City staff’s proposal to take back the fifth floor of Brackenridge Hospital and create a separately licensed “hospital within a hospital” for reproductive services hit yet another snag during last week’s City Council meeting. Representatives of Seton Healthcare Network — the Catholic nonprofit that in 1995 signed a 30-year lease with the city to manage Brack — said they couldn’t accept a resolution, drafted by Council Member Beverly Griffith, that would make emergency contraception available not only to rape and sexual assault victims, but to other women seeking the medication at the proposed $9.3 million hospital.
Griffith’s proposal would expand services provided in the current Seton/Brack lease by making emergency contraception — a time-sensitive medication also known as “the morning-after pill” — accessible to indigent women at risk of becoming pregnant due to condom breaks, missed birth control pills, and other unforeseen circumstances. But Seton Interim President and CEO Pat Hayes told Council that Griffith’s idea wasn’t workable. “Currently, women can’t receive emergency contraception there simply if they ask for it,” she said. Hayes also rejected another Griffith proposal to delete a clause allowing Seton to terminate “ancillary services” such as housekeeping and meals at the city’s new hospital if the city “intentionally and knowingly provided abortions.”
By proposing her resolution, Griffith said, she hoped to “make clear that the city would not be able to do whatever it thought best medically and financially for women, babies, and taxpayers, even in space that was supposed to be controlled by the city. Unless we want air conditioning and cleanup to be withdrawn, we’re going to have to conform to what others think is best.” She was also responding to concerns raised by the Brackenridge Hospital Oversight Council, an ad hoc coalition of reproductive health and consumer advocacy groups, and representatives of the National Women’s Law Center, who assert the city’s draft lease doesn’t pin down Seton’s definition of abortion when considered within the context of emergency contraception or ectopic pregnancy (when fertilized eggs become implanted in the fallopian tube, instead of the uterus). “This decision should be made in light of health concerns, not necessary pure administrative concerns,” Griffith said. “These are life and death issues.”
Earlier this week, a Seton spokesperson told the Chronicle that Hayes and other representatives haven’t changed their position on Griffith’s two amendments, but would accept city staff’s version of the lease agreement. City Council is expected to vote on staff’s version at today’s (Thursday) meeting. Last week, Council decided 6-to-1 (Mayor Gus Garcia dissenting) to postpone making a decision until members could get additional information on the emergency contraception issue and explore the many other unresolved questions, including financial ones.
City Manager Jesus Garza told Council that women arriving at the new hospital hoping to receive EC-on-demand would be directed to city clinics or their private physicians. “I think one of the keys here is this [proposed hospital] is an acute care facility,” Garza said. “We work hard not just on this issue, but we work hard on trying to get folks not to come to the emergency room for primary care services because otherwise that takes up space for people who really are in need of emergency room services and acute services from the hospital.” But Mayor Pro Tem Jackie Goodman pointed out that not everybody knows how the city’s clinic system works — including young kids for whom Brackenridge might be the only recognizable public health facility.
Some observers of the negotiations complain that city staff seems to be relying on Seton and its attorneys in order to clarify terminology about emergency contraception and other matters under negotiation. “It’s like city staff is working for Seton,” said one council aide.
In June, the city proposed its new hospital in order to circumvent modifications to the Catholic Ethical and Religious Directives for Health Care Services, which Seton is obliged to follow. The directives prohibit Catholic hospitals from providing certain reproductive services, and treat emergency contraception as an antibortifacient — a position that is inconsistent with medical definition. One of Seton’s previous dealbreakers included its October announcement that the directives would require the city’s new hospital to test patients for ovulation before giving them emergency contraception. Seton later retracted its position; city staff said the new hospital will follow medical protocols requiring pregnancy tests, but not ovulation tests.
“I keep wondering, what are the city’s dealbreakers?” said Danielle Tierney of Planned Parenthood Central Texas Region, which belongs to the ad hoc coalition opposed to the city’s plan (but supportive of the idea that the city’s new hospital should allow Brack patients to have access to emergency contraception). “It now feels as though the goal is to offer the least amount of services we can possibly offer in order to keep Seton as a partner.” In June, the city’s proposal included not only a 24-hour primary care facility, but also a Center of Excellence for women’s health care. “I can’t remember the last time I heard those words spoken in the context of this proposal,” Tierney said.
Peggy Romberg, executive director of the Women’s Health and Family Planning Association of Texas, says the “vast majority” of sexual assault victims don’t present themselves as such when they arrive at a hospital, particularly women assaulted by their husbands, boyfriends, or family members. Women “may come to the hospital … late in the time allowable or medically appropriate to provide emergency contraception [72 hours],” Romberg told council. “And they may have delayed because of embarrassment and being ashamed. They need the protection of the city hospital.”
This article appears in February 8 • 2002.