Page Two
Seton Healthcare Network's undermining of a proposed hospital district -- combined with the city's consistent lack of long-term planning -- may have tragic, real-world consequences.
By Louis Black, Fri., Nov. 22, 2002
Austin's greatest and ongoing failure is the lack of long-range planning. There is no area of civic endeavor that boasts any kind of a coherent vision for the upcoming decades: from basic public-service infrastructure involving the police, fire department, EMS, transportation, etc.; from the environment to construction development requirements and zoning; from city offices and where they're located to county/city relations. Within any of these categories, the planning is based around today's crisis as interpreted through yesterday's concerns. Tomorrow's needs are barely considered, with the next decades' issues farther away than Oz.
The failure of cohesive planning within these categories is bad enough; far worse is that there is no interdisciplinary, comprehensive planning. The few attempts at any kind of major vision structuring have been all but doomed by the astonishing range of strident political constituencies, each demanding their concerns be carefully addressed. More bizarrely, but in a classically Austin fashion, when the most ambitious of these plans have been proposed, they've been undermined almost immediately by the daily, mundane governance of the city that has ignored if not actively contradicted them. Almost deliberately, minor legislation has been enacted as though these plans were scripts for another city in a distant time.
If there were a poster child for this failure, it could be the current hospital district negotiations. Here is a sincere attempt by a range of civic leaders to create a district similar to those most Texas urban areas already have. The commitment is to long-range planning that preserves quality care while maintaining and improving the safety net of services for the communities that can't afford evermore expensive medical services.
Seton sat at the table as this planning went on. Then, late in the game, they announced their attempt to take the Children's Hospital away from Brackenridge, undermining the ongoing planning. The district will be supported by taxes -- a hard enough sell under any circumstances -- but Seton's actions in removing the Children's Hospital from the equation cast a shadow, potentially devastating, over the whole campaign.
Recapping briefly, as Smith lays out in her excellent piece: In 1994, Brackenridge Hospital was in terrible financial shape, with the mayor and council shocked to find a crushing budget shortfall. This led to City Manager Camille Barnett losing her job. The expected strategy was the privatization of the hospital, but instead Seton stepped in, securing a 30-year lease (since extended to 60 years) to manage the hospital. The most controversial aspect of their tenure has been reproductive and abortion services, which the Catholic Church ordered them not to continue (though a strategy has been implemented to preserve them). The only profitable part of Brackenridge's operation is the Children's Hospital, though by all accounts demand is overwhelming the hospital and adversely affecting services offered and patients served.
In order to address the long-term health needs of the community, planning to create a hospital district with modest taxing abilities is under way. Regardless of needs, planning, or financial caps, new taxes in today's Texas are an almost-impossible sell. Numerous planning meetings have been held to structure the proposal and to get it before the voters with as much of a chance for passage as possible. Seton, of course, was a major and crucial player in these discussions. Seton's announcement of its plans to open a new, privately owned children's hospital while backing out of some of its lease obligations came as a complete surprise to nearly everyone. Since then, in response to sustained outrage, they've retreated from renegotiating the lease, but still plan to open their own children's hospital. The range of services at Brackenridge will be cut.
A few modest observations offered here. Seton obviously has been planning this for some time, even while they were engaged in hospital-district discussions. Not only is their plan fairly far along, they just announced the hiring of the head of this hospital. A national search takes a long time to execute. Renegotiation of the lease would have involved a council vote. As powerful and arrogant as Seton is, it seems unlikely they would have extended this effort without at least lining up some council support. Backing away from lease renegotiations, however, removes the City Council from planning. Still, some in city government must have known what was being planned.
A hospital district would serve the entire community into the future. Seton will vigorously deny this, but the current patchwork planning will undermine the effort of selling this district to the taxpaying voters. The consequences will have the least impact on continued quality health care for the insured and those who can afford it. Commitments to other parts of the community, however, will begin to deteriorate.
The real-life consequences of Seton's plan would be horrific enough. But the undermining of the kind of community-wide, long-range planning we need more of is tragic. The failure of the council to vigorously participate in this discussion is symptomatic of its ongoing failure to effectively serve this community with planning. Austin specializes in bandages and temporary salves, avoiding preventive medicine and corrective surgery.
It is too easy to blame the council for these failures. In Austin, almost any position or action engenders several aggressive, contradictory, community-deep responses. At any time, this city is strapped by too many demands, too many agendas, too many concerns, and too many ongoing crises for effective governance -- never mind future visions. Planning is drowned by mundane concerns. We all suffer. Brackenridge and community-wide health care are issues that should have been addressed decades ago, not in the "maybe" tomorrows where so much of Austin's planning seems scheduled to happen.
A wide range of community activists will agree with that position, but most will have contradictory agendas that they think should be prioritized. I see no easy solution here except a concerted effort at genuine planning, with realistic considerations and strategic, doable implementation plans. Regardless, Seton's actions and arrogance are staggering, and exactly the kind of effort that most negatively impacts on the effective functioning of this community. This is the real horror story -- the sacrifice of public policy to narrowly focused private concerns and priorities. Only this isn't a story told around campfires, but one that may well have tragic, real-world consequences in people's lives. The next chapter is just being written, and the ending, unfortunately, is a complete mystery.
Our radio show continues, on Talk Radio 1370AM, 6-7pm Fridays. Listen in as we try to figure out exactly what it is that we are doing. 
