In recognition of 2025 Black History Month, we are posting the following excerpt from the upcoming The People Collector: The Life of Dr. Richard A. Smith, the first complete telling of the life and times of this visionary civil rights and healthcare leader.
Two years before Dr. Smith moved from Washington, D.C. to Seattle, WA to pursue an idea that he had long fostered — the creation and launch of MEDEX Northwest — he was part of the executive staff within the U.S. Surgeon General’s Office. His assignment in the Surgeon General’s Office had followed on the heels of his pivotal leadership work in Nigeria with the then newly-created Peace Corps.
This excerpt, “Dr. Richard Smith and the Call to Desegregate America’s Hospitals,” begins with Dr. Smith sitting in the office of his boss U.S. Surgeon General William Stewart and learning of his new assignment as Deputy Director of the Office of Equal Health Opportunity (OEHO). His specific task in this new role was to desegregate the nation’s hospitals, which numbered over 7000 at the time. This daunting task would prove to be a transformative experience for the 34-year-old Richard Smith, and “the biggest contribution I’ve made to my country,” he would later claim.
See the Editor’s Note at the bottom of this post for an explanation of the immersive historical narrative style being employed in this piece of writing.
The Assignment
In February 1966, Richard Smith sat in U.S. Surgeon General William Stewart’s office. Outside, the cherry trees were just beginning to bud, though Richard barely noticed their delicate pink promise. His attention was fixed instead on Stewart’s demeanor, his thoughtful and measured expression. The atmosphere in the office crackled with anticipation of what Stewart was about to propose.
In July of the previous year, President Lyndon Johnson had signed the Medicare Act, a groundbreaking moment for American healthcare. Hidden among its transformative policies was a single line with seismic potential: hospitals receiving federal funds must desegregate—not just their patient wards, but every facet of their operations. Now, less than a year later, the compliance deadline loomed like a storm cloud on the horizon.
Stewart leaned forward slightly, his gaze locking onto Smith. “We need someone to lead the field operations for hospital desegregation,” he said, his voice calm but firm. “Someone who understands both medicine and civil rights. Someone who can handle delicate situations with diplomacy, but also with strength.” A pause hung between them before he added, “I want you to do it, Dick.”
Smith’s mind raced. Seven thousand hospitals. The number staggered him. Seven thousand institutions entrenched in decades of discriminatory practices, now required to change, and quickly. The newly passed Medicare legislation had given the Surgeon General’s office leverage: hospitals would receive federal funds only if they ended their practices of segregation. Of course Smith knew from experience that laws alone didn’t change hearts. Still, he took the assignment.
Getting Underway
Working with Deputy Surgeon General Leo Gehrig and Bob Nash, a skilled administrator, Dr. Smith began assembling a team of 350 staff members. Their first task was deceptively simple: send questionnaires to every hospital in America, asking them to detail their racial policies. The responses revealed the sobering truth of segregation in medicine, particularly in the South. Separate wards, duplicated X-ray facilities, different waiting rooms, even segregated blood supplies—these practices weren’t just tolerated, they were systemic, openly described and defended in many of the written responses.
Late one night, Smith sat alone in his office, reading through the damning documents. His stomach tightened as he read hospital administrators’ justifications for these practices, written in cold bureaucratic language. Medicine is supposed to heal, he thought, his anger simmering beneath the surface. Not divide. How could institutions meant to save lives perpetuate a system that cost so many? But he knew that his personal outrage wouldn’t dismantle a legacy of injustice. Closing the file, he resolved to focus on what came next. This was a battle for the soul of healthcare, for the soul of America, and he was determined to see it through.
The work would prove to be both ambitious and dangerous. Smith and his team faced resistance from hospital administrators and local officials, and sometimes even faced violent threats. But with President Johnson’s backing and the power of Medicare funding as leverage, they began the painstaking process of dismantling decades of institutional racism in American healthcare. One story of many stands out as an instructive one: the challenge of desegregating a hospital in Marshall, Texas, the hometown of Lady Bird Johnson, the First Lady of the United States.
A Call from the Vice President
Just two months into his new role as Director of Field Operations for the Office of Equal Health Opportunity (OEHO), Dr. Smith was hard at work when his secretary knocked on the door.
“Excuse me, Dr. Smith. I think you’ll want to take this call. It’s Vice President Humphrey’s office.” Smith’s steady hand betrayed none of the tension coursing through him as he reached for the phone.
“Dick, this is Hubert Humphrey,” came the Vice President’s unmistakable voice, warm and full of energy. “How are you, my friend?” It seems Vice President Humphrey had been keeping his eye on the important work that Richard Smith had been doing since the two of them met the previous year at the White House Conference on Health. “The Surgeon General speaks very highly of you, Dick, and I have to say, I’m impressed.”
“Thank you, Mr. Vice President,” Smith replied, his voice steady but curious about the reason for the call. “What can I do for you?”
“Well Dick, I’ve got a special request from the President himself,” Humphrey continued. “He wants you to personally oversee the desegregation of the hospital in Lady Bird Johnson’s hometown of Marshall, Texas.”
Smith straightened in his chair. A direct order from the President. “I understand, sir,” he said, already feeling the weight of the assignment settling on his shoulders.
“We know it won’t be easy,” Humphrey added, his tone softening. “But this is an important step—not just for Marshall, but for the entire country. I don’t need to tell you how much is riding on this.”
“You don’t, sir,” Smith said firmly. “I’ll get it done.”
Humphrey’s voice brightened. “That’s exactly what I was hoping to hear. Good luck, Dick—and let us know if you need anything.”
As the line clicked off, Smith set the receiver down slowly. There can be no failure here, he thought.
Coming Into Marshall
The flight from Washington D.C. to Dallas, TX left Dr. Smith with knots in his stomach, though years of navigating racial tensions had taught him to maintain an outward calm. At the airport, he was met by the Regional Director of Health, Education, and Welfare, a man whose name briefly caught him off guard. “Dr. Bond, James Bond, at your service,” the man said with a wry smile.
Smith raised an eyebrow at the absurdity. James Bond? You’ve got to be kidding me. A faint smile formed in the corners of his mouth, and for a moment, the tension eased. “Well, I suppose it’s fitting, given the mission,” he said, shaking the man’s hand firmly. Anything to break the ice before we step into the fire.
Any amusement at the coincidence of his encounter with “007” vanished as the two crossed into Harrison County on their way from Dallas to Marshall. Out of nowhere, more than a dozen pickup trucks had materialized behind them, gun racks prominently displayed through their rear windows. We notified the hospital administration, he thought, watching another truck roar past with a blaring horn, but who told these hooligans we were coming?
The convoy took turns tailgating their government car, each pass off accompanied by the obnoxious and threatening sounds of horns and engines. Bond maintained a steady speed. His calm presence countered the increasingly aggressive display around them. The harassment continued until they reached the Marshall city limits, where the trucks peeled away as suddenly as they had appeared. When they finally pulled into the hospital parking lot, Smith let out a long breath, the tension in his shoulders finally releasing. But the knot in his stomach didn’t dissipate. That was just the welcome committee, he thought. The real fight’s waiting inside.
We Won’t Comply
Inside the hospital, everything gleamed. The floors were polished to a mirror-like shine, and the staff’s tight smiles felt rehearsed, their cheerfulness too perfect to be genuine. Dr. Smith could spot the performance—years spent acting in his younger days in summer stock theater back in Norwalk, CT had taught him how to recognize when someone was putting on a show. The administrator’s handshake was firm but fleeting, a practiced gesture that revealed little. He knew the real test would come in the boardroom.
The hospital board members arranged themselves around the long table, their faces offering little. Smith withdrew the documents from his briefcase with deliberate care – first the Surgeon General’s introductory materials outlining the new law, then the hospital’s own completed OEHO questionnaire. The familiar rhythm of these movements helped steady him. He’d done this in training sessions dozens of times, but this was different. This was the real thing. This was for the President.
As Smith spoke, the administrator leaned back in his chair, arms crossed. His expression shifted from feigned politeness to open defiance. Then Smith reached for what those in his office had come to think of as their ace in the hole – the financial consequences of non-compliance. He laid out the stakes with absolute clarity. His voice remained steady as he explained that continuing their discriminatory practices would mean forfeiting millions in annual Medicare payments. The hospital would lose its access to Department of Defense surplus equipment and their supply of Department of Agriculture surplus food would be cut off.
“We won’t comply,” the man said flatly. “This law is unfair, and we won’t be bullied by Washington.”
The silence that followed was deafening. Smith’s hand froze mid-motion as he reached for another document. His eyes met the man’s gaze, and without blinking, the administrator said, “We don’t need your money.”
You will, Smith thought, but he didn’t say it aloud. Instead, he let the silence settle into the room, heavy and oppressive. His eyes quickly panned the room looking at each board member, searching for any sign of dissent. Nothing. Their faces were stone, their silence was complicit. They’re united, every single one of them, he thought. There’s no cracking this today.
Doing the Math
The drive back to Dallas was a somber one. As the Texas landscape rolled past, Dr. Smith’s mind churned with the implications of this apparent failure. Each mile marker seemed to bring him closer to the moment he’d have to report back to Washington. After some time, Bond broke the silence, his voice calm and pragmatic.
“Dr. Smith,” he said. “Texans in power will fight tooth and nail to protect their pride—until they realize it’s costing them more than they’re willing to pay.”
Smith glanced over, the defiance of the hospital administrator still fresh in his mind. “And when they do realize it, what happens?”
Bond smirked, his eyes steady on the road. “They find a way to save face while quietly doing what benefits them most. You hit them where it hurts today: their wallets. Trust me, they’re already doing the math.”
Smith let out a tired laugh, shaking his head. “You seem pretty sure of yourself.”
Bond chuckled confidently. “Because I’ve seen it before. Pride might keep them stubborn for a while, but it doesn’t pay the bills. Once they figure out the dollars will dry up, they’ll cave quicker than a sandcastle at high tide.”
Smith stared at the fading horizon as his colleague’s words echoed in his mind. The tight knot in his chest began to ease, but his doubts didn’t fully lift.
Back in Washington, D.C., Dr. Smith briefed his superiors on his failure to fulfill President Johnson’s personal request. His senior colleagues at OEHO decided the best course was to let the situation simmer for a bit. Three days crawled by with no word from Marshall. Then, on the fourth morning, Smith’s phone rang. The chairman of the hospital board’s voice came through clear and firm: “The hospital will immediately end all racial discrimination.” When Smith reminded him of their administrator’s adamant stance just a few days prior, the chairman’s response was: “Well, Dr. Smith, the hospital just got a new administrator, and things have changed.”
As Smith hung up, he allowed himself a brief smile. Bond was right, they had done the math.
The Biggest Contribution
The work would continue, hospital by hospital, state by state. Some facilities chose compliance over financial ruin. Others required more persuasion. Resistance to change involved falsified hospital records, staged hospital scenes for influential tv news reports, and even the murder of internist committed to supporting desegregation. But the numbers told the story that mattered most. Every life saved, every child spared, was worth the struggle. For Dr. Smith, the fight for change was far from over, but he knew one truth: before you can heal, you have to stop the bleeding.
By the spring of 1966, the OEHO was under siege. The midterm elections that year handed Republicans significant gains, empowering conservatives and Southern Democrats to attack civil rights enforcement. They targeted the OEHO, pushing for centralization under congressional control, effectively dissolving the office by 1967. For those who had fought to desegregate over 7,000 hospitals in that short period of time, the dismantling of the OEHO was deeply disheartening.
Yet for Smith and his colleagues, those few months in 1966 were transformative. “It was the biggest contribution I’ve made to my country,” he would later claim. The relentless pace, the personal sacrifices, and the challenges faced in desegregating America’s healthcare system became defining moments for all those involved. Though the OEHO closed, the impact of its work and the personal growth of its staff remained enduring legacies, shaping their careers and their commitment to justice for years to come.
Editor’s note: Our approach in telling the impressive life story of Dr. Richard Smith is through what is called immersive historical narrative. This is a form of historical writing that combines deep research and historical accuracy with a narrative style intended to highlight the lived experiences of Smith and those around him. It might be thought of as fact-based history presented in the narrative style of fiction. The historical figure we know as Richard Alfred Smith was by all accounts a compelling, engaging and dynamic person. We want the reader’s engagement with him to be compelling, engaging and dynamic in equal measure. The narrative decisions at work here are never made at the expense of accuracy or fact. For instance, even when we include exchanges of imagined dialogue or assign certain interior thoughts, we rely on the historical record to do so. Primary among the resources we rely upon are materials collected in the growing Dr. Richard Smith Archives, which include drafted memoirs, diaries and personal notes, professional and private letters, published books and articles, transcripts of interviews, public talks and presentations, even television scripts and musical compositions! Our interest throughout is to place the reader in moments that certainly happened to Richard Smith, but to convey those moments as they might have played out in the context of this extraordinary life.