The Devilish Details
Council holds a hearing on the new Brackenridge lease plan.
After months of delays and postponements, the City Council finally held a public hearing last week on the proposed "hospital within a hospital" at Brackenridge Hospital: city staff's effort to maintain reproductive public health services deemed "immoral" by the Catholic Church. Staff briefed council on its newly released draft amendment to the city's contract with Seton Healthcare Network, the Catholic nonprofit that has operated Brack since 1995. The new language is the result of meetings among staff, the Brackenridge Hospital Oversight Council (BHOC), Seton representatives, and an ad hoc coalition of women's health and consumer advocacy groups, working to circumvent Seton's adherence to the Ethical and Religious Directives for Catholic Health Care Services -- which prohibit tubal ligations, emergency contraception, and other services, even when provided by city-contracted employees.
City staff, including Austin/Travis County Community Health Centers CEO Trish Young (who would oversee the new hospital), Assistant City Manager Betty Dunkerley, and Financial Services Director John Stephens, detailed the complicated financial arrangements for the $9.3 million facility, which will reside on Brack's fifth floor. (For a full account of the proposal, see www.ci.austin.tx.us/news/brack/). Seton will cover any duplicate expenses required by the new arrangement, and the city will pay the rest of the bill -- $6.8 million plus interest -- spread over the remaining 23 years of its lease with Seton.
Critics of the plan, including the BHOC, a city-appointed panel of citizens and health-care professionals that monitors Brack, recommended that Seton cover all expenses for the new facility. Staff now responds that the city is paying expansion costs necessary to meet growing demand for reproductive services. The proposed lease amendment allows the city to re-evaluate the arrangement in 2005; if, after five years, it decides to discontinue operating the fifth floor, city staff say they will find a third party to deliver the services, or provide them at another location.
Under the plan, women seeking care would be directed to either the city's fifth floor hospital or Seton's second-floor maternity unit based upon their needs. Pregnant women who don't request tubals will be directed to Seton's second-floor maternity unit, while women seeking the operation will be sent to the fifth floor; the city estimates that annually 1,200 women could deliver at the new facility. Rape and sexual assault victims who arrive at Brack's emergency room would be offered counseling and could receive emergency contraception at the city's fifth-floor hospital. The city and Seton would develop a "patient transfer agreement" for women who might, for example, need a tubal on the fifth floor but non-reproductive care elsewhere at Brack, and establish communications protocols between Seton and city staff. The law already requires Seton to allow patients access to visitors -- including city staff charged with family planning education.
"Our objective is that the patients receive seamless, high-quality care in either setting," Young said. But critics of the plan complained they had trouble following the staff's complicated flow-charts showing which patients would go where. Coalition members said they were worried that under the lease Seton staff -- not staff employed at the city's new hospital -- would be in charge of directing patients to the fifth floor.
Dunkerley and city staff planned to discuss the new lease with coalition members earlier this week; results of that meeting were not available as the Chronicle went to press. Council will likely take up the issue once again at its Jan. 30 work session and Jan. 31 meeting.
At last Thursday's hearing, proponents of the new hospital included officials from local nonprofits and social service agencies, former council members, and City Manager Jesus Garza, who spearheaded the original deal with Seton in 1995. Of nearly 50 audience participants who signed up to testify, a minority supported the city's plan. Many praised Seton's $60 million, nonobligatory capital investments at Brack and Children's Hospitals, and its generous, multi-million-dollar contributions to charity care, but only a few supporters actually referred to the lease agreement and its specific contents -- and none exuded unbridled enthusiasm. Longtime Austin health-care advocate Kevin Reed, who served as the BHOC's first chairman, mustered lukewarm support. "I will tell you after having looked at the lease closely and having watched this process, this is probably not the best option for women's health services," Reed said. "But I can honestly tell you and very sincerely that I think it is the very, very best option that we have available to us as we stand here tonight."
Coalition members remain opposed to the plan, preferring instead the BHOC's recommendation that the city take back all reproductive services at Brack. City staff never fully explored this option after Seton announced it couldn't afford to lose revenues generated from providing such care. Coalition representatives also used their time at the podium to raise questions that the lease doesn't articulate -- including staffing and quality assurance at the new hospital.
Several council members expressed reservations about what they saw -- or didn't see -- in the city's proposal. "The answers aren't clear," said Council Member Danny Thomas, who raised "the separate but equal issue" as a subject demanding further inquiry. Mayor Pro Tem Jackie Goodman echoed that misgiving, particularly after BHOC member DeAnn Friedholm warned, "The danger in this setup is that this [could] completely become a second-rate system. Separate is not equal most of the time."
Goodman asked Friedholm, "What mechanisms or what operating system are you thinking of when you say that?" Friedholm said the city could face difficulties hiring quality staff and paying them competitive salaries, especially given a national nursing shortage. Seton handles its staffing shortage -- 10% to 15% last year, according to Seton human resources officials -- by shifting workers between campuses, Friedholm pointed out, but cities run more bureaucratically. "Interesting," said Goodman, "because that was the problem we had when the city ran Brackenridge."
"The devil is in the details," Friedholm later told us. "No pun intended." Meanwhile, throughout the hearing one couldn't help noticing the absence of poor women -- those who will be most affected by the city's plans for Brack. Without their testimonies, the most important details of all may well remain unaddressed.