To accommodate recently revised religious directives that apply to Roman Catholic-run hospitals, officials in Austin, Texas, have approved a plan to convert one floor of Brackenridge Hospital to a city-owned and managed "hospital within a hospital." The plan will enable 331-bed Brackenridge to continue providing sterilizations, emergency contraception and family-planning services without violating religious and ethical directives that prohibit Catholic health systems from providing such services.
The move has stirred controversy in the area and drawn criticism from women's groups that say access to reproductive services will suffer. Brackenridge leases its space from the city of Austin and is managed by Seton Healthcare Network, a system governed by St. Louis-based Ascension Health, the largest Catholic system in the country. Last June, Ascension gave notice that Brackenridge could no longer provide reproductive procedures after a decision by the National Conference of Catholic Bishops to tighten rules for sterilizations and other reproductive services.
Although Brackenridge is a special case-few Catholic hospitals are owned by the city and leased to a health system-the arrangement Austin's city council approved earlier this month may give other Catholic hospitals affiliated with non-Catholic groups ideas about how to navigate religious directives in their own organizations.
Last June, the National Conference of Catholic Bishops clarified its directives regarding the provision of reproductive services, saying that Catholic-affiliated hospitals needed to distance themselves sufficiently from the governance, management and financial operations of any facility that provides sterilization, emergency contraception and family planning.
Faced with attempting to satisfy those religious directives without curtailing services available to women, the city of Austin-which has leased Brackenridge to Seton since 1995-opted to lease back from Seton one floor of Brackenridge. Starting in July 2003, women who visit Brackenridge for sterilizations or emergency contraception will be referred to the fifth floor, a legally separate, city-run hospital that will not be bound by the same directives as Seton.
Under the lease amendment, Seton is obligated to convert the fifth floor to a full-service OB/GYN unit that will perform tubal ligations, emergency contraception in cases of rape or sexual assault, and family-planning counseling.
It will cost roughly $9 million to complete the conversion, $6 million of which Brackenridge will pay for up front but get back later from the city, said Patricia Hayes, interim president and chief executive officer of eight-hospital Seton Healthcare Network. Brackenridge will pay for the remaining $3 million without reimbursement.
"Services that are available now will be available in this new form, (only) the city will be providing them," she said.
Some members of the Austin community don't see it that way.
"Reproductive healthcare took a wallop as far as I'm concerned," said Peggy Romberg, executive director of the Austin-based Women's Health and Family Planning Association of Texas. "It is disappointing that our city has let Catholic religious directives decide what women's healthcare is in a public hospital."
Romberg and others, including the Washington-based Catholics for Free Choice, believe women visiting a public hospital should be given emergency contraception regardless of the reason they request it. But several sources contacted by Modern Healthcare pointed out that if rape isn't involved, emergency contraception is not a reimbursable service and is better provided by a clinic.
"Most women will go to a clinic, and that's what they should do," said Patricia Young, CEO of Austin/Travis County Community Health Centers. Just five patients per month visit the Brackenridge emergency room seeking emergency contraception, said Young, who worked with Seton officials to negotiate the lease amendment that creates the hospital within a hospital.
After implementation of the Brackenridge lease amendment, the city of Austin anticipates incurring deficits from running the hospital within a hospital, Young said. To insulate itself from those costs, Austin negotiated language in the amendment stipulating that it can subtract any deficit the city incurs from the $5.6 million that Austin gives Seton annually for the charity care Brackenridge provides.
It is unclear what effect, if any, the Brackenridge situation will have on other hospitals and health systems grappling with how to reconcile recent Catholic religious directives with the delivery of reproductive services.
"Some current arrangements are being reviewed, and the outcome of those reviews is not clear," said the Rev. Michael Place, president and CEO of the St. Louis-based Catholic Health Association.
Instead of creating the hospital within a hospital, Austin officials also considered taking control of Brackenridge as a whole, a move that would have cost the city an estimated $65 million to $70 million per year, Young said. "Faced with a looming budget crisis, (the city of Austin) is not in a position to take back that hospital," she said.