Naked City

City officials are starting to work on a new Brackenridge Hospital lease agreement that they hope will satisfy the demands of the Catholic Church while ensuring the availability of reproductive services for Austin residents.

The latest controversy in the relationship between the city and the Church-affiliated Seton Healthcare Network, which holds a 30-year lease on the hospital, began June 8 when Seton informed the city that it would no longer be willing to manage any hospital that provided family-planning services such as sterilization, which runs contrary to Catholic teaching.

The move came in anticipation of a June 15 decision by the National Conference of Catholic Bishops, who voted to place direct sterilization on par with abortion as "intrinsically immoral" in the church's revised Ethical and Religious Directives for Catholic Health Care Services.

Currently, the Brackenridge lease stipulates an agreement of "material cooperation": Reproductive services at Brackenridge are contracted out by the city to a private company that provides clinical staff -- such as registered nurses and surgical technicians -- to assist doctors with sterilizations. Since Texas law prohibits hospitals from directly employing doctors to practice medicine, according to Seton interim director and CEO Pat Hayes, the arrangement did not affect the doctor-patient relationship.

Hayes estimates that about 400 people will have received direct sterilizations at Brackenridge by the time its fiscal year ends June 30. But the new directives, which state that Catholic health care providers cannot materially cooperate "in actions that are intrinsically immoral, such as abortion, euthanasia, assisted suicide, and direct sterilization," could change all that.

Abortion has not been an issue in the lease because Brackenridge did not provide abortions. But the revised directives would also prohibit other reproductive services that are currently provided at Brackenridge, such as contraception, according to the Austin Diocese's communications director, Helen Osman.

Hayes said the city has always been prepared for changes to the agreement. "Seton's original agreement relied on mutual respect and common concern for the welfare of the community. Seton believes those elements remain a cornerstone in the relationship between the city and Seton," Hayes said in a statement. "Both Seton and the city understood at the time the lease agreement was formed that should circumstances change, the lease would need to be modified. That time has come."

Despite the upcoming changes, Austin Mayor Kirk Watson has been adamant that reproductive services will remain available to Austinites, regardless of their ability to pay. Without giving specifics, the mayor stressed at a June 8 press conference that the question isn't if reproductive services remain available, but how. "We will take our time in discussing this matter with interested parties, and in the end, we will have a solution in place that is in the best interest of the community," Watson said. And according to his office, there will be no gap in service while the city decides what to do. Last Thursday, the City Council was briefed about the situation at Seton; the council should complete the revised lease later this summer. Representatives from Seton and the city are in the process of meeting with concerned citizens about the issue.

That decision won't be an easy one for the mayor, the council, or even church officials, all of whom have already caught heat over the merger from activists on both sides of the reproductive services issue. There are several potential solutions to the dilemma, and Watson says the council isn't ready to speculate about which one they'll choose.

One possibility would be to move some services -- such as maternity care -- to other facilities such as city-run clinics and area hospitals to allow mothers who want to be sterilized after childbirth to exercise that option. Another option is to create a so-called "hospital within a hospital," in which a separate entity would get a license to manage reproductive services elsewhere in the building.

Although reproductive choice advocates are concerned that access could be restricted, they're generally complimentary of the city's handling of the situation. "We do think the city has been upfront about protecting reproductive services, and we're confident about seeking a solution," said Sarah Wheat, director of public affairs for the Texas Abortion and Reproductive Rights Action League (TARAL).

Some critics of mergers between Catholic hospitals and nonreligious facilities say the trend can be dangerous even in cases where resolutions can be reached. Jon O'Brien, vice-president for communication and education of Catholics for Free Choice, called the new directives "incredibly disturbing," adding that the move erodes the credibility of the Catholic Church.

According to CFFC, the impact of the bishops' decision reaches far beyond Austin, since the organization reported 159 mergers of Catholic and non-Catholic facilities over the past 10 years. CFFC reports that nearly 20% of all hospital beds are in facilities either owned or operated by Catholic systems, meaning that the changes in the directives have the potential to affect millions of people nationwide.

For now, advocates of reproductive rights say they plan to wait and see what happens. Kae McLaughlin, TARAL's executive director, called the new directives just another example of the challenges of allowing faith-based institutions -- especially the Catholic Church -- to deal with public medicine. And as city officials debate the terms of a new lease with Seton, McLaughlin said, activists have to stay in the forefront of the debate.

"As the church squeezes tighter and tighter, and we turn up the heat, there is going to be an explosion," McLaughlin said. "It is up to us to keep the heat on."