The words “missed opportunity” understate.

The visionary Berwick, champion for patients, was picked for the job because his “triple aim” (his words) at health care was the same as President Barack Obama’s reform goals: improving the patient experience, improving population health and reducing costs — and because Berwick had decades of experience successfully achieving those goals in this country and worldwide.

Through the organization he founded in the early 1990s, the Institute for Healthcare Improvement, care has been redesigned and hospitals trained to prevent thousands of injuries and deaths.

How has Berwick achieved these changes? Intractable problems in health care are identified, and IHI, often in partnership with the Robert Wood Johnson Foundation, take aim at them.

In the hospital system where I work, we know about Berwick, and we’ve worked with people from the IHI and the RWJ foundation. In 2003, we were chosen as one of 13 pilot sites to transform care at the bedside in medical-surgical units.

Direct-care, front-line nurses were challenged and given full license and encouragement to develop and test methods to improve care. And that we did. Many of the innovations Seton nurses designed are practiced in thousands of hospitals worldwide.

In the eight years since the project began, physicians, patients and families have become engaged in care; bedsores, patient falls, infection and birth trauma have been drastically reduced; communication during shift report has improved; multidisciplinary rounds are made to enhance discharge planning, teamwork and safety; patients are checked on hourly; response teams rush to a patient in crisis before it’s too late; and patient and nurse/doctor satisfaction and retention have dramatically improved. Hospital readmissions have fallen.

Through the transforming care project, in the perinatal area, birth trauma has effectively been eliminated. Clinicians developed a bundle of best practices for obstetricians.

This safety initiative has saved the government a bundle of money. In 2003, Seton billed Medicaid $500,000 for birth trauma; in 2009, zero.

Berwick has promoted understanding of this concept as a way to curb government spending on health care. As part of the Affordable Care Act, Berwick implemented financial incentives for doctors and hospitals to coordinate care and improve patient outcomes.

Stunningly, Congress refused to confirm the nomination of this proven, accomplished and promising leader. Eager to demonstrate contempt for the Affordable Care Act, Republican demagogues seized on Berwick as an irresistible target.

They dubbed him Dr. Death Panel. Why? Because he — and the Affordable Care Act — encourage end-of-life discussions between doctor and patient/family when medicine can do no more.

In addition, they exploited his remarks as an academic praising Britain’s health care system for covering all its people and reining in costs while improving outcomes.

Taking his remarks out of context, Republicans portrayed him as an advocate of rationed care and socialized medicine. This, despite Berwick’s insistence all along that the British system cannot be copied here and that America’s system, having evolved around insurance, needs its own solution.

If you repeat “Dr. Death Panel” and “rationing care” enough times, you begin to brand and unfairly define Berwick and the health care reform law.

Marilyn Tavenner, a nurse and his top deputy, will succeed him. Let’s hope that she will be able to execute his goals. Congress will be more comfortable with her, as she is more manager than visionary.

Back to his triple aim. Has his work improved the patient experience? Yes. Has it improved population health? Yes. Has it reduced costs? Yes.

Have we missed an opportunity? Oh, and how.

Anne Mitchell (left) and Vickilyn Galle after their indictment in 2009

Facing a $27 billion budget shortfall, Gov. Rick Perry has revived a failed and tired idea from past legislative sessions. To save a paltry $7 million, he proposes to combine under one umbrella some of the most essential agencies in state government — the boards regulating doctors, nurses, dentists, chiropractors, podiatrists, optometrists, pharmacists, psychologists and physical and occupational therapists.

The health professions boards were created to protect the public from harm. Although sluggish from recent years’ budget cuts, they are effective in protecting us because they are separate agencies with investigators trained specifically for each respective health discipline. They make you, me and every Texan a lot safer when we seek health care.

From the economic and public safety standpoints, the governor’s one-size-fits-all gesture makes no sense at all.

It costs the state $29 million to run these boards, but through licensing fees and disciplinary fines they collectively bring in $79 million for the state’s general fund (numbers courtesy of the Legislative Budget Board and the Texas comptroller’s office).

For example, the Texas Medical Board, which oversees doctors, had a budget of $9.4 million for fiscal year 2010 but brought in $35.7 million to state coffers.

The separate regulatory boards are cash cows for the state. It makes me wonder if the governor can count.

The professions are exceedingly different, with vocation-specific investigators. Nursing experts know nothing about regulating dentistry and vice versa.

The complex Winkler County case demonstrates the importance of a separate health board to protect the public.

The medical board first investigated Dr. Rolando G. Arafiles Jr. in 2007. It found that among other unprofessional and unethical offenses, he failed to keep adequate medical records in supervising a physician assistant who was prescribing nontherapeutic drugs at a weight loss clinic. His penalty was a $1,000 fine and a three-year stipulation on his license.

The doctor relocated, and in 2009, nurses Anne Mitchell and Vickilyn Galle of Winkler County reported the doctor to the board citing numerous cases of improper care, one of which was examining the genitalia of patients in the rural emergency room whose symptoms included stomach distress, headache and sinus pain, and blood pressure and jaw problems.

When the board notified Arafiles of the complaint, he enlisted his golfing buddy, the county sheriff, to find out who reported him. After identifying the nurses through spurious means, the hospital administrator immediately fired them, and the county and district attorneys charged the nurses with misuse of official information — a third-degree felony punishable by 10 years in prison and/or a $10,000 fine.

The medical board sent a letter to the prosecuting attorneys stating that it is improper to criminally prosecute people for raising complaints with the board — that the board depends on the eyes and ears of health care professionals to carry out its duty to protect the public from improper practitioners.

After the nurses’ report, the board investigated Arafiles and charged him with poor medical judgment, nontherapeutic prescribing, failure to maintain adequate records, overbilling, witness intimidation and other violations.

Mitchell and her family endured a torturous eight months waiting for the criminal trial to determine if she would go to prison or be fined an amount she could not pay. In 2010, Mitchell was acquitted in less than an hour, making national headlines and prompting a Texas attorney general investigation into the doctor and Winkler County officials.

The medical board subsequently issued a public reprimand of Arafiles, ordering physician monitoring of his practice and a $5,000 fine. He also was ordered to complete a rigorous course followed by assessments of his competence and medical jurisprudence.

Soon thereafter, the doctor, sheriff, county attorney and hospital administrator were indicted on charges of retaliation against the nurses. They await trial.

The Winkler County case demonstrates the crucial role of a board in protecting the public. The complexity of this case likely would not have been handled effectively by an umbrella agency. Functioning as a single agency would only dilute and weaken the power to protect the public’s safety.

If Lyndon Johnson had been alive on March 24 when President Barack Obama signed the Patient Protection and Affordable Care Act into law, he would have remarked from experience that the battle for health care reform had only begun.

We remember the July 30, 1965, signing of Medicare into law as the smooth establishment of a popular program. But that’s not at all how it went down. The program was nearly destroyed by doctors and hospitals threatening to boycott it.

Calling it “socialized medicine,” the American Medical Association waged war against the program before and after it became law, with doctors warning their patients against it, thus threatening the public support that Johnson needed.

Johnson outmaneuvered them by giving the AMA a seat on an advisory council that oversaw rules and regulations, one of which was setting physician fees, and the doctors acceded. Thus began wealth among physicians.

Many hospitals, especially in the South, were segregated and threatened to boycott because of the provision that hospitals be integrated. Johnson allowed no compromise and set up a battle council.

He had Vice President Hubert Humphrey telephone mayors to pressure resistant hospitals. In the final weeks before Medicare’s beginning, the hospitals integrated rather than lose federal dollars. LBJ sent hundreds of inspectors to ensure hospitals receiving Medicare funds were indeed integrated.

Thus began Medicare.

Fast forward to 2010. On the campaign trail for president, Obama got his strongest applause when he spoke of insuring all Americans and keeping insurers from denying coverage based on pre-existing conditions. The brightest minds in health care drafted a plan that would achieve those results.

The bill enjoyed the support of organized doctors and hospitals. Insurance companies were the holdout. When the public option was ultimately dropped in favor of insurance exchanges, the companies jumped on board, and the bill was passed.

Unlike the interest-group battle over Medicare, this law is threatened by party politics. The ads from this election cycle show how prominent the issue weighs and how ugly the rhetoric can get. The fact that the provisions in this law kick in more slowly than Medicare leaves it even more vulnerable to attack.

If the conservatives regain power, they’re not likely to repeal the law. But if they strip away critical, easy-target elements — such as the requirement that uncovered individuals be required to buy at least a basic policy and the subsidies to make sure they can afford them and/or the requirement that large employers provide health benefits — then coverage for the uninsured will be effectively gutted. With 21 states, including Texas, suing to stop parts of the reform, a showdown looms.

The major objection is the insistence that it is unaffordable. When Medicare became law, health care represented 6 percent of U.S. economic output. Today, the figure is an unsustainable 18 percent. Our health care system pays for the quantity rather than the value of care, and it should be clear to everyone that without fundamental change, the same trend will continue.

Included in the overhaul is a Center for Medicare and Medicaid Innovation where local hospitals can do what the hospital where I work did. Within six years, we reduced our term infant birth trauma from 0.3 percent (half the national average) to 0.01 percent. We did this by bundling best practices and improving interdisciplinary communication in the delivery room.

In 2003, we billed $1.5 million for birth trauma. Last year, we billed $25,000. While representing a loss for our hospital, it’s a huge savings for Texas, which foots much of the Medicaid bill.

Rather than a government takeover of health care, the law frees communities and local health systems from existing payment rules and allows them to experiment, as my hospital did, for ways to deliver better care and ultimately lower health care costs.

The midterm elections seem to be all about exploiting the down economy and taking aim at those who courageously cast a vote to overhaul an unsustainable system. They should not be targeted and punished. People would do well to remember the fury and acrimony that surrounded the passage of Medicare.

This law is designed to insure nearly all Americans while increasing the value of care. If allowed to stay intact, it may well be as momentous as Medicare.

Conspicuously absent from the health care overhaul were meaningful measures to control costs. There’s a reason for that: Government cannot legislate that issue, as health care is inherently too complex. An example of a clumsy congressional attempt was the enactment into law in the late 1990s to cut Medicare physician payments. The draconian law has resulted in politically messy fights, with Congress blocking the cuts 10 times in the last eight years, including four times since January.

If there’s one man in the country who knows how to proceed with controlling health care costs, it’s Berwick, a Harvard clinical professor of pediatrics and health care policy.

Republicans should be the ones most interested in his nomination succeeding. Stunningly, they are the ones opposing it. Why? They cite remarks he has made — all taken out of context — about rationed care, the British National Health Service and primary care “medical home” models of care.

Professors by nature think outside of the box, and they are rewarded for it. Any beginning student of U.S. health care policy learns that in a country with a fifth to a quarter of its population uninsured, it’s a matter of public policy by omission that health care is rationed. I suspect most health care policy professors will rightly instruct that if rationing is a given, then as a society, it’s in the public interest to do so with eyes open rather than closed, something Berwick referred to in an interview last year in the journal Biotechnology Healthcare.

In this interview, Berwick referred to an initiative funded in the American Recovery and Reinvestment Act of 2009 to evaluate the comparative effectiveness of targeted therapies and recommend reducing those that are ineffective and costly. The program is named Comparative Effectiveness Research; he calls it what it is, evidence-based medicine. He cautioned against mandating compliance with CER directives, preferring instead making information and research available to clinicians in the form of advisories.

Berwick knows what he’s talking about. He founded the Institute for Healthcare Improvement in the early 1990s, which has worked with thousands of hospitals worldwide to develop evidence-based best practices. As part of Ascension Health, the hospital where I’ve worked as a neonatal intensive care nurse for 30 years is one of those hospitals working with IHI. Berwick certainly has made a transformational change in my area and in most areas of my hospital.

During this past decade, Berwick’s organization successfully has tackled some of the most deadly, costly, tragic — and avoidable — events in health care: hospital-acquired pneumonia from ventilator usage, central venous line infections, adverse drug reactions and many more. Real cost controls in health care will take place from within the industry, and using evidence-based practice is the best hope.

In my own area, we have effectively eliminated birth trauma injury to term infants. Our hospital also worked with Berwick’s organization to develop another IHI life-saving innovation — rapid-response teams. These teams, which have spread all over the United States, consist of a critical care nurse and respiratory therapist available 24/7 to seek out patients and answer calls from nurses on the floor, usually outside of the intensive care unit, who see patients going downhill. The teams provide oxygen, IVs, drugs or other therapies to stabilize patients.

Hospitals have seen a 50 percent reduction in “code blue” calls — patients who need to be resuscitated because they’ve stopped breathing and their hearts have stopped beating. Every time I hear the hospital operator call overhead, “Rapid response team, report to room X,” I smile and think of Berwick. I think of how grateful that patient and his or her family will be that the patient was caught in time before it was too late.

The smile vanishes quickly, though, when I think of the impending disaster of taking professorial remarks out of context and destroying what may well be this country’s only real hope of improving health care while reining in costs. Despite Republican rhetoric, Berwick, more than anyone, recognizes that local communities and clinicians, not a national system, will be the ones to rein in costs.

Inglis is an editor and neonatal intensive care staff nurse with the Seton Family of Hospitals in Austin and a former student of health care policy.

Undoubtedly overlooked by most, that statement struck me as profound and rocketed me back to 1992. The gods had smiled upon me, and I found myself at the LBJ School of Public Affairs, out of place among 10 promising graduate students chosen to take the last policy seminar taught by the late Barbara Jordan. The first African American elected to the Texas Senate since Reconstruction, Jordan went on to a distinguished career in Congress, ended her public service teaching at the LBJ School of Public Affairs.

U.S. Representative Barbara Jordan opens the impeachment hearings on July 25, 1974. Her brow remained unfurrowed during the electrifying eight-minute and 45-second speech.

I was old enough to be my classmates’ mom, but I was as bendable as a wire hanger. We studied policy from every conceivable angle, dissecting it into many parts — politics (not a dirty word), democratic pluralism, congressional prerogative, the U.S. Constitution, the presidency, leadership, vision, interest-group impact, agency roles in the policy process, the judiciary and more. To this day, Jordan’s reverence for our democracy is as ingrained within me as her conviction that public service is a high and honorable calling.

One important lesson we learned is that Americans are not comfortable with fundamental policy change, and that’s clearly been in evidence during the past year’s health care reform brawl. The nation has not legislated fundamental change since the 1960s, and, unaccustomed, emotions have run high.

Members of congress yelled “you lie” and “baby killer” from the chambers of the people’s House. Congressmen were spat upon and were the target of racial and homophobic epithets by angry protestors as they walked the steps to the Congress to cast their difficult votes.

After the bill was signed into law, all hell broke loose. Several representatives who voted for the bill have received death threats, profane voicemails, white powder mailed in envelopes and bricks hurled through their home and office windows with hateful notes attached. Three days after the vote, attorneys general from more than a dozen states, including Texas, filed suit asserting as unconstitutional the mandate for individuals to buy insurance.

The late Jake Pickle, who represented the 10th Congressional District from 1963 to 1995, knew firsthand about difficult votes. As a new congressman, he was confronted with the 1964 Civil Rights legislation. His constituency was bitterly divided on the issue. He knew in his heart that forbidding discrimination based on race and sex was the right thing to do. He also knew as a new congressman, a “yes” vote could well cost him his seat. He voted his conscience: “Aye.” He remembered that vote in his 1997 memoir, “Jake,” as his gutsiest, proudest moment in the U.S. Congress.

The health care legislation was never about socialism, red versus blue, a public option, abortion, government takeover, poll numbers or midterm election fallout. Those are all abstractions or side issues. All along, this legislation has been about uniting around the principle of equality, so that, like all other industrialized nations, in America health care will be available for everyone, not just the privileged.

In her keynote address to the National Democratic Convention in 1976, Jordan said with her voice and wisdom ringing from the mountain top, “First, we believe in equality for all and privileges for none … But this is the great danger America faces: that we will cease to be one nation and become instead a collection of interest groups — city against suburb, region against region, individual against individual. … But a spirit of harmony will survive in America … if each of us remembers, when self-interest and bitterness seem to prevail, that we share a common destiny.”

We also learned in Jordan’s class that true leadership is rare, that it requires a vision for the people along with the trust, skills, faith and perseverance to carry it out. How I wish she had lived to see a young visionary black senator swept into presidential office with the promise of “real” (meaning fundamental) change.

How proud the congresswoman would be that within 14 months of inauguration, Obama accomplished what three presidents had failed to do. Franklin Roosevelt, Harry Truman and Richard Nixon each placed universal coverage high on their agendas and fought valiantly for it. The late Sen. Edward Kennedy called it the last great unfinished business of our society.

The president rightly could have added to his remarks, “This is what leadership looks like.”

Part of our professional code of ethics tells us that we’ll strive to “improve standards of nursing practice and promote … efforts to meet health needs of the public.” I’ve always taken that aspect of the code very seriously.

During the 12 years that I was a hospital staff and head nurse, I was also involved in local politics. During that time, an influx of foreign nurses pointed to the need for a clearer definition of nursing responsibilities in the Nursing Practice Act. After joining the Governmental Affairs Committee of the Texas Nurses Association, we set to work to rewrite parts of the act and then to lobby the Legislature for its passage.

It became clear to me during that time that policy work in state government was the most efficient way to improve nursing and health care for people. I could see that as a nurse I was in a unique position to make that happen, so I decided to run for state office. Having worked in local politics, I was able to garner a lot of support and campaign help.

Survey after national survey has shown that the public at large trusts nurses and holds them in high esteem. I certainly found that to be true both within my hometown of El Paso and within the Legislature. People in my district trusted me and re-elected me every term for 13 years until I retired in 1997. My fellow legislators relied heavily on me for expertise in health care. When I spoke on health care, it got their attention.

Was it difficult for you to juggle work and family?

That’s difficult for any woman. I had a husband and 10 children, so I needed to work. When the children were young, hospital work with its 24/7 coverage requirements offered me the opportunity to work a flexible schedule to accommodate child care and events.

I didn’t run for state office until the youngest child graduated from high school. Serving in the Legislature is a full-time job, whether in session or not.

What are you proudest of in your legislative work?

I feel good about the work I did for AIDS. When I was first elected in 1984, the AIDS epidemic was becoming public. Legislation was needed to cover many of the problems-like confidentiality, directives for health care workers (precautions), regulations, funding for education. My health care background was important in overcoming the hysteria. Every subsequent session, there was a lot of work to be done to refine legislation and to make sure that what was gained was not torn apart.

One of the first bills I worked on was assuring that licensed respiratory therapist regulations did not conflict with nursing practice. I worked with the Texas Nurses Association every term to update the Nursing Practice Act. I helped get funding for a huge study about the nursing shortage in Texas.

The Board of Nurse Examiners Sunset review would come up, and every session I worked to get the [board] the money it needed for testing and checking out complaints against people. I worked with [the Texas Department of] Mental Health and Mental Retardation for smaller group homes for the developmentally disabled and to review lawsuits for better care for custodial or institutionalized patients. I made sure state-funded institutions kept up with best-practice standards.

I am glad I was there to give my input from the nursing perspective to health care legislation and the budget wars. I know it helped. Serving on the Public Health and Appropriations Committees allowed me to balance finances with political considerations. That’s important work.

What reaction have your children had to your political activity?

I think it has affected them pretty profoundly. All of them really enjoyed helping me with my campaigns. They all tell me they’re proud of me for the work I’ve done.

My son, Chuck McDonald, was assistant press secretary to former Texas Gov. Ann Richards. He is now a busy political consultant with a public relations firm.

My youngest daughter, Elizabeth, is a neonatal intensive care nurse in Austin. She tells me that since becoming a nurse, she’s often amazed at seeing the tangible results of my labor in the Legislature.

For example, in El Paso, she made the connection with my work and how AIDS patients and those with mental illness were treated more humanely. She tells me she knows how my work has made life better for a lot of Texans, and that makes me happy.

About a year ago, I worked in the same NICU bay at Seton Medical Center in Austin with a nurse new to our staff, Elizabeth McDonald. She’s quite distinctive — tall with very long hair, poised, cool, funny and ardently self-assured. She defines “cool.”

On a lark, I asked her if she had family in El Paso. She said, “Yes.” Intrigued, I asked if she knew Nancy McDonald. To my utter astonishment, she told me Nancy was her mother! In case you don’t know RN Nancy McDonald, allow me to enlighten you.

Nancy McDonald, 67, is an icon of Texas nursing. She’s one of my personal heroes. She was a hospital staff and “head” nurse for 12 years. Nancy had a large family — 10 children. When the youngest graduated from high school, Nancy went into politics. Like Elizabeth, she’s absolutely delightful — warm, compassionate and no-nonsense when it comes to serious matters — things like health care. She’s a strong believer and achiever in an area of nursing that’s important but often overlooked: government work.

Our professional code of ethics tells us that we’ll strive to “improve standards of nursing practice and promote…efforts to meet health needs of the public.” Nancy takes that aspect of the code very seriously.

Nancy represented El Paso for 13 years in the Texas Legislature, carrying every piece of important nursing and healthcare legislation during her tenure. El Paso’s a somewhat geographically isolated and disparate border city with 900,000 people with many health needs, and I imagine representing El Paso would be a tough job. Yet Nancy represented it well, being elected to every term from 1984 until her retirement in 1997.

Nancy was a revered member of the Lege, serving on the Public Health Committee and even as vice chair (with Chair Rob Junnell) of the powerful House Appropriations Committee. Her healthcare expertise was greatly needed and sought after. Jim Willmann, longtime TNA Director of Governmental Affairs and known for understating said, “When Nancy was there, nursing was fortunate to have a legislator who was an insider. Whenever Nancy spoke on health care, it got legislators’ attention.”

With the exception of Eddie Bernice Johnson, senator from Dallas (now serving in the Congress) who was there when she first arrived, Nancy was the only registered nurse in the Texas Legislature. Unfortunately, she was the last.

On a sad note, recently Nancy was diagnosed with ovarian cancer. She has received her care and treatment at the hospital where I work, and during a visit I interviewed Nancy and her daughter Elizabeth for Texas Nursing.

Toni: “Nancy, what are you proudest of in your legislative service?”

Nancy: “I feel good about the work I did for AIDS. When I was first elected in 1984, the crisis of the AIDS epidemic was becoming public. Legislation was needed to cover many of the problems, like confidentiality, directives for healthcare workers (precautions), regulations, funding for education. My healthcare background was important in overcoming the hysteria. Every subsequent session there was a lot of work to be done to refine legislation and to make sure that what was gained was not torn apart.

“One of the first bills I worked on was assuring that licensed respiratory therapist regulations did not conflict with nursing practice. I worked with the Texas Nurses Association every term to update the Nursing Practice Act. I helped get funding for a huge study about the nursing shortage in Texas.

“The Board of Nurse Examiners sunset review would come up, and every session I worked to get the BNE the money they needed for testing and checking out complaints against people. I worked with MHMR for smaller group homes (a more normal setting) for the mentally retarded and to review law suits for better care for custodial or institutionalized patients. I made sure state-funded institutions kept up with best practice standards.

“Serving in the legislature is a full-time job whether in session or not. I am glad I was there to give my input from the nursing perspective to healthcare legislation and the budget wars. I know it helped. Serving on the Public Health and Appropriations Committees allowed me to balance finances with political considerations. That’s important work.”

Toni: “Texans are better off because of your efforts, Nancy, and we appreciate your years of hard and serious work. We in NICU love having your daughter Elizabeth on staff. She’s fun, helpful, speaks Spanish, has a great mind and great hands. What did you think when she told you she was going into nursing?”

Nancy: “I was very happy. I thought she would be a very good nurse. She had lots of experience in the El Paso hospital and clinics as a dental assistant before she ever decided on nursing. In moments of crisis she reacts quickly and was always very independent. She can be tough, has stamina and does the right thing. Those are qualities important for a nurse.”

Later in neonatal, after the interview with Nancy, I asked Elizabeth what it was like being the daughter of such an accomplished nurse and legislator. Elizabeth said, “I remember helping mom with her campaigns, and that was always fun. Since becoming a nurse I have been continuously amazed at how often I see the results of her labor with the Legislature, especially back in El Paso. I could see how AIDS patients and those with mental illness were treated more humanely. It became clear that she was in large part responsible for those changes. She has made life better for a lot of Texans, and I am very proud of her.”

Nancy is receiving chemotherapy for her cancer at home. For those of you who know and remember Nancy, I’m sure she would enjoy hearing from you. Her address is 1501 Barton Springs Rd., #217, Austin, Texas 78704.

[Epilogue: Nancy Hanks McDonald died May 14, 2007 at the age of 72.]

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.

The Tuesday after Venola died, former Gov. Ann Richards read the article in the Austin-American Statesman written by reporter Leah Quin. She called me from Washington, DC, and thankfully I had the presence of mind to get a quote from her. “My generation had few mentors—women who taught us what to do. But I had Latane Lambert, Venola Schmidt, Ruth Ellinger and Jean Lee,” Ann said. “Venola was one of those gentle people who loved you in spite of your faults and encouraged you in everything you did.” Once again, Ann Richards hit the nail right squarely on the head.

It’s a mystery to me how I got to be so lucky to move into a house that was directly across the street from Venola Schmidt. It was 1981. I was 34 years old and had a lot to learn about a lot of things. She was 62 and had a lot to share. Our relationship was ideal because we didn’t have the burden of being family or of living together.

We recognized right away that we both shared the same core values. The difference was that Venola knew how to channel her passions for the public good; I did not. Venola wasn’t like anyone I had ever met. She was plain-spoken. She meant what she said and she said what she meant. She held the lantern and shined the light in places that were dark to me in the Pre-Venola Era: politics, great painting, great authors, good cooking. She never “taught” me; that wasn’t her style. She just shared with me, and I would learn from her.

During the Venola Era, she never once — not once — commented on external things about me, like what I was wearing or my hair. I once considered renting a clown costume to wear over and see if she would notice. I never did that. When I would pop over, she would look deep inside and know exactly where I was emotionally. That was what was important to Venola. She shared my victories and triumphs, and she shared and made sense of my darkest hours.

In the 20 years and countless hours I spent with Venola I never once heard her say anything petty about anyone. Disagreements with individuals always were issue-based, never personal. Venola often commented how thinking people would naturally disagree and that debate was healthy and productive. Now that’s class in the truest sense.

Venola and I shared a love for writing, and we wrote many a position statement together. The year I moved across the street from her was the year my first published article came out. It was awful. I never showed it to her. The next thing I wanted published I brought over for her to edit. She tore it to shreds, but in the kindest, gentlest way. She had a strict zero-tolerance policy for rambling sentences, big words, or vague meaning.

Within a few years she had me writing as plainly as late President Harry Truman spoke. My happiest moments were when she’d come across a commentary I’d written in the newspaper, call me, and say simply, “That was good. It needed to be said. Thank you.”

Another thing we did really well together was laugh. It’s comforting beyond words to me that in the last few hours of her life we shared a good, hard laugh.

Venola died Saturday night, June 9 around 11 p.m. At 8 p.m., her daughter Sandy and I first learned of her symptoms. We rushed over, and when Venola told me what was going on, I knew she had to go to ER and that she would resist. She told me to call her doctor. I knew that wasn’t necessary, but I sensed Venola wanted to stall a bit and, besides, when Venola tells you to do something, you do it.

Sandy and Venola were sitting on her living room couch, and Sandy was rubbing her back where it hurt. I was sitting across the coffee table from them in my favorite rocker. I dutifully called the medical exchange. A young girl answered and I asked for Dr. Leverich. She sighed and said, “Wait just a minute.” She came back and asked for his first name. I rolled my eyes thinking, “Jeez, how many Dr. Leveriches can there be with this service?” And I asked Venola his first name.

Venola laughed at my reaction and said, “Dick.” I told the girl, “Dick.” Another sigh and, “Wait just a minute.” She came back and said, “I’m sorry. All we have here is a Richard Leverich.”

I found myself in the position of telling this woman who had spent the last 35 years of her life working for access to healthcare for all, “Venola, you’re out of luck. All they have is a Richard Leverich.” And we shared our last good, hard laugh together.

During the Venola Era, it was as if my life map were on the wall, and her hand was over mine connecting the dots. Borrowing from poet W.H. Auden, “(S)he was my North, my South, my East and West.” I don’t know what the Post-Venola Era will be like. But I do know that my world makes a lot more sense and is a bigger, brighter place because of her.

Barbara Jordan’s candle burned out in January of 1996. It was too early; she was not finished. Her ghost haunts me constantly these days. In the spring of 1992, I took a graduate seminar from the former Congresswoman at the LBJ School of Public Affairs in Austin. The presidential primaries were taking place.

Reps Barbara Jordan and Charles Rangel weigh in on Watergate, 1974.

In a rare digression from discussion of high governmental principles, we would briefly touch on the primary candidates. One of my classmates favored Tom Harkin, some Paul Tsongas, and another California’s explosive Jerry Brown. Professor Jordan respected them all, and in a rare peek at her own view, she opined that the governor from Arkansas seemed the most presidential, the most capable of leading the nation. Moreover, she regarded his wife, Hillary, as caring and capable, fitting for a first lady.

At that time, Gov. Ann Richards had tapped Jordan to serve as Ethics czar for state government. Shortly after Professor Jordan’s gatekeeper/secretary rolled her into class one January day, the professor announced that she had gotten a call the night before from Arkansas Gov. Bill Clinton. The Gennifer Flowers story had broken the day before, and Gov. Clinton sought Barbara Jordan’s advice on whether to proceed.

She told us that she advised the governor that those matters were private, that the American people had the ability to distinguish between actions that were personal and those that affected the national interest. She advised him to level with the American people, and in her deliberative, authoritative voice that invariably sent shivers down my spine, she told him unequivocally, “You must press forward.” It was that simple. The rest is history.

I learned a lot in Professor Jordan’s class. I absorbed her conviction that public service is a high and honorable calling. I learned that the Constitution of the United States is a purposely vague and sacred document, that it forged a government in which our liberty was not entrusted to a particular branch, that one branch would check the others. Above all, I learned that in our great American experiment in democracy the people hold the power, and rightly so.

Barbara Jordan served on the Judiciary Committee of the House of Representatives when considering the impeachment of President Richard Nixon in 1974. On July 25, Congresswoman Jordan made a riveting 15-minute speech that effectively focused the nation. Two weeks later, the president resigned.

[To view that speech, click here.]

In her speech, Congresswoman Jordan proclaimed, “My faith in the Constitution is whole, it is complete, it is total.  I am not going to sit here and be an idle spectator to the diminution, the subversion, the destruction of the Constitution.” Later in the speech, “Impeachment must proceed within the confines of the constitutional term, ‘high crimes and misdemeanors.’” And later, “Common sense would be revolted if we engaged upon this process for petty reasons. Congress has a lot to do…. Pettiness cannot be allowed to stand in the face of such overwhelming problems.”

I would not presume to speak for Barbara Jordan posthumously. But I can’t help wondering what she would think of publicly examining presidential sexual indiscretions under a microscope, when in her day high policy was often made at night by powerful white men in smoke-filled rooms with plenty of alcohol, women, and playing cards. She, of course, was not invited. The press was invited, but such conduct was not news. Reporters turned their heads away from unseemly behavior.

This I know. If Barbara Jordan were here today, what would disturb her the most about this imbroglio is the resultant tipping of the delicate balance established in the Constitution among the branches of government. Federal Court (judicial branch) decisions allowing the nation’s highest officer to be sued and allowing those closest around him to testify against him have effectively weakened the presidency (executive branch). And I know she would be alarmed that the power of the recently established Office of the Independent Counsel has been allowed to escalate unchecked.

I think Professor Jordan would smile knowing that the fate of the remaining two years of the Clinton presidency is left in the hands of the people. Her faith in the American people’s careful, deliberative and fair judgment was whole, complete and total. As she told Gov. Clinton, she believed in the people’s ability to distinguish between actions that were personal and those that affected the national interest. She would remind us again that impeachment is solemn and must be reserved for treason, bribes, high crimes and misdemeanors, not petty offenses.

She would tell the House Judiciary committee to embark on a course of action that would cleanse, not pollute the body politic, that would strengthen, not divide a weary nation and leave us more cynical. If we could ask her now, “What should we do as a nation?” She would tell us authoritatively, like she told the promising governor from Arkansas in 1992, “You must press forward.”