When Anthony Jackson was named the new CEO of all three Roper St. Francis hospitals this spring, he became one of the most powerful men in South Carolina's increasingly competitive hospital industry.

That doesn't stop him from sometimes being mistaken for a chaplain.

It happened recently at Bon Secours St. Francis in West Ashley. A nurse needed help with an ER patient in distress. Jackson was standing there, caught up in the chaos.

“What’s happening?" he asked.

“This guy is really in a bad way," the nurse told him. "Maybe if you could go ahead and say a prayer?”

Jackson thought to himself, "I’m probably the last one you want doing that!"

"I’ll do what I can," he told the nurse. "'I’m not the chaplain, though."

They both started laughing. "Oh! You’re Anthony!" she said.

Part of it's the bow tie he typically wears. Part of it’s a friendly habit: Jackson enjoys walking around his hospitals unannounced and striking up conversations with front-line employees who aren't prepared to meet the man in charge. He does it to unwind, when he becomes over-tired reading financial statements.

"I want to make sure they know just how important they are to us," Jackson told The Post and Courier. "And how do we let them know that? We spend time with them. It’s not just a ‘hey, how you doing, keep moving’ answer. It’s truly engaging people for the adult professionals that they are."

Jackson was hired by Roper St. Francis three years ago to run the system's Mount Pleasant Hospital. This spring, he also took charge of Roper Hospital on the peninsula and Bon Secours St. Francis. Combined, these hospitals pull in the better part of $1 billion in patient revenue every year. When the system's Berkeley County hospital opens this fall, Jackson will manage that medical center, too.

His promotion marks a shift in business strategy for the hospital system. Historically, Roper St. Francis leaders have hired a different CEO for each hospital.

"We are a system of care working to meet the needs of the community, not individual hospitals and we need to make decisions as a system," said Lorraine Lutton, chief executive of the Roper St. Francis health system and Jackson's boss.

Jackson's new responsibilities also mark a big moment in the hospital system's 163-year-old history. Exactly 50 years after a federal judge ordered Roper Hospital to start admitting black patients in 1969 — making it one of the last in the United States to do so — Jackson became Roper's first black CEO. 

"I want to somehow thank the leadership team that saw me for what I could offer the system and finding me worthy of this opportunity," Jackson said. "I just happened to be black."

'This is where I started'

Jackson was raised by his mother, a nurse, and his father, who drove heavy equipment, outside Aiken in a small community called Petticoat Junction. 

"My mom worked in the OR," he said. "She got called in and my brother and I would get in the back of the car and go sleep in the car, sleep in the nurses’ locker room while she worked her cases. I got a chance to spend a lot of time with physicians. That kind of piqued my interest in medicine."

Jackson enrolled at the University of South Carolina in 1986 but dropped out after two years when tuition money dried up. He'd long dreamed of becoming a radiologist, but an adviser suggested he transfer to Trident Technical College in North Charleston instead. 

"I probably needed Trident more than I knew," Jackson said. "I got a chance to really connect with the instructors and the program. I got a chance to really engage and share my background. They were extremely encouraging and really gave me the confidence I needed to push through."

That's how he ended up at Roper Hospital. In 1989, he was hired as a student X-ray tech. 

"This is where I started," he said. "My first real job was here at Roper."

Jackson completed his associate degree in 1990 and over the next 20 years climbed the corporate ladder at HealthSouth, which was recently acquired by Encompass Health. He moved from Charleston to Columbia to Birmingham, Ala., to Rock Hill, picking up bachelor's and master's degrees along the way. In 2015, he was back in Columbia running a rehabilitation hospital when Jackson promised his wife Kayren they could put down roots. She built their forever home. 

"Eight months later, Roper comes calling," he said. 

Jackson hesitated when he was asked to run the Mount Pleasant hospital. In fact, he turned the offer down. When he'd visited the facility and met board members during his interview, the hospital was empty. 

"The hospital was beautiful, but it was a ghost town," he said. "There was no one there."

He returned the following weekend on his own. 

"I went to Walmart, went to Starbucks, went to Firestone, and just sat down in the waiting area and engaged people that were coming in," he said. 

He asked them about the school system. He asked them where they went for health care services. Most of them knew about Roper St. Francis, he said, but mentioned the system's Mount Pleasant hospital as an after-thought. It had only opened in 2010.

"It just clicked," he said. "Not enough people knew about who we are and what we do."

He called the hospital system back. "I changed my mind," he told them. "Will you still take me?"

'A place of public accommodation'

Thorton Kirby, president of the S.C. Hospital Association, first met Jackson when Kirby's father was a patient at HealthSouth's rehabilitation hospital in Columbia. Jackson was later asked to join the hospital association's board. 

"He's got this wonderful Southern charm about him," Kirby said. "I think he's a great fit for Charleston."

He's also representative of the community, Kirby said, in an industry where few hospital CEOs are black.

"The fact that he’s an African American leader in a city with so many minority community members, really helps patients see themselves in the face of the leader of the hospital," Kirby said.

Jackson's appointment is particularly significant at Roper Hospital, which, in 1969, became one of the last hospitals in the country to admit black patients — and only did so after a federal judge ordered it. 

The case largely hinged on the fact that Roper Hospital operated a snack bar and cafeteria on the ground floor. Because the hospital was selling food that had been purchased across state lines to customers who had traveled to Charleston from places far and wide, its owners were engaging in interstate commerce.

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"No attempt is made to purchase only food originating in South Carolina," Judge James Robert Martin Jr. wrote in his order 50 years ago this spring. "Since the cafeteria and the snack bar are located within the premises of Roper Hospital and are held out as serving the same patrons, Roper Hospital is a place of public accommodation.”

It compelled the hospital to comply with the Civil Rights Act, which prohibits discrimination based on race inside places of public accommodation, including businesses and restaurants. Von Bakanic, a sociology professor at the College of Charleston, called the case pivotal.

"It had national implications," she said. "It’s basically Brown vs. Topeka (Board of Education) for hospitals."

Forcing the hospital to admit black patients was only part of it. The federal government ordered that Roper fix its hiring practices, too. The court found that white hospital workers who had less experience and less education were getting preferential treatment over black workers. And the highest paid black employees at the hospital made less money than the lowest paid white employees.

"This is not a case of subtle racial discrimination," said Randall Kennedy, a Harvard University law professor and a Columbia native. "The statement of facts given by Judge Martin reads like something in the mid-1950s."

The federal lawsuit was filed against the Medical Society of South Carolina, which owned Roper Hospital at the time and continues to hold a majority stake in the health care system.

Medical Society President John Holloway explained that the group has been part of Charleston’s fabric since its first meeting in 1789. Today, the organization focuses on giving grants to community nonprofit groups, such as the Dee Norton Child Advocacy Center and the Barrier Islands Free Medical Clinic. He couldn’t recall the society’s members ever discussing the possibility of apologizing for past policies. 

"It’s not been a part of our discussions since I’ve been here because we don’t really think about it that way. We think of patients as patients," Holloway said, "not as a race, not as a gender, strictly as a patient."

'It's come a long way'

Dr. Julian Buxton didn't talk about it much — only when he was asked — but he was long known as the first doctor who admitted a black patient to Roper Hospital. 

As best his sons can figure out, it happened around 1964, about five years before the hospital was ordered to comply with federal law. 

An African American hospital employee was suffering from acute appendicitis and needed an emergency operation. As he was being transferred to a nearby hospital, Dr. Buxton ordered that the man be returned to Roper. He operated and admitted him as an inpatient, even after a nurse tried to block the surgeon's way into the operating room. 

Buxton died in 2003. His son now sits on the Roper Hospital board. 

"Roper is a microcosm of the community. It’s got a dark past," said Jim Buxton, an attorney. "Roper is a place where you can see the good, the bad and the ugly of how this community is being transformed over time. I think it’s telling. It’s come a long way."

The way forward is now in Jackson's hands — and he'll be navigating uncharted waters. This fall, Roper St. Francis will open the first hospital in Berkeley County. The system must figure out how to remain competitive alongside other hospital systems, including the Medical University of South Carolina and the Upstate's Prisma, which continue expanding their geographic reach. All this is happening amid challenging financial times for Roper St. Francis. 

Last year, Moody's downgraded the hospital system's credit rating, a reflection of its tighter profit margin. 

Buxton is confident that Jackson is the man to lead them forward. 

"He knows the community and knows the system and knows the changes it’s gone through — sometimes awkward and painful changes," Buxton said. "I don’t think the color of his skin is really a factor. He’s qualified."

Jackson turned 51 on June 15. On the day he was born, he would not have been admitted as a patient at the hospital he now runs.

"The only thing I've ever wanted in life was a fair opportunity," Jackson said. "But it’s also important to me that minorities never see a role like this as unobtainable. Because of what I do, if it helps one other person to believe that they too can achieve, that would mean the most to me."

Reach Lauren Sausser at 843-937-5598.

Lauren Sausser is the Features Editor at The Post and Courier. She also covers health care issues in South Carolina.

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