Brackenridge Plan Aborted

The latest solution to the Brackenridge reproductive services crisis collapses.

Even as the City Council prepared to vote on details at last Thursday's council meeting, the city's plans to continue reproductive services for low-income patients at Brackenridge Hospital remained hazy. Critical insight arrived in the nick of time, when executives of Seton Healthcare Network -- Brack's nonprofit Catholic managers -- informed Mayor Kirk Watson they might require women -- including rape victims -- to be tested for ovulation before receiving emergency contraception. In other words, emergency contraception -- a high dose of birth control pills that prevents pregnancy (not the same as RU-486, which terminates pregnancy) -- could be given only to women who didn't need it in the first place. Though medical definition treats emergency contraception as pregnancy prevention, the Catholic Church equates administration of contraception to ovulating women as the equivalent of abortion.

It was a bitter pill for Watson and city staff. Since June, they've steadfastly supported plans to build a separate, licensed "hospital-within-a-hospital," offering tubal ligations, emergency contraception, and other reproductive services on Brack's fifth floor as a workable solution to changes in the Catholic Ethical and Religious Directives. In June, the U.S.Conference of Catholic Bishops changed the directives to prohibit Catholic health-care providers like Seton from managing facilities providing unapproved services, or even providing "material cooperation" to any such services.

So it should have been no surprise that Seton declared that the city's proposed fifth-floor hospital would not be exempt from Catholic standards on contraception. Watson, who regards emergency contraception as an "integral" component of women's health care, said Seton's pending procedural change was "not negotiable" and postponed the council vote. (At press time, Seton representatives had not responded to several requests for comment. "Seton's clinical personnel are reviewing the patient care standards for sexual assault victims to ensure that our practice is consistent with our policy and the lease," said a statement from Seton Interim President and CEO Pat Hayes, who supported Watson's decision to postpone.)

"We have to figure out whether it still makes sense," said Trish Young, CEO of Austin/Travis Co. Community Health Centers, of the hospital-within-a-hospital plan. Given Seton's latest proclamation, will the city have to build a separate facility to provide reproductive services? "Oh, that hasn't even been brought up," Young said. "But I guess that's an idea, isn't it?"

Critics of the city's plan were stunned but pleased by Watson's decision. "This is a clear indication of how, under Seton, we have Catholic doctrine imposed on the public hospital," said Peggy Romberg, executive director of Women's Health and Family Planning Association of Texas. She had planned to testify before council in favor of recommendations made earlier last week by the Brackenridge Hospital Oversight Council, a board of citizens and health-care professionals who rejected the city's plan in favor of taking back all reproductive services at Brack. Asserting that such a plan would inhibit Seton's fiscal viability, the city has opposed that proposal as well as suggestions to take over Brack's second floor, already a functional maternity and delivery unit.

Seton's announcement has cast a heavy shadow on both the city's plan and Seton's own ability to continue managing the hospital. City officials have adamantly supported keeping reproductive services at Brackenridge, even though current law apparently does not require it. Under state law, hospitals that get state funding are required to provide all medically approved modes of contraception. But by eliminating distribution of emergency contraception -- or tubal ligations, for that matter -- neither Seton nor the city would be acting in violation of these requirements, because Seton is a private nonprofit, and the city -- which continues to own the building -- doesn't receive state funding to provide reproductive services. According to sources at the Texas Dept. of Health, no legislation exists or has been proposed in recent sessions to mandate that every county has at least one hospital providing emergency contraception.

Elsewhere in Texas -- from Lubbock to Luling -- poor women have watched their reproductive care options get churchified out of existence. Last month, Texas Abortion and Reproductive Rights Action League (TARAL) and Access Texas co-released "Where Can a Woman Go?: Reproductive Services in Texas Hospitals," a survey of 222 general-care hospitals in 48% of Texas counties that evaluates access to emergency contraception, as well as abortion and sterilization. They found that 67% of surveyed hospitals do not offer contraception in their emergency rooms, "even to rape survivors."

TARAL Public Affairs Director Sarah Wheat says Seton employees at Brack would not participate in the survey. "One of the things you often hear is that women are supposed to go to St. David's, but we hear that about 60 rape victims [a year] go to Brack," she said. "That's 60 women too many, who might not necessarily be getting what they need."

Wheat says city staff has gone "out of their way" to include TARAL and other groups in its negotiations. "It's clear from where the proposal started in June," she said, "that the city has taken a lot of our suggestions into account." A day after Watson's announcement, however, at least some council staff hadn't been notified of the details. "No one has sent us a memo, e-mail, nothing regarding the item, only that it was pulled," said Linda Dailey, executive assistant to Council Member Danny Thomas and a former nurse who has closely monitored the city's plans for Brackenridge.

Watson's last meeting as mayor is Nov. 8 (after which he will be running for Texas Attorney General), which precludes a Brackenridge resolution during his term. His spokeswoman, Kristen Vassallo, said Watson will remain involved "as an advocate and citizen." Meanwhile, mayoral candidate Gus Garcia said he met with City Manager Jesus Garza and Bishop Gregory Aymond last week to remind the bishop that for many indigent women in Austin, Brackenridge is their only option. Garcia said the meeting did not resolve the matter, but that Aymond committed to do what he could to facilitate further negotiations with the council. Was he concerned that the Catholic position on abortion might create a pretzel-knot that can't be negotiated? "In my life," said Garcia, "I've worked my way out of a lot of pretzels."

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city council, Brackenridge, Seton Healthcare Network, Kirk Watson, Catholic Church, Pat Hayes, Trish Young, Peggy Romberg, Brackenridge Hospital Oversight Council, Texas Department of Health, TARAL, Access Texas, Sarah Wheat, St. David's, Linda Dailey, Danny Thomas, Kris

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