Before EMTALA, There Were Black Women With Hidden Histories

Dr. Sabreen Akhter (left) and Susie Revels Cayton (right)
Dr. Sabreen Akhter (left) reflects on how Susie Revels Cayton (right, courtesy of the University of Washington) and the Dorcas Charity Club partnered with Seattle Children’s to establish an ongoing policy of admitting and treating sick or malnourished children regardless of their race, religion or the ability to pay.

One of the things I take great pride in, as a pediatric emergency physician, is that the Emergency Department (ED) is a place where the doors are always wide open.

The ED is a place that takes all patients, no matter how minor or major the concern; no matter the time of day; no matter the ability to pay; no matter the language, race, religion, or identity — our unifying goal is that all will be seen and be given compassionate care.

As an ED provider, I see my work as a kind of care that is more rudimentary even than primary care. It is a place of hope and sanctuary to the patients and families that we see, for the worried parents bringing their child in at all hours of the day or night, and for those who have no access to their own pediatricians.

This “open door” policy of the ED was not always the norm at pediatric hospitals. Prior to the passage of the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986, private hospitals commonly “dumped” patients, mostly those who were poor and minority status, into county hospital systems where they would fare much worse. This was often done without the patient’s consent. After review, it was determined that this practice of denying care to certain patients was primarily due to financial reasons and was unethical. Monetary penalties were introduced for hospitals found to be in violation of this law, and soon the landscape of emergency and hospital care changed permanently.

The provisions are complex, but essentially after EMTALA was passed any person presenting even within the vicinity of a hospital emergency department must be given a medical evaluation in accordance with the law.

Seattle Children’s ED was not part of the original envisioning of the hospital. As someone interested in how medical histories intersect with social movements, I have long been fascinated by the story of how this hospital came to be.

The history, as it is told, is that Anna Herr Clise, a prominent white Seattleite, lost her young son to “inflammatory rheumatism” in the late 1800s. Today, juvenile idiopathic arthritis is rarely life threatening and can typically be brought under control by a combination of anti-inflammatory medications, but in 1898, Anna Clise was bereft. The death of her son affected her deeply and galvanized her to convene a group of 23 other eminent women to build the first version of our hospital.

What started as a small fresh-air house in Queen Anne, mostly treating children who were post-operative from orthopedic procedures, has now become one of the most advanced institutions for the care of children in the nation.

Anna Clise and her contemporaries, the “Lady Bountifuls,” had a unique vision to start a hospital dedicated to the care of children, in a time when only a handful of such places existed in the country. There are stories of the ladies actively reaching out to the community to find patients in need of care and holding luncheons where attendees would commit to donating $10 to secure funding for the new hospital. It is a riveting story, and one that inspires me to think of how ordinary mothers, spurred by their great love of children, could motivate a community to create a place of service and healing.

But there is a name that gets lost in Children’s history, one that is well known to historians of Black Seattle but rarely mentioned in pieces written about the foundations of this hospital. That name is of Susie Revels Cayton.

Susie Cayton was born in 1870 in Mississippi, the same year her father, Hiram Revels, became the first Black senator in the United States. She was a teacher, a nurse, an author and eventually an associate editor at the newspaper her husband, Horace R. Cayton, himself the son of a formerly enslaved person, founded.

Susie joined her husband in Seattle in the late 1800s, and the couple became very involved in civic activities, particularly as they related to the small but growing Black community in the Pacific Northwest.

She raised four children of her own, a few of whom grew up to be prominent sociologists, authors and community organizers. She became deeply involved in politics and activism in her later life. She was also a founding member of the Dorcas Charity Club, a group of Black women dedicated to improving social conditions for their community at the time, ranging from finding homes for orphaned children to helping widows with their living expenses.

One of the most enduring and least-known legacies of Susie Cayton was that of the alliance of the Dorcas Charity Club and Children’s. Within the first year of the hospital’s establishment, a young Black girl named Madelaine Black was admitted for treatment of tuberculosis of her knee. Her hospital stay proved longer than expected, leading Susie and the Dorcas Club members to meet with Children’s leadership and come up with funds and a plan to pay for the child’s ongoing treatment. Through this collaboration, Children’s established an ongoing policy of prohibiting discrimination based on race, religion or the ability to pay when it came to admitting and treating sick or malnourished children.

In a time when many prominent hospitals across the country actively turned away non-white patients or established entire alternate and discriminatory health care systems for Black people, this act of intentional inclusivity was one of radical proportions. And, like so many social movements of our current time and those whose histories have been obscured by dominant cultural narratives, it was led by a Black woman.

As a female-identifying physician, I find Anna Herr Clise’s story of her impetus to start a children’s hospital and her ability to organize her peers captivating and moving. As a physician of color, I find Susie Revels Cayton’s story of her unending ambition to support her community and enact lasting social change simply inspirational.

There are countless other hidden histories of the good works of Black women in our society, many of whom likely never achieved the social prominence of the Caytons, but whose works, large and small, have laid the foundations of a more equitable and just world today.

To Susie Revels Cayton, and to all those women with hidden histories, we owe a great debt. As an emergency physician in a hospital that has been forever edified by her work, I strive to live up to her vision of a place that provides equitable care to all the children who walk through our doors.

Learn more about Children’s history and Susie Revels Cayton in the book Hope on the Hill.