The Michigan cases follow a 2010 decision by the 7th U.S. Circuit Court of Appeals, which held that the federal Civil Rights Act prohibits nursing homes from making staffing decisions for nursing assistants based on residents' racial preferences. The ruling stemmed from a lawsuit filed by a black nursing assistant who sued her employer for racial discrimination.
In another federal lawsuit filed in 2005, three black employees of Abington Memorial Hospital, near Philadelphia, claimed they were prevented from treating a pregnant white woman by her male partner, who was a member of a white supremacist group. The man used a racial slur when forbidding any care by any blacks.
The complaint alleged that supervisors honored the man's request. The case was settled confidentially before going to trial, and the hospital admitted no liability. Frank Finch III, the attorney for the employees, said hospital officials also cited employee safety in their defense.
"That defense doesn't fly under the anti-discrimination law," Finch said. "Hospitals cannot use that as a defense in nonemergency situations."
He said every hospital has a policy against discrimination and "undoubtedly acquiescing to such a demand is a violation of a written, internal policy in addition to being a violation of the law."
Fordham University law professor Kimani Paul-Emile said she suspects nurses file more discrimination suits than doctors.
"With nurses and other sorts of staff, the hospital is telling them they can or cannot do something," she said. "That might go to why you might see more lawsuits brought by nurses."
She wrote an article last year in the UCLA Law Review titled "Patients' Racial Preferences and the Medical Culture of Accommodation." It was the source of the "open secrets" phrase.
Paul-Emile's research cited a 2007 study at the University of Michigan Health System and others on how physicians respond to patients' requests to be assigned providers of the same gender, race or religion.
The survey of emergency physicians found patients often make such requests and they are routinely accommodated. A third of doctors who responded said they felt patients perceive better care from providers of shared demographics, with racial matches considered more important than gender or religion.
"The notion of white patients rejecting minority physicians for bigoted reasons in emergency departments and other hospital settings is deeply troubling and uncomfortably reminiscent of the type of discrimination that the civil rights statutes were designed to eliminate," Paul-Emile wrote in her article.
Another study she cited found that patient requests for care by a physician are most often accommodated when made by racial minority patients.
Lance Gable, a law professor at Wayne State University in Detroit, said he believes such requests "are made more often than we'd like to think about" even if they aren't frequently agreed to by hospital management. He suspects a supervisor might honor them but not say anything explicit to employees and only in rare instances would signs be posted as alleged in the Flint case.
"Maybe their explanation is an accurate description of what happened -- the supervisor was scared of the father of this patient and made a decision that was ill-advised," Gable said. "It might have been the right thing to do for the safety of the staff, and it still might be a violation of anti-discrimination laws."