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Bi-Weekly Case Briefs: Students are expected to write a Case Brief for the assigned case located in the "Apply" folder for each module. You can explore additional available newsletters here. This, however, would later prove difficult as discrimination persisted. Follow the guided process and soon your order will be available for our team to work on. Summary. 835 (1883), it has been firmly established that the inhibitions of the Fifth and Fourteenth Amendments to the Constitution relate solely to governmental action, state or federal, and that neither amendment applies to acts by private persons or corporations. 2d 179 (1957). Wesley Long Hospital denies admission to all Negro patients. Enter the email address you signed up with and we'll email you a reset link. The NAACP Legal Defense Fund was also instrumental in promoting the outcomes of the cases. . two African American patients that sought medical and dental services of their physicians but Judge Stanley contended that Moses H. Cone and Wesley Long were both private hospitals, not government entities. The framework for analyzing the cases (and creating your Case Brief) can be found in the Preview . The Cone Hospital owns, and has owned since 1911, the fee simple title to the real property on which its hospital is located. Title VII in the Federal Courts - Private or Public Law Title VII in the Federal Courts - Private or Public Law. Health care and civil rights: an introduction. Ethnicity & Disease 15.2 Suppl 2 (2005): S27-30. The plaintiffs, A. V. Blount, Jr., Walter J. Hughes, Norman N. Jones, Girardeau Alexander, E. C. Noel, III, and F. E. Davis, are medical doctors licensed to practice and practicing medicine in the City of Greensboro, North Carolina. al. After World War II, leaders in the black community were determined to improve health care for black persons by ending discrimination in hospital policies and practices. Cases involving a hospital in North Carolina and the other hospital in Virginia were determined in these proceedings. The plaintiffs 1. The nursing students carry out assignments at the hospital under the supervision and direction of their own teachers, and not of the hospital staff. The land upon which the hospital was constructed was conveyed to the James Walker Memorial Hospital by the city and county, to be held in trust for the use of the hospital so long as it should be maintained as such for the benefit of the city and county, with reverter to the city and county in case of its disuse or abandonment. Falk, Carruthers & Roth, Greensboro, N. C., for defendants Moses H. Cone Memorial Hospital and Harold Bettis, Director of Moses H. Cone Memorial Hospital. Who won at the trial-court level? The monetary value of the services rendered the hospital by the student nurses is not commensurate with the substantial contributions the hospital has made of both its funds and facilities to the furtherance of the nursing educational programs. There is an interesting discussion of a somewhat related problem by Judge Matthews in Mitchell v. Boys Club of Metropolitan Police, D.C., 157 F. Supp. Apply to become a tutor on Studypool! (The holding should answer the question presented in the Issue.) What was the courts specific rationale for that decision? For this assignment, be sure to carefully read Chapter 1 from the textbook as well as the court case below, Simkins v. Moses H. Cone Memorial Hospital. Intrigued by the apparent irony of their story, Rosen weaves a complex chronicle that outlines how Southern Jewsmany of them recently arrived immigrants from . The lawyers actively sought for state action or the involvement of the federal government with regard to activities of a private hospital. MeSH Your brief should be written in complete sentences using the above headings. Describe an organizational situation in which problems were encountered. Desegregating Hospitals. Learn NC North Carolina Digital History, Achieving Civil Rights, 1960 1965. Simkins v. Moses H. Cone Memorial Hospital, 211 F. Supp. The plaintiffs, George C. Simkins, Jr., Milton Barnes and W. L. T. Miller, are dentists licensed to practice and practicing dentistry in the City of Greensboro, North Carolina. The assertion that the participation of the hospital in this program in any way affects the character of its operation is completely unsupported by any authority that has been brought to the attention of the Court. 3. This document was sent to the Supreme Court so that they could review the decision made on the Simkins case by a lower court. The NAACP assisted the plaintiffs as they gained support behind their petition, and the activist group hired Conrad Pearson, an NAACP attorney from Durham, to file the petition to federal district court. After an initial loss in trial court, a federal appeals court supported the plaintiffs, whose claim rested on the principle that federal health care funds . 1963) Jackson v. Metropolitan Edison Co. 419 U.S. 345(1974) 1. Case Brief #1: Simkins v. Moses H. Cone Memorial Hospital, The parties involved in Simkins v. Moses H. Cone Memorial Hospital were African, American physicians, dentists and patients, who were the plaintiffs, and Moses H. Cone Hospital, and Longwood Community Hospital, who were the defendants. Students are required to utilize the following analytical framework for briefing cases: Procedure. Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants. American College of Physicians Internal Medicine. On July 12, 1962, an order was entered denying plaintiffs' motion for a preliminary injunction, the Court being of the opinion that the injunction was not required pending the final determination of the action on the plaintiffs' motion for summary judgment and the defendants' motion to dismiss. View Image & Text: Download: small (250x250 max) medium (500x500 max) Large. Docket sheet not available via the Clearinghouse. The federal government's use of Title VI and Medicare to racially integrate hospitals in the United States, 1963 through 1967. den. National Library of Medicine Vermont Oxford Network: a worldwide learning community. Pull in as many good HR practices as possible.Choose one of the following: George Simkins and other African American doctors and patients filed a suit against the two Piedmont hospitals alleging that the facilities refused to accept black patients. The role of Chief Justice Simon E. Sobeloff remained instrumental in this landmark ruling. Andy is working as a quality assurance specialist in the plant and Ismal is an IT robotics specialist. Civil rights in a changing health care system. Finally, it had large legal loopholes to promote racial segregation. v. petitioners, hobby lobby stores, inc., respondents. Running head: CASE BRIEF The plaintiffs make the interesting, but in the opinion of the Court, completely untenable, argument that the hospital, in expending its resources to aid student nurses enrolled at the two State institutions involved, are doing the work of the State, and thereby become agents of the State, "subject to the constitutional restraints of governmental acts to the same extent as private persons who govern a company town." Case Brief: Simkins v Moses H. Cone Memorial Hospital Case Brief: Simkins v Moses H. Cone Memorial Hospital Procedure: George Simkins, other . of Managers of James Walker Memorial Hospital, 4 Cir., 261 F.2d 521, affirming 164 F. Supp. 1998 Jan 15;128(2):158. doi: 10.7326/0003-4819-128-2-199801150-00022. California-Style OpenHouse. 15. 24, International Brotherhood of Electrical Workers Moses H. Cone Memorial Hospital case. 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. n.d. The charter now provides, and has provided at all times pertinent to this action, that the eight trustees originally appointed by Mrs. Bertha L. Cone, and the one trustee originally appointed by the Board of Commissioners of the County of Watauga, or a total of nine members of the fifteen-member Board, are to be perpetuated through the election of the Board of Trustees. 17. amend. The entire appropriation of $1,269,950.00 had been paid to Cone Hospital, and $1,596,301.60 had been paid to the Wesley Long Hospital, through the Treasurer of the State of North Carolina, as of May 8, 1962. Plaintiffs vs. Case Brief: Simkins v Moses H. Cone Memorial Hospital Norris v. Mayor and City Council of Baltimore, 78 F. Supp. In 1883, the Supreme Court declared that the Equal Protection clause applied only to government entities, not private groups and organizations, in The Civil Rights Cases (1883). Health Inequities in Simkins v. Moses H. Cone Memorial Hospital. 1997 Jan-Feb;16(1):90-105. doi: 10.1377/hlthaff.16.1.90. Reynolds, P. Preston. Our company is extremely efficient in guarding the privacy of our clients. "Health Inequities in Simkins v. Moses H. Cone Memorial Hospital." States were free to distribute money to expand existing hospitals or construct new ones. Pediatr Res. What would be different today if the case had been decided differently? 1998 Jan 15;128(2):157-8. doi: 10.7326/0003-4819-128-2-199801150-00021. Blount was one of 11 plaintiffs in the landmark 1962 Simkins v. Moses H. Cone Memorial Hospital case that helped desegregate health care. As a matter of policy, neither hospital grants staff privileges to Negro physicians or dentists. In counter arguments, it was noted that the appropriations bill was not under the jurisdiction of hospitals. [12] The only contacts Wesley Long Hospital has with public agencies are (1) exemption from ad valorem taxes (2) state license and (3) the receipt of Hill-Burton funds. These statutes and regulations permit the Surgeon General to waive the requirement of nondiscrimination on the basis of race upon a finding that separate but equal facilities are available for separate population groups. The federal government interpreted the law to support the position of Black professionals and patients. 518, 671, 4 L. Ed. In rejecting this argument, the Court stated: What the Court of Appeals for this Circuit has said with respect to licenses required of restaurants in Virginia is equally true with reference to licenses required of hospitals in North Carolina. 1971), the "good deal more" was the significant public function carried out by each of the respective recipients of state money. McLendon, Brim, Holderness & Brooks, Greensboro, N. C., for defendant Wesley Long Community Hospital and A. O. Smith, Administrator of Wesley Long Community Hospital. Do you agree and why or why not? The African American founding fathers of the United States are the African Americans who worked to include the equality of all races as a fundamental principle of the . Ann Intern Med. privacy policy disclaimer contact / feedback 2403. Consequently, the manner of selection of the Board of Trustees of Wesley Long Hospital is not a factor in determining whether the corporation is public in character. Revenue cycle management is the process of collecting payment for the patient medical bill to help the hospital generate r Revenue cycle management is the process of collecting payment for the patient medical bill to help the hospital generate revenue. E.g. Sign up for our free summaries and get the latest delivered directly to you. The presence of the reverter clause makes the conveyance even more significant. Before First page of the Civil Rights Act of 1964. The monetary value of the services rendered the hospital by the student nurses is not commensurate with the substantial contribution the hospital has made from its own funds and facilities to the furtherance of the program. It provided opportunities for hospital integration based on the Hill-Burton Act and the provisions under the Civil Rights Act and the Medicare hospital certification program. Your matched tutor provides personalized help according to your question details. Laying a foundation for universal access to health care in the United States depended on a victory in the courts, in national health legislation, and in public opinion. Under these circumstances, they earnestly contend, and at the time of the oral arguments both parties conceded, that the Hill-Burton funds received by the defendant hospitals should be considered as unrestricted funds. You already receive all suggested Justia Opinion Summary Newsletters. 629 (1819), stated: The plaintiffs principally rely upon Commonwealth of Pennsylvania v. Board of Directors of City Trusts of City of Philadelphia, 353 U.S. 230, 77 S. Ct. 806, 1 L. Ed. 1). V Sept. 11th 1856. New York University, 492 F.2d 96 (2d Cir. Educational video on the history of Western medicine presented by the University of South Carolina's College of Library and Information Science as part of a workshop created by th Our tutors are highly qualified and vetted. Cone Hospital has incurred direct costs of $3,337.59 in connection with the Agricultural and Technical College program since 1954, and has paid these costs from its own funds. Print. 4. Under these circumstances, it cannot be said that the defendants waived their privacy by accepting Hill-Burton funds. 323 F.2d 959 (4th Cir. Henry wants to impress his boss and thought what an opportunity.Im going to prepare a plan to save ACME from losing these and other ACME star employees as well.AssignmentPrepare a 3-page actionable plan addressing HRs role (ACME-wide) for one of the three areas of your choice related to employee retention noted in the video. Provide details on what you need help with along with a budget and time limit. The corporation was formed many years ago under the laws of the State of North Carolina to conduct, without profit and for charitable and humane purposes, a general hospital in the City of Greensboro, North Carolina. . Chief Justice Sobeloff and other judges of the Fourth Circuit Court shifted the legal opinion on racial discrimination in hospitals. WILL SCAN DOCUMENT FOR PLAGARISM PRIOR TO RELEASING PAYMENT. A series of court cases litigated by the National Association for the Advancement of Colored People Legal Defense and Education Fund between 1956 and 1967 laid the foundation for elimination of overt discrimination in hospitals and professional associations. It was further provided that, after the death of Mrs. Bertha L. Cone, or earlier if she should renounce her right to appoint, the eight trustees originally appointed by her should prepetuate themselves by the election of the Board of Trustees. The US Supreme Court set a precedent for subsequent cases. Docket Number(s): 57-00062. Provision is made for the organization and qualification of medical staffs of hospitals, and certain facilities are required for operating rooms, delivery rooms, rooms occupied by maternity patients, and rooms occupied by children. For the fiscal year 1961-1962, the City tax rate was $1.27 per $100.00 valuation, and the County tax rate was $0.82 per $100.00 valuation. Both defendant hospitals have received substantial federal funds under the Hill-Burton Act[9] in aid of their construction and expansion programs. The, defendants also testified to the fact the Hill-Burton Act separate-but-equal clause allowed, segregation in the hospitals that they funded if a waiver was signed and approved by the Surgeon, Fourteenth Amendment to the United States Constitution. The level of the judicial court system emerged from the US Court of Appeals Fourth Circuit (Reynolds 710). While the case resulted in significant improvements, Robert C. Bowman seems to suggest that the current healthcare design has left some Americans behind (Bowman par. What were the parties arguments? The total estimated funds required to complete the project were $120,000.00. Horbar JD, Edwards EM, Greenberg LT, Profit J, Draper D, Helkey D, Lorch SA, Lee HC, Phibbs CS, Rogowski J, Gould JB, Firebaugh G. JAMA Pediatr. This Private Act "fully ratified, approved, and confirmed" the original Articles of Incorporation, and provided that, in carrying out its corporate purposes, the corporation should continue to "have and enjoy all the powers and privileges conferred by the general corporation law of this State upon corporations of like character," but that it should not become effective as the act of incorporation unless and until it was accepted as such by the original incorporators of the corporation. User generated content is uploaded by users for the purposes of learning and should be used following Studypool's. Am J Public Health. 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 . bike frames for sale near manchester; greenwood gardens vineland, nj; mike david comedian; smbc interview process; which is the fastest way of conducting a survey; why did melanie and derwin leave the game; The defendants, The Moses H. Cone Memorial Hospital (hereinafter sometimes referred to as "Cone Hospital"), and Wesley Long Community Hospital (hereinafter sometimes referred to as "Wesley Long Hospital"), are North Carolina corporations, and each has established, owns, and maintains a general hospital in the City of Greensboro, North Carolina. Get free access to the complete judgment in SIMKINS v. MOSES H. CONE MEMORIAL HOSPITAL, (M.D.N.C. Thurgood Marshall, Hero of American Medicine. What the plaintiffs and the United States are really asking in their prayer for declaratory relief is an order desegregating all private facilities receiving Hill-Burton funds over a period of years, even though the funds were given with the understanding that the private facilities might retain their freedom to conduct their private affairs in their own way. Am J Med. Hosp $3.25 million in state and federal "construction fund". professional specifically for you? 20 June. 1976-1977 Annual Survey of Labor Relations and Employment Discrimination Law 1976-1977 Annual Survey of Labor Relations and Employment Discrimination Law The plaintiffs drew into question the constitutionality of the separate but equal provisions of the Hill-Burton Act, and the United States moved to intervene pursuant to the provisions of 28 U.S.C. Full Size. Facts: The first plaintiffs claimed that as employees of the hospital they were denied not just Simkins v. Moses H. Cone Memorial Hospital ( U.S. District Court for the Middle District of North Carolina) back to case Save. Construction of Moses H. Cone Memorial Hospital in Greensboro, N.C., was partially funded by the Hill-Burton Act. Questions are posted anonymously and can be made 100% private. .. i have included all the necessary documents as attachments. The only additional contacts Cone Hospital has with governmental agencies are that six of its fifteen trustees are appointed by public officers or agencies, and it aids two publicly owned colleges in their nursing program. The requests of the parties for findings of fact, conclusions of law, and briefs having been received, the Court, after considering the pleadings and . Bowman, Robert C. Is the Institutes of Medicine Waking Up? Basic Health Access. To enter your registration details, click on. [12] Section 131-126.3, General Statutes of North Carolina. At the conclusion of the hearing conducted on June 26, 1962, the Court gave the parties a specified time within which to file proposed findings of fact, conclusions of law, and briefs. End of Preview - Want to read all 5 pages? and transmitted securely. The same is true with respect to the real and personal property owned by other private religious, educational and charitable organizations. 1. In Williams v. Howard Johnson's Restaurant, 4 Cir., 268 F.2d 845 (1959), it was argued that if a state licensed a restaurant to serve the general public, such restaurant thereby became "burdened with the positive duty to prohibit unjust discrimination in the use and enjoyment of the facilities." This historical analysis investigates the strategies that were used by lawyers alongside physicians, dentists, and patients in elevating health care for black persons. It happened that most hospitals in the South had refused to admit black patients at the same rate as white patients. AnyLaw is the FREE and Friendly legal research service that gives you unlimited access to massive amounts of valuable legal data. Party Type(s): Plaintiff-Intervenor. Post a Question. on writs of certiorari to the united states courts of appeals for the tenth and third circuits brief amici curiaeof julian bond, the american civil liberties union, the aclu of The case Simkins v.Cone (1963) was a federal case that termed racial segregation in public facilities that received funds from the government was a breach of equal protection, as provided for by the U.S. Constitution. The lawyers argued that the clause violated the 5th and 14th Amendments of the US Constitution, which had prohibited against racial discrimination. Ann Intern Med. After an exchange of correspondence, Project Applications NC-86 and NC-330 were amended, with the approval of the North Carolina Medical Care Commission and the Surgeon General, to permit a waiver of the non-discrimination assurance. Print. 1962) on CaseMine. Would you like to help your fellow students? Access over 20 million homework documents through the notebank, Get on-demand Q&A homework help from verified tutors, Read 1000s of rich book guides covering popular titles. Issues. [8] Under the rules and regulations of the North Carolina Medical Care Commission, all professional and non-professional personnel of hospitals must be given pre-employment physical examinations. Gen., Washington, D. C., William H. Murdock, U. S. Atty. [4] Sections 105-296 and 105-297, General Statutes of North Carolina. Negro patients are admitted to Cone Hospital on a limited basis, and on terms and conditions different from the admission of white patients. The Moses Cone Memorial Hospital Defendants. Although President Johnson ratified the Title VI of the Civil Rights Act of 1964 three months later, it was instrumental in this case. The legislative charter of the corporation was enacted as Chapter 400 of the Private Laws of North Carolina, Session of 1913. "Health Inequities in Simkins v. Moses H. Cone Memorial Hospital." Summary of this case from Byrd v. Local Union No. On April 2, 1962, the defendants moved to dismiss the action for lack of jurisdiction of the subject matter for the reason that the plaintiffs were seeking redress for the alleged invasion of their civil rights by private corporations and individuals. Atty. You may need to do additional research for the final question to support your analysis. According to Karen Kruse Thomas, the Simkins v. Cone (1963) decision marked the first time that federal courts applied the Equal Protection clause of the Fourteenth Amendment to prohibit racial discrimination by a private entity (Encyclopedia of N.C., p. 1038). Simkins v. Cone. It altered the use of the federal government's public funds to expand and maintain segregated hospital care. The total estimated funds to complete the project were $492,636.00. Both Cone Hospital and Wesley Long Hospital are exempt from ad valorem taxes assessed by the City of Greensboro and the County of Guilford, North Carolina. Retrieved from https://ivypanda.com/essays/health-inequities-in-simkins-v-moses-h-cone-memorial-hospital/. The principal benefit to Cone Hospital from the operation of the student programs is the intangible benefit to be derived from the creation of sources of well-trained nurses. by Kiengei | Sep 3, 2022 | Uncategorized | 0 comments. Pathways for Employees Resolved: Release in which this issue/RFE has been resolved. Health Inequities in Simkins v. Moses H. Cone Memorial Hospital. Studypool matches you to the best tutor to help you with your question. To hold that all persons and businesses required to be licensed by the state are agents of the state would go completely beyond anything that has ever been suggested by the courts. Edwards EM, Ehret DEY, Soll RF, Horbar JD. 451, 458 (D.C. Maryland, 1948). Compulsory Employment Arbitration and the EEOC Compulsory Employment Arbitration and the EEOC. The IOM and other healthcare stakeholders must solve primary care, address healthcare access and long-term investments. Making civil rights litigation information and documents accessible, for free. One of the most controversial cases that dealt with racial discrimination which transpired in the early 1960's was the case of Simkins versus Moses H. Cone Memorial Hospital. If Jackson had been decided differently - that is, if the court had held that . It played a critical role in other legal decisions and showed tremendous shift in legal opinion toward hospital discrimination. (268 F.2d 845, 847.) As of the date of the filing of this action, the United States had appropriated $1,269,950.00 for Cone Hospital, and the sum of $1,948,800.00 for Wesley Long Hospital. The complaint was filed on February 12, 1962. What arguments can be made to distinguish Jackson from Simkins? The management of the hospital was vested in a self-perpetuating board of trustees. In that case, the entire trust was administered by the Board of Directors of City Trusts of Philadelphia, a body created by an act of the Pennsylvania Legislature. The surgeon general, however, published that hospitals were required to offer services without discrimination because of race, creed or color. 2. U.S. attorney general Robert F. Kennedy filed an amicus brief on behalf of the plaintiffs. There was poor voluntary compliance because Black physicians and patients still experienced racial discrimination. The students participating in the program are not employees of the State, and they participate in the educational program provided by the hospital on a purely voluntary basis. 2. Later influences were noted in court cases such as Dr. Hawkins and Dr. Cypress applications and an attempt by Senator John C. Stennis to promote patient segregation, which the House of Representatives defeated. of Managers of James Walker Memorial Hospital, 4 Cir., 261 F.2d 521, affirming 164 F. Supp. According to Reynolds, discrimination was demonstrated in several ways, including denial of staff privileges to minority physicians and dentists, refusal to admit minority applicants to nursing and residency training programs, and failure to provide medical, surgical, pediatric, and obstetric services to minority patients (710). The hospital has also *634 provided scholarship loans in the additional amount of $10,500.00 for student nurses at Woman's College, which scholarship loans are administered entirely by the college, and not by the hospital, and are available only to nursing students selected by the college. Bi-Weekly Case Briefs: Students are expected to write a Case Brief for the assigned case located in the Apply folder for each module. IN COPYRIGHT. Pleading / Motion / Brief 57-00062 Pleading of the United States in Intervention None None Pleading / Motion / Brief 57-00062 . Research the case of Simkins v. Moses H. Cone Memorial Hospital, from the Fourth Circuit, 11-01-1963. According to historian Karen Thomas, Most hospitals in North Carolina and throughout the South did not accept black patients on an equal basis and did not allow black physicians to admit patients or train as interns. Even though most North Carolina hospitals were privately operated, some accepted state and federal funds and that implicated possible government discrimination. As in the case of licenses issued to restaurants, the hospital licensing statutes and regulations are designed to protect the health of persons served by the facility, and do not authorize any public officials to exert any control whatever over management of the business of the hospital, or to dictate what persons shall be served by the facility. Federal government websites often end in .gov or .mil. Simkins v. Moses H. Cone Memorial Hospital, 323 F.2d 959 (4th Cir. The plaintiffs allege that the participation of the Cone Hospital in training student nurses from Woman's College of the University of North Carolina and the Agricultural and Technical College of North Carolina, both State-supported institutions, should be considered in determining whether the institution is an agency of the State. Home Encyclopedia Entry Simkins v. Cone (1963). It altered the use of the federal governments public funds to expand and maintain segregated hospital care. Because the hospitals had accepted government funds they were not strictly private, Simkins and other plaintiffs filed their suit on these grounds. All were achieved through strategic efforts to amass widespread support for the elimination of discrimination in medicine. 14. This will help you to organize your brief and require you to locate the essential elements. In other words, the defendants argue that zero multiplied by any number would *640 still equal zero. This application states that Cone Hospital had given adequate assurance that the facility would be operated without discrimination because of race, creed or color. This applied to both government-owned facilities and voluntary not-for-profit hospitals. June 20, 2020. https://ivypanda.com/essays/health-inequities-in-simkins-v-moses-h-cone-memorial-hospital/. The provisions of the Hill-Burton Act were recently considered by the Supreme Court of Appeals of the Commonwealth *639 of Virginia in Khoury v. Community Memorial Hospital, Inc., 203 Va. 236, 123 S.E.2d 533 (1962). Efforts culminated in the case of Simkins v Moses H. Cone Memorial Hospital; this case became the landmark decision by the U.S. Supreme Court and led to the elimination of segregated health care. The funds appropriated to Cone Hospital amounted to approximately 15% of its total construction expense, and the funds appropriated to the Wesley Long Hospital amounted to approximately 50% of its total construction expenses.