1963),[1] was a federal case, reaching the Fourth Circuit Court of Appeals, which held that "separate but equal" racial segregation in publicly funded hospitals was a violation of equal protection under the United States Constitution.

With the assistance of the NAACP and other medical professionals in the area, Simkins filed suit, arguing that because the Moses H. Cone Memorial Hospital and Wesley Long Hospital had received $2.8 million through the Hill–Burton Act that they were subject to the Constitutional guarantee of equal protection.

[3] In a 3-2 decision, the Fourth Circuit overturned the district ruling, looking to whether the hospitals and the government were so intertwined by funding and law that the hospitals' "activities are also the activities of those governments and performed under their aegis without the private body necessarily becoming either their instrumentality or their agent in a strict sense.

The Court then found the provision for segregated "separate but equal" facilities to be unconstitutional, and it struck down that portion of the Hill–Burton Act.

[6] In 1964, Title VI of the Civil Rights Act of 1964 banned discrimination on the basis of race, color, or national origin for any agency receiving state or federal funding.