I read with interest the recent article by Reynolds [1] on the role of the federal courts in desegregating health care. The article refers to the U.S. Supreme Court as having decided, by denying a writ of certiorari in Simkins, to desegregate health care facilities. In fact, what the article details is a 1963 "decision" made by a federal appellate court (the U.S. Court of Appeals for the Fourth Circuit), after which the U.S. Supreme Court chose not to consider the case further (denying certiorari). A denial of certiorari lets a lower-court decision stand by inertia. A decision on certiorari, formally speaking, is an act of "judicial discretion" [2], and decisions to deny or grant certiorari are not an expression of either agreement or disagreement with the merits of the decision of the lower appellate court.

The distinction is more than a legalistic one. The Supreme Court had indeed made a major step in 1954 when it declared unanimously in Brown v Board of Education of Topeka, Kansas that segregated public schools were unconstitutional; however, it did not at that time call for immediate school desegregation, nor did it initially articulate the position that segregation was out-lawed in all state activity [3]. It was not until 1967 that the Supreme Court made clear, for example, that a state ban on interracial marriage was unconstitutional [4]. This gradual approach by the Supreme Court left an important role for others in the judiciary and legislative bodies. The Simkins case discussed in Reynolds's article illustrates the important role that the federal courts throughout the South played in shaping, consolidating, and reinforcing the push toward racial equality, both before and after the Supreme Court's 1954 decision in Brown v Board of Education [5].