One month before the Seton Healthcare Network announced plans to replace the city-owned Children's Hospital at Brackenridge with a new, privately owned pediatrics facility, City Manager Toby Futrell offered Seton a counterproposal that would have preserved Children's place in the public sector.
Had Seton accepted it, the city's offer would have enabled Children's transfer into a proposed countywide hospital district, which voters will almost certainly decide as a ballot issue next year. The city's proposal called for a public-private partnership under which Seton would build the hospital on city-owned property. "We didn't have any specific site in mind," Futrell said. "But the city has a lot of land, and we have condemnation power. And we were also willing to swap land [with a private landholder]." Moreover, the city manager said she "would not have been averse" to the city selling bonds to help fund the construction of a new hospital -- anything to prevent the privatization of the most profitable division of Brackenridge Hospital, which Seton has leased and managed for the city since 1995.
But by September, when the city made its proposal, Seton's private-hospital plans were already firm -- and the offer was rejected. "They gave us a fairly quick answer," Futrell said.
Failing that plan, Futrell laid out another proposal. Why not, she asked Seton, let the city pay for interim expansion improvements at Children's to allow time for a hospital district to fall into place? That way, Futrell reasoned, the district's board of trustees and other stakeholders would have a say in deciding Children's fate. Again, Seton declined the offer. In an interview earlier this month, Patricia Hayes, Seton's interim president and CEO, said capacity limits at the existing hospital have left Seton with little choice but to pursue a new facility. "My primary response," Hayes said, "is that when I look at the numbers and talk to physicians, I don't believe we can wait."
City officials don't agree, but say they can't stop Seton from building a new hospital. "I'm not angry," Futrell said of the situation, "but I am concerned, and I am frustrated. An issue like this can suck all of the oxygen out of the air." Seton has since withdrawn a request to amend its lease agreement with the city -- to eliminate the requirement that Seton provide the city's pediatrics care needs at Brackenridge. Now, however, Futrell wants to bring Seton back to the table to renegotiate certain aspects of the contract. City and Seton officials will hold their first meeting on the lease agreement in January. Specifically, Futrell wants some written guarantees that all children will have access to health care at the new hospital -- a 164-bed facility scheduled to open in 2007 at Parmer and I-35, about 11 miles north of the Children's Brackenridge site at 15th and I-35. Also, since Children's is the most profitable division of Brackenridge, Futrell wants to see a percentage of that profit invested in capital improvements at Brack, particularly in the areas of trauma and emergency care.
Futrell says she only recently learned that Seton officials first raised the issue of a new hospital in February with outgoing City Manager Jesus Garza, who had announced his resignation in January. Seton's timing was curious, coming at the tail end of a controversy over its inability to provide birth control services at Brackenridge because of its affiliation with the Catholic Church, which bans such services. The City Council had just approved a settlement on the issue when Seton broached the subject of a new hospital, but the discussion between Garza and Seton went no further. According to Futrell, Garza didn't think Seton's decision was imminent, so he didn't pass along the query to city officials until the Healthcare Network's decision to build the hospital had already been made. Garza did not return calls seeking comment.
Futrell officially assumed the city manager's post in May. In August, Seton informed her that overcrowded conditions at Children's had forced them to look into building a replacement hospital. At the time, Futrell was knee-deep in budget issues; she asked Seton to delay further discussion on the matter until she had cleared her plate of the annual number-crunching ritual. By the time city officials were able to turn their attention to Seton, the new hospital was already a done deal. "They had already gone through the process from A to Z," Futrell said. "They had identified the problem, weighed the pros and cons, and found a solution. They were at Z while the rest of us were at A. What we suggested to them was to open it up for public discussion to help the rest of us get to Z."
While Seton's actions initially threatened to derail the hospital district process, public health care advocates have since redoubled their efforts to get district-enabling legislation drafted and filed before the state legislative session begins in January, and hospital district proponents are confident it will win approval. Once that's accomplished, the next task involves selling the idea to taxpaying voters -- sure to be a greater challenge now, without Children's Hospital as part of the sales pitch.
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