Brack's Ex-Watchdogs Say Seton Thwarts 'Oversight'

Dr. Jim Brand and DeAnn Friedholm (Photo By John Anderson)

Two members of the Brackenridge Hospital Oversight Council resigned in frustration last week, and they say the source of that frustration -- the wall of secrecy that inhibits their role as public watchdog -- has been an ongoing problem since the BHOC's inception seven years ago. The point of no return for Dr. Jim Brand, the BHOC chair, and DeAnn Friedholm actually came several months ago, when they learned that the Seton Healthcare Network, which leases and manages the city-owned Brackenridge and Children's hospitals, was moving forward with plans to build a new children's facility that it would own and manage. Seton's plans had been in the hopper for months, but BHOC members were left in the dark until October, when they, like the rest of Austin, read about it in the daily newspaper. "There was no courtesy of a phone call or anything," said Brand, who until his March 3 resignation had served three years on the City Council-appointed group.

"I should have quit then," added Friedholm, "but I hung in there thinking there was some value in doing this." That's saying a lot, since she and Brand very nearly quit in late 2001 over another Seton brouhaha -- its declaration that it could no longer comply with the lease agreement pertaining to reproductive services because of a new ethical directive of the Catholic Church. "We thought it was part of our charge to be a part of that debate," said Brand, referring to the weeks of wrangling the city, Seton, and representatives of pro-choice organizations spent trying to balance Seton's directive without jeopardizing poor women's access to health care. "We saw it as our job to protect that population's interests," Brand said. But staff made it clear that the city did not want the BHOC involved in the process, say Brand and Friedholm.

Friedholm recalled one particularly upsetting meeting attended by then Mayor Kirk Watson, then Assistant City Manager (and now Council Member) Betty Dunkerley, and a group of women's health advocates. Friedholm said she pressed the argument for BHOC's inclusion in the discussion, but "it was at that point that I was informed [by Dunkerley] that it wasn't necessary for us to participate." Friedholm said her jaw dropped, and Watson, sensing her shock, overruled Dunkerley and insisted that BHOC have a say in the matter. (Dunkerley could not be reached for comment.) In the end, the city and Seton agreed to open a city-run "hospital within a hospital" to continue providing reproductive services at Brack.

Looking back on its history, the BHOC's problems started well before that controversy and the subsequent debacle over Seton's decision to yank the profitable Children's Hospital out of a future public health care district. The oversight council may have been designed to fail from the beginning, because the city never blessed it with a clear direction and purpose. Brand and Friedholm (and others before them) place most of the blame on former City Manager Jesus Garza, who brokered the lease agreement with Seton and then failed to back the BHOC when it tried to get information on how Seton was complying with the lease. As one former BHOC member, Mark Gentle, explained to the Chronicle in 1999: "I felt like I was beating my head against a wall, the wall being Jesus Garza." The former city manager has since gone to work for Seton -- as the CEO of Brackenridge.

In a joint resignation letter to City Council members, Brand and Friedholm wrote that there is "no meaningful or effective public oversight" to ensure that Seton is meeting its contractual obligations: "Unless the city decides it really wants to monitor compliance with the lease provisions, changes the authority and enhances resources given for that important task, we recommend that the [BHOC] be abolished and the pretense of oversight abandoned."

The City Council might indeed decide to abolish the BHOC, on the recommendation of City Manager Toby Futrell. Her deputy, Michael McDonald, says the current preferred scenario would have Seton present semiannual reports to the City Council during public meetings. Brand and Friedholm said that method might prove more effective -- provided council members push Seton to be more forthcoming with them than they were with the BHOC.

As a private nonprofit, Seton does not and isn't required to disclose most of the operating information that would help the city monitor compliance with the lease agreement, a fact that has prompted several members to resign over the years, while others just stopped attending meetings. The two recent resignations left just one member -- Donna Ammons -- on the council. Two other BHOC members had earlier been relieved of their responsibilities for lack of attendance.

Brackenridge and Children's are the only publicly owned hospitals of their kind in a 10-county region, providing health care to thousands of both indigent and paying patients each year. Seton receives a fair amount of local, state, and federal dollars to provide this care, giving rise to the BHOC's long-standing argument that public dollars for publicly owned entities should translate to public access to information.

On the whole, the City Council's appointees to the BHOC were no slouches; they were public health care advocates who took their positions very seriously -- which made their jobs all the more frustrating. Brand is the former medical director of People's Community Clinic, which provides health care services to low-income people, and is currently the emergency room medical director at DeTar Hospital in Victoria. Friedholm, a longtime player in public health care policy, is the executive director of the Children's Defense Fund of Texas and co-chair of the CHIP Coalition, which advocates children's access to health care. Both serve on People's board of directors.

Last week, McDonald, speaking for the city manager's office, said he sympathized with the members' feelings of ineffectiveness. "I understand their point of view," he said, "and I'm disappointed that they volunteered this time and they feel it was a waste."