It’s infuriating that a group of aging, celibate men in Rome could threaten women’s reproductive services at a public hospital in Austin. But public debate on this issue should focus on a community solution, not on whether the Catholic-sponsored Seton Healthcare Network should continue to manage our public Brackenridge Hospital.
In June, Seton advised the city of the need to renegotiate its 30-year lease of Brackenridge due to recently adopted clarifications of the Ethical and Religious Directives for Catholic Health Facilities. The changes preclude Seton from managing the delivery of certain reproductive services currently offered at Brackenridge Hospital. The events have sparked some in this community to advocate severing ties with Seton, one argument being separation of church and state.
I am a fierce defender of this fundamental principle, but it seems to me that in the case of health care in Austin, church and state must work together — out of necessity — to meet people’s needs at Brackenridge. Collectively, we have not decided as a nation to finance health care for everyone. The only entity with the scope and resources to provide for national health care is the federal government, which so far has taken the incremental approach of providing only for certain groups of people — such as the aged, members of Congress, the disabled, armed forces veterans and poor children.
The Roman Catholic Church, on the other hand, has a tradition of a worldwide health ministry dating to the 1600s, and for a century in the Austin community. For example, in the 1980s, the Daughters of Charity National Health System opened inpatient and outpatient AIDS treatment centers all across this country at the same time that government, for perceived political reasons, refused to respond appropriately to the epidemic. The Food and Drug Administration was refusing to approve and release AIDS drugs, and President Ronald Reagan was insisting that AIDS was a moral problem, not a public health problem.
When the city negotiated its lease of Brackenridge with Seton in the mid-1990s, free-standing hospitals nationwide were merging to take advantage of economies of scale and survive the harsh economic environment created by managed care. It was during that time that St. David’s Community Hospital partnered with the for-profit Columbia/HCA.
The Brackenridge-Seton lease agreement made sense at the time, and it makes sense now — because both institutions share the mission to care for all comers regardless of ability to pay. With the uninsured in Central Texas reaching an alarmingly high rate of 25 percent, that’s a hefty number of people.
As a nurse who has served at the bedside and at the policy table for indigent care, it’s clear to me that our community needs the combined efforts of church and state to meet people’s health-care needs. After all, our community is unique among large urban areas in Texas for not having a hospital taxing district to pay for that care.
All hospitals — the for-profits and the nonprofits alike — are struggling today because the 1997 Congress ruthlessly balanced the budget on the backs of health care. Hospital Medicare payments, a main source of revenue, were drastically reduced. The 1997 Balanced Budget Act, managed care, escalating prices and consumer demand combine to create a cutthroat economic environment for hospitals. It’s hard to imagine another health-care system that would be willing to accrue the expense of taking on our public hospital. None, in fact, stepped up to the plate either in 1995 or at this time.
From a clinical standpoint, both Brackenridge and Seton have benefited from the lease agreement. The best practices of long traditions of high-quality nursing care from both Brackenridge and Seton have been incorporated into consistent, standardized practice. Wireless phones and upgraded information systems have made work far more efficient. The Seton-funded $10 million renovation and expansion of the Brackenridge critical-care areas were desperately needed.
The political will exists on both sides to maintain women’s reproductive services at Brackenridge, as evidenced by the city’s proposal for a “hospital within a hospital” solution and Seton’s embrace of this proposal. The lease agreement brings the best of two worlds together to benefit patient care, and it must be preserved.
Austin, Texas