Newark Accords binds University Hospital to the community
The front page of the Newark Accords, also known as the Newark Agreements of 1968 or the Medical School Agreements, and the product of the Newark Rebellion in 1967 and the Medical School Fight that followed.
As July 12 marks the 55th anniversary of the Newark Rebellion in 1967, Newark's Central Ward faces another transformation. The city's central but aging care and teaching facility, University Hospital, has become the focus of a long-overdue redevelopment project to renovate and expand the hospital and its health services. The project has the potential to build on the promises of the historic Newark Accords, also known as the Newark Agreements of 1968—the only contract of its kind in the United States codifying a hospital's commitment to promoting the public health of a community. But it is also a cause of concern for many Newark residents and activists.
As part of the approved budget for Fiscal Year (FY) 2022, the state allocated $500,000 to fund a planning and design study, or master plan, to revitalize University Hospital. University Hospital awarded a contract to the global design and architecture firm Gensler, who will use the funding to complete the study of existing facilities and proposed new construction.
The hospital will use the master plan to guide the preservation, restoration and redevelopment of current facilities and identify new facilities that can meet the community's healthcare needs. Mary Maples, the chief legal officer at University Hospital and current interim chief executive officer (CEO), attended a People's Organization for Progress (POP) assembly meeting in March to discuss the project. Maples said she and the board of directors hope to see the first rough draft of the master plan in early summer.
“But between now and then, we’re in this learning phase,” she said—trying to engage with clinicians and community members to gather initial information about what forms of transportation they need and what facilities, programs and medical services they think the hospital should provide and include in the draft.
Once they have an educated idea of what the community wants, a second draft will be made to show actual designs and explanations for those designs, which will be shared with the public to give feedback.
“It's an iterative process,” Maples said. “We do not want to come with a fully baked design and ask you what paint color. That’s not community engagement…we’re going to be publishing on our website a calendar of where we will go and have those initial discussions.”
So far, University Hospital’s community oversight board posted two community listening sessions on their webpage to gather public input as they search for CEO candidates. The first occurred on June 23, and the second on July 6.
The medical campus, comprising University Hospital and Rutgers New Jersey Medical School (NJMS), is recognized across the country for its collaboration with communities. The governor's task force on higher education launched a report in 2010 stating that the hospital needs to continue to expand and "commit to enhancing an ongoing residential and community presence," per the accords, but many Newark residents feel that their input is falling on deaf ears.
They say their participation is limited to receiving information and making comments, as opposed to actual engagement or conversation.
"It's like, okay, they spoke, moving on with our budget line item," LaVita Johnson said, a lifelong resident of Newark and co-chair of Newark’s NAACP Health Committee. "We get no responses back as much as we come in. They have the community moment where you speak. That's all we do. We don't get any replies or responses. And that's so disappointing. And I call it very unprofessional."
The last time the hospital site faced significant redevelopment was in the 1960s. An urban renewal program initiated a "slum clearance" in Newark's Central Ward, the heart of the city's most densely populated Black community. In the name of economic revitalization, a 167-acre medical school would displace thousands of residents. Urban renewal allowed big developers to acquire cheap land to make big profits.
Original Newark Housing Authority (NHA) plans to clear 166 acres of land and thousands of homes for a medical school in 1967. (Photo courtesy of Newark Public Library)
Across the country, the program displaced mainly Black populations with few places to move to other than another slum under the threat of another urban renewal project. In 1960s Newark, some residents had moved two or three times within a given year because of urban renewal displacement. The threat of displacement was one of the drivers of the Newark Rebellion and Newark Accords.
Residents and activists today say it's about time University Hospital receives an upgrade, as flooding, piping and electrical issues cause evacuations and units to shut down, but many are on edge. They want assurances that the project will improve health care services for Newark while remaining a public hospital—steering clear from private partnerships—and that decisions concerning its future will involve community input, honoring the Newark Accords.
The accords set an important precedent for Newark and communities across the country—binding a hospital’s duty to a community and demonstrating how decisions regarding health policies can be collaborative and effective. It resulted from lengthy negotiations between state, federal and local officials, and community organizers representing Newark and their expert advisors in land use planning, law, medical facilities construction and health services development.
The community negotiating team was made up of nine community members and organizers, including Junius Williams from the Newark Area Planning Association (NAPA), Louise Epperson from the Committee Against Negro and Puerto Rican Removal, Duke Moore from the United Community Corporation (UCC) and Rev. Horace Sharper of the Abyssinian Baptist Church.
“The accords represented a very good use of power in the Black community in Newark,” said Williams. “And it came about because people rebelled.”
The 1967 rebellion changed the power structure in Newark. State and federal officials feared future uprisings and bad publicity, so when Williams formed NAPA—an organization that brought the Black community together, along with other groups and professionals, in opposition to displacement—officials were on edge.
“Instead of continuing to protest, in that formal way of going to City Hall and letting it all hangout, we said we wanted a negotiating team, composed of the leading groups in the city that had been leading the charge against the medical school,” Williams said.
The negotiations didn’t just provide a forum for public discussion, it marked an important shift in how redevelopment took place, with officials negotiating with community groups on the terms of the project. The terms of the project are outlined in the accords: reduced the size of the site to 57.9 acres, provided job opportunities for minorities in construction and residents in the institution, established relocation plans for displaced residents, outlined efforts to recruit minorities for medical training and outlined health and education services the hospital would provide.
It also created several community-based institutions to ensure the city and hospital met the negotiating team's demands. For example, the accords disbanded the Model Cities Citizen Advisory Board, which was part of an anti-poverty program that received federal funding to revitalize urban centers. The problem was that board members were all supporters of the mayor's administration, handpicked by the mayor.
The accords replaced those members by requiring an election conducted by the community, forming a new Model Neighborhood Council. This council would have joint veto power with the City of Newark over any Model Cities proposal sent to the United States Department of Housing and Urban Development (HUD) for funding.
"If we wanted to, we could veto what the city wanted to do," Williams said. "The only Model Neighborhood Council in the country that had that…it was a joint veto. Whatever we wanted, they could veto. So, it made us talk together. So that was important."
A Review Council—composed of unions, contractors, and state, city and community representatives—was established to ensure that the construction workforce would include one-third journeymen and one-half Black and Puerto Rican apprentices.
A Housing Council determined which community-based sponsors would receive parcels of land—out of the sixty-three acres of land granted in the accords for housing development for low and moderate-income families. The Newark Housing Authority (NHA) agreed to give land to these groups, and a Relocation Review Board would review progress and offer residents a place to make complaints.
The accords also promised that the community would be the majority representation on a Health Review Council tasked with monitoring health care quality and creating an affirmative action job-training program for Blacks and Latinos in health professions.
“The Health Council was the only one of our proposals that did not get teeth,” Williams said. The health council was supposed to be just as powerful as the Housing Council but failed to situate itself in a position where it could tell the hospital what to do. “They were strictly an advisory group,” he said.
Although not perfect, the accords helped create around 2,600 new jobs, the majority held by Newark residents, and NJMS had the largest enrollment of minority students in the country. NJMS also established community health services for Newark, such as a Family Health Center, preventative medicine and substance abuse programs and an ambulance service.
Williams said making the agreements into a reality was another fight, but the rebellion helped force officials to the negotiating table, which led to the negotiating team's victory in the medical school fight. In his book, “Unfinished Agenda,” Williams called it "an organizational high point" for Black people that created opportunities and solutions for housing and employment.
In August 1968, months after the Newark Accords passed, an urban renewal plan shows about 55 acres of land slated for clearance for a new medical center, a significant reduction from the original NHA plan in 1967. (Photo courtesy of Newark Public Library)
Initial resistance, such as protests and even a lawsuit from organizers and community representatives, wasn't enough to stop the state and city authorities from pushing the development of the medical school. A shortage of physicians at the time forced leaders in Northern New Jersey to find a way to train future physicians locally. They wanted to establish a University Hospital, and the city knew building one in Newark could boost the local economy. But organizers didn't want a medical facility for 167 acres of land.
Epperson ran a hairdressing shop and was one of the first to fight against "slum clearance." She organized homeowners and renters, calling mass meetings that eventually outgrew her home and forced her to hold them elsewhere. She and Wheeler—a Newark public school teacher—formed the Committee Against Negro and Puerto Rican Removal. They held protests and attended planning board hearings to voice their opposition to the “slum clearance” in June of 1967, before the rebellion.
After the rebellion, Williams said there was no organized resistance movement to the medical school plan and no meaningful conversations or bargaining opportunities—just shouting matches. One of the reasons he helped form NAPA was to establish a set of objectives for relocation and an alternative plan that could put the community in a bargaining position.
The alternative plan was a means to galvanize the community and prove to officials that the school didn't need 167 acres of land.
“It’s not enough to be mad, but you have to be smart,” Williams explained. “Organizing means that you take your time to learn what has to be done over the long run, not just the short run, but the long run. And organizing means that people are willing to take risks to achieve gains.”
Williams was only 22 years old when he formed NAPA. He not only brought together dissenting groups but dozens of professional volunteers, such as the NAACP Legal Defense Fund to provide legal advice.
Williams utilized an essential strategy in his organizing efforts: working with neighbors and professionals. He had his friends at the Yale School of Architecture and Planning draw up the alternative plan. They proposed 17 acres for the medical school, which was consistent with American Medical Association (AMA) standards.
Along with the Newark Rebellion, there was a series of rebellions in the summer of 1967 across the country and New Jersey. To avoid another, undersecretary Robert S. Wood of HUD and undersecretary Wilbur J. Cohen of the United States Department of Health, Education and Welfare (HEW) sent the Wood-Cohen Letter to New Jersey Gov. Robert J. Hughes. The letter instructed state and city officials to “resolve all differences” with the community.
"You will give them what they want," Williams summarized, and the letter included a list of NAPA's demands. "We weren't there just to holler and shout. And that's what they actually expected us to do once they got this Wood-Cohen letter. They came in and said we're going to have some hearings. And we said, 'no, you're not going to have hearings. We're going to have negotiations.'"
There was $35 million in federal funds lined up for the project, and community participation was necessary if the city wanted funding. At the negotiating table, Williams and his team would arrive prepared with detailed demands backed by data, expert testimony and the Wood-Cohen Letter.
While there was tension between the negotiating team and officials from the medical school, city and NHA, there was tension between the negotiating team, acting as community representatives, and the community itself, partly because residents wanted to speak for themselves.
Williams details in his book that officials at the table asked the team how they could be sure the team represented the community. "White people in power always want to play the 'who-do-you-represent game,'" he wrote, but a tactic the team saw coming. While the mayor sent some audience members to disrupt the negotiations and create doubt, Williams, Wheeler and Epperson silenced much of the opposition while backed by 200 supporters. Their goal was to avoid speak-out sessions and negotiate a contract instead.
"You can't be just mad," Williams said. "You can be mad. People have the right to be mad. And being mad is helpful…but you also have to know what you're talking about. And we knew what we were talking about. We'd done the homework. We had experts. And we had to have the respect of the opposition instead of just their discomfort. And we had both."
The negotiating team was clear that they wanted a medical facility in Newark, but one that addressed inequities and lack of access to resources such as proper housing and employment in the city, which contributed to severe health disparities as well. Newark had the country's highest maternal and infant mortality rate at the time, high substance abuse rates and tuberculosis cases.
The status of health care in the city wasn’t a priority in the plan for the medical school. It would have done little to upgrade the health of the community, so the team proposed a Health Council to monitor success in treatment and training for jobs when the facility was running.
Junius Williams seated with attorney Jack Greenberg from the NAACP Legal Defense Fund and Harry Wheeler, the spokesperson for the Committee Against Negro and Puerto Rican Removal, in 1967. (Photo Courtesy of Junius Williams)
The accords laid the foundation for University Hospital and NJMS today. It legitimized the medical campus's place in the community and its purpose—to uphold public health in Newark by providing access to all essential health care services for the Newark community and enhancing the hospital's relationship with residents and unions.
When looking at how the accords came to be, William said it serves as the perfect example for future endeavors. “People have not learned from the past,” he said. “This should be a template. That medical school should fight should be a template for all the rest.”
University Hospital plays a vital role in meeting the public health needs of Newark, Essex County and New Jersey, especially for those with limited access to healthcare due to insurance or affordability restraints. And it has played a fundamental role in revitalizing Newark's economy and public health since the 1960s, but it’s far from perfect.
Dr. Robert R. Cadmus, who served as the President of the New Jersey College of Medicine and Dentistry (NJMD) from 1966 to 1971, made promises that the hospital would improve management and relations with the community and that the hospital would collaborate with the community to develop programs that address the city’s health needs. These are promises residents of Newark want to see fully realized and maintained.
Some support a community ombudsman to negotiate on their behalf as the redevelopment project is underway since they feel no one is negotiating at the same level as the board of directors, echoing the negotiations between officials and community organizers in the 60s.
Similar to what Williams did that led to the Newark Accords, "you can neutralize people's power with numbers and organizing," said Linda McDonald Carter, the director of the Paralegal Studies Program at Essex County College.
The Newark Coalition of Concerned Citizens—which consists of 23 labor unions and organizations such as POP, NJ Citizen Action (NJCA), NJ Communities United, NJ Appleseed and Newark NAACP—was formed within the community to monitor University Hospital.
In 2018, when the hospital considered moving its pediatric services to Newark Beth Israel Medical Center—reducing those services by more than 80 percent, which by statute is considered an essential health service—the coalition formed in opposition to the move, and CEO at the time.
They hosted town hall meetings to discuss their concerns about outsourcing the services and the 2018 monitor report that assessed University Hospital after a series of scandals came to light. Since then, the coalition has investigated any proposals or changes that could weaken the hospital and advocates for hospital improvements.
“If they allow us, we can play a huge part in all of this,” Johnson said. “Because we're always telling them what's wrong, but we never get back the replies or the responses.”
Although residents feel that participation in the redevelopment process is limited, they welcome a project that will improve existing services and potentially bring in more to address the health needs of Newark and beyond, honoring the promises made in the Newark Accords. But the project and repairs that University Hospital needs mean the hospital will need more funding—something the state has fallen short on over the years.
In Part II of this series following the changes underway at University Hospital, PSA will explore the shortfalls in state funding and the call for more community and union representation in positions of power.
