabama—Personal Narratives. 3. African Americans—Alabama—Personal Narratives. 4. Prejudice—Alabama—Personal Narratives. WZ 100]

R695.H47 2011

610.89'96073—dc22

[B]

2010024098

Cover: Dr. Sonnie Wellington Hereford III and six-year-old Sonnie Hereford IV leave Huntsville's Fifth Avenue Elementary School on September 6, 1963, minutes after being turned away by state troopers dispatched by Gov. George Wallace. Taken by an anonymous photographer, who sent the print to Dr. Hereford several months after the 1963 integration.

For my wife, Martha Adams Hereford, and for all of my family

—Sonnie Wellington Hereford III

For Joy, Callie, Lyrissa, Nicholas, and Noah

—Jack D. Ellis

Contents

Acknowledgments

Introduction

Map

1.  Through a Glass Darkly

2.  To Be a Doctor

3.  Medical Practice under Segregation

4.  Bringing Freedom to the Rocket City

5.  Integrating the Hospital and the Schools

6.  Troubles and Trials

Afterword

Notes

Bibliography

Index

Photographs

Acknowledgments

I am pleased to acknowledge the assistance of numerous individuals in the preparation of Dr. Hereford's autobiography.

Historian Waymon E. Burke at the Huntsville branch of Calhoun Community College in Decatur, Alabama, who played a key role in helping Hereford produce his 1999 documentary A Civil Rights Journey, read an early draft of the manuscript and made many useful suggestions, as did William H. Goodson Jr., a Vanderbilt medical school graduate whose career in psychiatry overlapped Hereford's years of practice in Huntsville and who was familiar with many of the people and events described in the book.

Several other local physicians were willing to share their memories of medical practice in Madison County during the 1950s and 1960s, particularly Richard L. Lester, Milton Booth Peeler, William A. Kates, and the late Virgil M. Howie. I am indebted as well to the late Geneva Drake Whatley, a Meharry nursing graduate of 1944 and widow of the local black physician Harold Fanning Drake (1922–1979), whom I interviewed at her Huntsville home in July 1999.

My former colleague at The University of Alabama in Huntsville (UAH), Andrew J. Dunar, author of several important studies in oral history, supported my application for sabbatical leave in 1997 in order to begin work on Alabama's African American physicians and as chair of the Department of History strongly encouraged my efforts over the years. The staff of UAH's Salmon Library provided constant assistance in my search for materials, including Gary Glover, Linda K. Vaughan, Elizabeth Rose, and Rose Bridgeforth.

My thanks also go to Ranee G. Pruitt, archivist in the Heritage Room of the Huntsville-Madison County Public Library, who helped me locate historic maps of Huntsville, and to Linda Bayer Allen, who served in the Planning Division of the city from 1976 to 2004 and shared her extensive knowledge of streets, historical structures, and locations of black neighborhoods before 1960. Mark H. Yokley, president of GW Jones & Sons, an engineering and land surveying firm that has been producing Huntsville city maps since the nineteenth century, provided computer scans and permission to use the map for 1948.

I especially want to thank Tim L. Pennycuff, assistant professor and university archivist at The University of Alabama at Birmingham (UAB), who from the start has been supportive of my efforts to preserve the oral histories of African American physicians in the state. The UAB Medical Archives and the Lister Hill Library were among the first places I worked as I began to document the largely forgotten role that black doctors have played in Alabama's history during the twentieth century. My thanks also go to A. J. Wright, associate professor and director of the Section on the History of Anesthesia in the Department of Anesthesiology Library of The University of Alabama at Birmingham, who for several years has been providing extensive Web-based documentation on Alabama's black doctors before World War I and who generously shared information with me.

Finally, I express my gratitude for the many excellent suggestions made by the readers who evaluated the manuscript for The University of Alabama Press and for the support and encouragement of the press's staff. As always, I owe a special debt to my wife, Diane M. Ellis, who read the manuscript and made valuable suggestions and whose knowledge of local historic preservation helped me provide an accurate historical context for Hereford's story.

Jack D. Ellis

Introduction

I first met Dr. Sonnie Wellington Hereford III in 1996 at a public screening of amateur film footage that he had made during Huntsville's civil rights demonstrations of the early 1960s. As I learned from the film, Hereford had played an active part in the local sit-in campaign of 1962, which had forced the city to integrate its lunch counters and, soon afterward, its parks and theaters. Next, he had led the drive to end discrimination at Huntsville Hospital, where black patients had previously been relegated to a small, poorly furnished section called the Annex, or Colored Wing.

Then, in September 1963, despite threats against his life, Hereford had held his six-year-old son's hand as they walked up the steps of the Fifth Avenue Elementary School on Governors Drive, where Sonnie Hereford IV became the first black child to integrate the public schools of Alabama. These early victories in the civil rights movement had happened without widespread violence, and they were achieved before President Lyndon B. Johnson had signed the Civil Rights Act of 1964 outlawing discrimination in public facilities.

The film that I watched was at that point a homemade production, but its images of black people marching in the downtown streets, some carrying posters that mocked America's claim to be the defender of freedom against the Soviet Union while denying freedom to its own citizens, were powerful and effective. The irony was especially appropriate for Huntsville, a city that was already forging a new conception of its past. It was one now focused on the exploits of Wernher von Braun and the team of German scientists who had once built rockets for the Third Reich and were now directing America's race to the moon at Marshall Space Flight Center. As this version was to evolve in the years after the moon landings of 1969, the racial discrimination that had once been a central feature of the town's history rated hardly a mention, and any role that black people had played in ending segregation peacefully and thus helping the city prosper as a center for investment and technology seemed largely forgotten.

When I met Hereford, I had only recently taken a position at The University of Alabama in Huntsville and was resuming research in the social history of medicine that I had started while at the University of Delaware. Broadly speaking, my interests focused on African American health care in the South, which in turn had grown out of my work on doctors and public health in pre- 1914 France and from my efforts to identify comparative frameworks for illustrating the links between sickness and social inequality. A study of Alabama's black doctors, I believed, would shed light on a larger historical narrative detailing the struggle of African Americans to achieve physical health as well as social equality.

In July 1997, as part of a series of oral histories that I had subsequently begun with black physicians throughout the state, I held the first of many interviews with Hereford. He made himself freely available and had ample time to talk, having by then experienced a long series of problems with the Alabama Board of Medical Examiners that had brought his medical practice to an end. At the time, I knew none of the details of Hereford's troubles, but I indicated that I was willing to discuss them if he wished, especially in light of his belief that his treatment had been unjust and may have been linked to his earlier civil rights activities. It was still painful for him to talk about, however, and I did not press the matter. Eventually, as all hope of being restored to his profession faded, he decided to give his side of the story, which occurred in taped interviews I conducted with him in 2003 and 2004.

Because we lived in the same city, it was easy to schedule our meetings, which offered a rare opportunity for me to explore in depth the background, education, and career of a black doctor. As time went on, I began to see another story unfolding that showed the enormous diversity of the black experience in medicine. It was the story of a man who, against great odds, managed to achieve his childhood dream of becoming a doctor and along the way scored important victories in the struggle for racial justice, only to see his life collapse in ruin. Hereford's recounting of what happened thus provided an intensely personal and human dimension to the history of black doctors in the South.

As was evident in our conversations, Hereford's consciousness had been shaped by his early family life and by the code of hard work and discipline imposed by his parents. His father, one of 26,000 blacks from Alabama who had been drafted during World War I,¹ returned home from France and built his own church, where he served as pastor. North of the city, where the family lived as sharecroppers on a 160-acre plot known as the Buell place, he farmed mostly cotton, paying the absentee owner a fourth of the product. Meanwhile, he rented out his own forty-acre farm to another black sharecropping family, which paid him half the crop because he provided the seed, fertilizer, mules, and plows. That was the typical arrangement. Civil rights leader John Lewis has recalled that in Pike County down in the Wiregrass, where he grew up, working on half was the most common form of sharecropping.²

Landownership placed Reverend Hereford among a small elite of black farmers, of whom the vast majority lived under the tenant-sharecropping system described in Theodore Rosengarten's classic All God's Dangers.³ That Hereford was an exception testified to his fiercely independent spirit and to his strategy of pooling family funds in order to buy up adjoining acreage over several years.⁴ He devised numerous moneymaking schemes to supplement his cotton crop, including a sorghum mill, which he let others use for a portion of the syrup, and a portable hay baler, which could be drawn by a single mule to neighboring farms.⁵ As cash dried up during the Depression, he put up his farm as collateral for loans, including one for $1,300 taken out under the New Deal's Emergency Farm Mortgage Act.⁶

Jannie Hereford shared her husband's belief in discipline and hard work and helped oversee the Buell place; among other things, she trimmed and salted the hams and shoulders of hogs killed in the late fall and cooked for the field hands hired during cotton season. Known affectionately as Big Mama, she kept a firm grip on management of the household, which, at the time of Dr. Hereford's birth, included his brother, Thomas, and two great-grandparents, Sonnie and Bettie Hereford, both born in Madison County during slavery times. Jannie Hereford also held the title of Mother of the Church, a term reserved for the most respected members of the congregation and that implied a center of power separate from that of the pastor.⁷

Dr. Hereford talked about his parents, cotton farming during the 1930s and 1940s, and how as a child he had witnessed the flight of black people out of the South. He described the powerful role the black churches had played in the life of the black community and how certain teachers in the city's all-black schools had encouraged him in his desire to learn. The schools themselves, he explained, operated under appalling conditions, plagued by chronic shortages of books and desks and offering little in the way of science education. Councill School, for example, named after the ex-slave who had founded Alabama Agricultural and Mechanical College, had only the barest of laboratory facilities to satisfy his growing curiosity about chemistry and biology.⁸

Among Hereford's most poignant recollections was the dawning of his racial consciousness and what it meant to be black in a white-dominated world. Reminders were everywhere, from segregated water fountains in the downtown stores to the occasional taunts he heard from white children in the nearby mill villages while walking to school. His awakening was one that other civil rights activists from John Lewis to Anne Moody to Melba Pattillo Beals have described.⁹ Hereford's reflections enrich this literature of memory, and they help us understand the importance that he and other black children attached to black heroes like Joe Louis and Jesse Owens and especially the black first lieutenant who once visited his ninth-grade class at Councill School wearing the uniform of a Tuskegee airman.

From there, our discussions turned to Hereford's student days at Alabama A&M. The school was within walking distance of his house, and he and his brother, Thomas, would take turns plowing while the other attended class. Although it lacked an arts and sciences division, Alabama A&M offered courses in biology, physics, chemistry, and biochemistry, and Hereford was able to get a sufficient grounding in these to pass the Medical Profile Test and Graduate Record Examination. This earned him admission to Meharry Medical College in Nashville after two years at Alabama A&M. For part of his tuition, he was able to benefit from a 1948 agreement between Meharry and the southern governors, who, as a way of keeping their medical schools all white, had agreed to provide tuition subsidies to Meharry in return for its reserving a set number of places for black medical students from each participating state.¹⁰

Hereford recounted in detail his experiences at Meharry, which produced the vast majority of black physicians practicing in Alabama.¹¹ His oral account, supplemented by notes on his course and clinical work, provided insight into the education of an aspiring black doctor during the early 1950s. It told a larger story as well, which was how young people from schools long deprived of funding managed to prove themselves the equal of whites in the field of medicine. While failure rates for Meharry graduates on state licensure board examinations had averaged around 26 percent during the 1920s, that figure dropped as standards improved. By 1946, it stood at 7 percent, as compared with 9.9 percent for candidates from all approved medical schools in the United States and abroad.¹²

After a shaky start, Hereford soon settled in and began making progress, eventually finding work as a lab assistant. This, plus what he earned by helping his brother on the farm during summers, enabled him to finish on schedule at Meharry, where he graduated second in his class. After passing his board examinations, he interned at a small Catholic hospital in Hammond, Indiana, where he met his future wife, a nursing student named Martha Ann Adams, daughter of a Kentucky coal miner.

In 1956, the young doctor returned to Huntsville and opened a practice. As our discussions shifted to these years, he began to paint a richly textured portrait of what medical practice had been like for him in those days. His account of the unsanitary conditions that existed in the Colored Wing of Huntsville Hospital, for example, and the blatant racism that he witnessed on the part of some local doctors shed important light on the treatment of black people in the American health care system during that era.

When Hereford opened his practice, Madison County had a total of forty-three white physicians. They included a large number of young people, but there was also a small group of older practitioners, including eleven who had been born in the nineteenth century. Highly regarded in local social and civic circles, several of them occupied positions of power and influence within the Medical Association of the State of Alabama (known by its ironic acronym MASA) and on the staff of Huntsville Hospital.

On matters of race, the town's doctors exhibited a range of attitudes. By the late 1950s, a handful of the younger ones had begun integrating their waiting rooms; others would have been willing to admit black physicians to the Madison County Medical Society had it not been for the opposition of the more senior practitioners. The latter included a minority that could be described as militant in their segregationist attitudes. In several instances witnessed by Hereford, their conduct reflected a deep contempt for black people, the roots of which lay in a powerful strain of pseudoscientific racism that characterized the state's medical past.¹³

Hereford's exclusion from the all-white Madison County Medical Society denied him any chance to join the American Medical Association (AMA), which required membership in a local affiliate. Earlier in the century, black physicians in the larger cities of Mobile, Montgomery, and Birmingham had created their own organizations, and many black doctors in the state had been active in the National Medical Association (NMA) since its creation in 1895 as an alternative to the AMA. Nevertheless, these organizations did not provide the access to professional growth and opportunities that the white societies afforded.¹⁴

Adding to Hereford's isolation was the near absence of black colleagues with whom he could consult and who could fill in for him when he needed time off. In 1920, Alabama had just 106 licensed black physicians, which represented only 4.7 percent of all doctors in the state, though blacks constituted 38 percent of the population.¹⁵ By 1950, the number had dropped to 73, reflecting medical flight to the North and the reluctance of newly trained black medical graduates to try their luck in Alabama. Those who did so were clustered in areas that had large numbers of black people, mainly Birmingham, Montgomery, Mobile, and some of the larger towns of the Black Belt counties. While the proportion of white physicians to the white population stood at 1 per 1,072 for the state, the ratio of black doctors to the black population was 1 per 13,605.

Huntsville itself had attracted relatively few black doctors over the years. Between 1879 and 1948 only eleven held degrees from a recognized medical school. The year that Hereford opened his office, there was just one other black physician serving Madison County, a Meharry graduate named Harold Fanning Drake, son of Alabama A&M's president. Yet by 1960 the county's black population stood at 22,000, about 19 percent of the total 117,000 inhabitants.

Hereford talked at length about the demands he faced in being one of only two black doctors in town, and he described in detail the grinding poverty he saw during house calls to black neighborhoods, where decrepit dwellings, overcrowding, lack of pure water, and ignorance of prevention often tested his skills. Some patients he treated for nothing, occasionally charging their medicine to his own pharmacy account. Others paid only minimal fees. His recall of places and events was remarkable and often corroborated by documents that he had saved from his first years of practice.

Although Huntsville's racial atmosphere struck many contemporaries as being less oppressive than elsewhere in the state, it was still a segregated community whose history had many dark chapters, including several lynchings. The presence of ten large cotton mills in the city, such as Lincoln Mills near Hereford's home, meant that thousands of poor whites were concentrated in company-owned villages surrounding the factories. The men, women, and children who worked the looms suffered their own forms of discrimination at the hands of respectable whites, which gave an ironic twist to the disdain and even hatred for blacks that often flourished in the mill villages and that Hereford and his brother experienced firsthand as children.¹⁶

Hereford's explanation of how he came to participate in a nonviolent campaign to end racial injustice is among the most compelling parts of his memoir. Although he had followed the Montgomery bus boycott while finishing his medical training in 1956 and admired the students conducting sit-in protests in Nashville and Greensboro in 1959 and 1960, his decision to become an activist grew out of his own private history—from his father's example and his own encounters with racism to the courage he witnessed early in his practice among several older blacks in town who were active in voter registration.

Starting with the sit-in campaign of January 1962, Hereford provided an eyewitness account of what was happening behind the scenes in Huntsville. Though events had been sparked by a young field agent from the Congress of Racial Equality (CORE), leaders of the black community quickly embraced the cause. In addition to his role in formulating strategy, Hereford served as the movement's physician, having volunteered for the task at one of the first mass rallies.¹⁷ What was most striking in his account was the part played by ordinary people and the degree to which conditions at the local level, far more than any centralized civil rights leadership, determined the outcome of the struggle, a pattern seen in other places across the South.¹⁸

What happened next was harder for Hereford to talk about. While he remains convinced that the problems he began experiencing during the 1970s were linked to resentments against him because of his earlier civil rights activism, he conceded that these problems were compounded by excessive numbers of patients, poor record keeping, and the informal arrangements that he and the other black doctors in town had devised in order to cover for each other during absences.

The trouble began with Hereford's participation in Medicaid, a joint federal-state program that was implemented in Alabama in 1970 to provide medical assistance for the indigent. Like Medicare, Medicaid extended to health and welfare some of the victories of the civil rights era.¹⁹ Though opposed by the AMA and the health care industry, both programs helped people who had long been deprived of care. At the same time, they contained hidden dangers for participating doctors, who had to cope with new medical bureaucracies and shifting political currents.

When Medicaid was finally put in place, great numbers of physicians, citing the program's restrictions, low fees, and excessive paperwork, refused to participate. A national survey of 3,482 doctors conducted in 1977 reported that 21.6 percent treated no Medicaid patients, while another 49.2 percent had practices in which Medicaid patients accounted for just 10 to 20 percent of their clientele. On average, Medicaid patients constituted just 13.3 percent of all caseloads. Large Medicaid providers, defined as those for whom patients in the program constituted 30 percent or more of their practices, represented just 15.8 percent of those surveyed.²⁰

That the large Medicaid providers included many black physicians is not surprising. In 1969 Lloyd C. Elam, president of Meharry, estimated that 80 percent of the school's graduates practiced in poverty-stricken areas.²¹ These, along with foreign-trained physicians in the inner cities, often bore the blame for driving up Medicaid costs through fraud, despite studies showing that the real cause was the growth in numbers of recipients, medical price increases, and soaring prices for nursing home care.²²

In Alabama, a backlash against the social programs of the Great Society was visible on many fronts, starting with Governor George Wallace's resistance to the integration of state hospitals.²³ Politicians complained bitterly over Medicaid costs, even though Alabama, like many poor states, benefited from a federal matching rate that usually stood at three to one. By the late 1970s, the state began reducing medical services as well as fees paid to participating physicians, and there were calls for vigorous prosecution of any doctors suspected of defrauding the system. To this end, in 1978 the Medicaid Fraud Control Unit was placed in the Alabama attorney general's office.

The following year the fraud unit accused Hereford, by now one of the state's top Medicaid providers, of submitting claims for hospital patients whom he had not personally attended. His efforts to explain that he had not intentionally done anything wrong and that the claims in question were the result of agreements that he and his black colleagues had worked out to cover for each other during absences were to no avail. State investigators indicted him on forty-six counts—one for each patient for whom he had filed a claim. On his attorney's advice, and rather than face trial and the possibility of prison time, he chose to plead guilty to two counts, accepting a three-year probation and repayment of double the claims that he had been paid.

Although Huntsville's black community rallied to Hereford's support, the Medicaid charges were only the beginning of his difficulties, and soon a new cycle began. In 1985, the Alabama Board of Medical Examiners began querying him about his treatment practices, accusing him of prescribing pain medications without sufficient diagnosis. Then, in 1992,