The City, the New Women's Hospital, and UTMB

As if its relationship with one health care provider weren't rocky enough, the city of Austin has added another marriage partner to the public health care daisy chain.

The University of Texas Medical Branch at Galveston has signed on to run the new Women's Hospital located on the redesigned fifth floor of city-owned Brackenridge Hospital. Meanwhile, partner No. 1, the Seton Healthcare Network, will continue to lease and manage all but the one floor of Brack.

No one knows how this arrangement between the city, Seton, and UTMB will work out in the long run, but if past and recent history is any indication, something tells us the city holds the least amount of leverage in this three-way roundabout.

The unique relationship grew out of a late 2001 directive from Seton's owner, the Catholic Church, to cease its reproductive services at Brack. City officials then came up with a plan to continue providing this type of care to indigent women by creating a separately licensed "hospital within a hospital" on the fifth floor. Seton agreed to that arrangement on one condition: Emergency contraceptives would be provided only to victims of sexual assault. In other words, indigent women seeking abortions would be directed to other city or social service organizations. Women's advocates protested that prohibition, but Seton was adamant and won the argument. When it came time to approve Seton's amended lease in February 2002, only two council members -- Beverly Griffith and Danny Thomas -- voted "no," arguing that the agreement shortchanged low-income women.

Then came a willing participant to manage the new Women's Hospital. With abortion choices no longer an option, the city asked UTMB to include midwifery services in its negotiated lease agreement. For whatever reason, UTMB said no, that it would need more time to determine whether women would have that option available to them.

As part of the five-year, renewable option deal with UTMB, the 12-bed facility will provide labor and delivery (up to 1,300 deliveries a year), newborn care, tubal ligations, and family planning counseling, including emergency contraceptives (only to victims of sexual assault).

This new arrangement doesn't come cheap. The city dedicated $9.3 million to establish and renovate the fifth floor and expects to lose $3 million in the hospital's first year of operation, according to Trish Young, chief executive officer for the city-county Community Health Centers. The $5.6 million the city contributes annually toward Brackenridge charity care will be reduced to about $2.6 million to help offset the cost of the new hospital.

These health care changes will also include a revamped and expanded -- and possibly more effective -- citizens group to provide oversight of both Brack and the Women's Hospital. The City Council will appoint a Hospital Services Oversight Council, whose members will include a physician who treats indigent patients, a pediatrician, an indigent health advocate, and a hospital or nurse administrator.

Advocates for reproductive rights -- whether that be the right to choose a midwife or the right to choose an abortion -- see a glimmer of hope on the horizon. A proposal to create a city-county health care district is expected to come before voters next year. If approved, the measure would bring Brack and the Women's Hospital under the jurisdiction of a public governing board.

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Seton Healthcare Network, Beverly Griffith, Danny Thomas, University of Texas Medical Branch at Galveston, Hospital Services Oversight Council, Trish Young, Beverly Griffith, Danny Thomas, UTMB

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