Academic journal article Nursing History Review

Conflict and Compromise: Catholic and Public Hospital Partnerships

Academic journal article Nursing History Review

Conflict and Compromise: Catholic and Public Hospital Partnerships

Article excerpt

Abstract. This article analyzes the tensions and uneasy negotiations, based on a case study, that occurred among Catholic sisters, administrators, bishops, physicians, and the Vatican for more than seven years at a hospital in Austin, Texas. Here, the largest health care system in the city, which was Catholic, joined with the local public, tax-supported hospital that provided the majority of reproductive health care services in the region. A clash resulted over whether the hospital could continue providing sterilization and contraceptive services to its primarily poor patients. This article examines the fierce debates that occurred, especially over emergency contraception and attempts to develop creative solutions after a hierarchical crackdown from the Vatican. The end result was a compromise that included the creation of a "hospital within a hospital."

On May 4, 1995, Charles J. Barnett, president and CEO of Seton Medical Center in Austin, Texas, announced an agreement between Seton, a Catholic facility owned and operated by the Daughters of Charity of St. Vincent DePaul, and the city manager of Austin, which owned Brackenridge Hospital. Seton would take full management and control of Brackenridge, a public facility that had primary responsibility to care for the medically indigent and that had accumulated a $61 million debt. The declared purpose of the transaction was to "ensure the continuation of essential health care services, including trauma, women's and reproductive services, and children' services, for all citizens of Austin and Travis County, regardless of their financial means." 1

Under the agreement, Seton committed itself to pay $10 million up front and $2.2 million annually to lease Brackenridge buildings and consolidate services, which would result in Seton becoming the city's largest hospital system. 2 In turn, the city would pay Seton $5.6 million dollars annually for charity care provided at Brackenridge. This public/private partnership was not unusual; it was part of a trend toward overall consolidation in the hospital marketplace. What complicated it was that Seton had to adhere to the Ethical and Religious Directives for Catholic Health Care Services , developed by the U.S. Conference of Catholic Bishops (USCCB) in 1994, which banned direct involvement in reproductive services to which the Catholic Church morally objected. These services included contraception, sterilization, abortion, and infertility services such as in vitro fertilization and artificial insemination. The Ethical and Religious Directives did permit an indirect role in the delivery of some of these services, should a Catholic hospital affiliate with a non-Catholic institution. 3

As a condition of the lease, Brackenridge insisted that its reproductive services be maintained, except for abortions, which had not been done in Brackenridge and were referred to an outside provider. Key to this agreement was that Brackenridge retain ownership of its facility and that Seton not identify Brackenridge as a Catholic institution. Because of this important stipulation, and after consultation with Catholic ethicists and theologians, the Daughters of Charity announced that, "in recognition of the community's need for reproductive services, those . . . that are currently available at Brackenridge will be retained." Seton Leader Letter, May 4, 2005.

The compromise agreement between Seton and Brackenridge served as a model for other consolidation efforts between religious and public hospitals. Between 1994 and 1999, 93 percent of mergers involving Catholic institutions were with secular partners. In 1998 alone, the Catholic Hospital Association (CHA) reported thirty-two such mergers and affiliations; other sources said the number was as high as forty-three. 4 The partnership between Seton and Brackenridge was a lease arrangement rather than a merger, but its saga can be viewed as a microcosm of the longstanding and complex debate over Catholic hospitals' involvement in reproductive health care services in the United States in the latter half of the twentieth century. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.