Griffith likely to propose amendments The proposed ‘hospital within a hospital’ amendment to the lease agreement between the city and Seton for Brackenridge Hospital is scheduled for a vote by the City Council today, but some council members at a Wednesday work session expressed dissatisfaction with the final language worked out in several months of negotiations.

Council Member Beverly Griffith had harsh words for several provisions of the proposed contract amendment and for the concept in general. “If we make a change, I want something that is better in terms of the health and safety of the moms, the babies, and the taxpayers. I am not going to be ready to accept the proposal as presented now,” she said.

Council Member Daryl Slusher countered that while the proposed lease amendment wasn't ideal, the city was making the best of a bad situation. “I would want to know what is the suggestion on how it can be better than what we have now, or how it can be better than what the staff has brought forward,” Slusher said. “It's not going to remain the same no matter what we do. What we're trying to do is keep the same services available to all women in the best way we can.”

For her part, Griffith cited the perceived lack of alternatives as a reason for delaying a vote on the lease amendment. “I agree with Council Member Slusher that we do need to look at options and alternatives and we have not been offered those yet,” she said. “When we get to that point we'll be more ready to make a decision.”

City Manager Jesus Garza reminded Council members that other options had been discussed at the beginning of the process, including finding another company to run Brackenridge or having the city take over all maternity-related services. The first was not deemed to be feasible because of a lack of alternatives to Seton, while the second was rejected by Seton because of its financial impact.

After laying out her concerns about the overall nature of the choice facing the Council, Griffith delved into specific points in the lease amendment she found objectionable. Most of those centered on a provision in the agreement concerning emergency contraception for rape victims. Under current policy, Brackenridge is able to provide morning after contraception to victims of rape or sexual assault. That service would be offered in the fifth-floor ‘hospital within a hospital’ if the lease agreement is approved. However, that leaves a possible scenario in which a sexual assault victim's injuries are so severe that she cannot be moved from the intensive care unit, even to another floor of the hospital, to receive the emergency contraceptive pill.

Most sexual assault victims, according to city staff, are taken to St. David's Hospital because nurses there receive specialized training in collecting forensic evidence from victims to assist police. Trish Young, d irector of the city's, told Council members that if a rape victim were to be hospitalized at Brackenridge she would likely be transferred to the city-operated fifth floor. “We looked at two years worth of data at Brackenridge. I can remember one specific instance of a rape victim actually hospitalized for overnight observation,” Young said. In other words, there was no circumstance that someone had sustained injuries and was hospitalized for a 72 hour period. That 72 hour period is important because emergency contraception is only effective when administered within 72 hours of a sexual assault. Slusher, who has indicated he would likely vote in favor of the lease amendment, expressed his frustration at the religious restrictions. “We should point out that under the strictures of the Catholic Church, they would let a rape victim just lay there and would not give them this emergency contraceptive, even if the victim wanted it, because of their philosophy,” Slusher said. “That's the core of this.”

In addition to concerns over medical procedures available to rape victims, Griffith also called on the Council to enforce recommendation of the Brackenridge Hospital Oversight Council regarding financial oversight. She presented language during the work session she believed would improve financial accountability. If that language were to be added to the lease agreement, it would read: The office of the City Auditor shall have the right to access, examine, analyze, and verify all Seton's records, accounts, and data pertinent to the execution of this lease amendment and records, accounts, and data maintained by outside contractors hired by Seton or by the City of Austin.Griffith also expressed frustration at the lack of availability of some data from Seton, but city staffers responded that financial oversight provisions are present in the current lease agreement and any changes would have to be negotiated with Seton.

The amendment to the lease agreement as drafted by staff runs 22 pages and is available on-line at http://www.ci.austin.tx.us/news/brack/ .

Multi-county task force still mulling idea

Even the controversy over the Brackenridge Hospital lease may not be enough to move local leaders to seriously consider the concept of a multi-county hospital district. The idea of the hospital district surfaced more than 20 years ago and, more recently, when former Mayor Kirk Watson formed a multi-county task force on health care last year. Yesterday, City Council members discussed the concept of a health care district or multi-county hospital district during the work session on the Brackenridge contract with Seton.

Short term, the city has held on to its hospital contract with Seton because Seton is the only non-profit in the region willing to share the cost of indigent health care, says assistant city manager Betty Dunkerley. Long term, however, city leaders will be forced to address the millions of health care dollars Austin now picks up on behalf of outlying counties.

“Right now we’re hard pressed to find someone who will do what Seton has done for us,” Dunkerley said. “That’s why we’ve been willing to work around the ancillary issues.” Long term, the money Austin kicks into indigent health care continues to increase. And, as Council Member Daryl Slusher pointed out, city residents are even covering the majority of the tab on the money that Travis County contributes to care at Brackenridge Hospital.

Austin still remains one of the few major metropolitan areas in Texas without a separate health care district to handle the cost of indigent health care, City Manager Jesus Garza told the Council yesterday. In the meantime, surrounding counties have provided the minimum on health care services to the poor, leaving the cost of acute and trauma care for the 11-county region to Brackenridge Hospital.

Council members expressed a variety of opinions on the issue. Council Member Danny Thomas said he was open to discussing the concept of a hospital district. Council Member Beverly Griffith said a hospital district may be relevant, but not in the context of a discussion about a 30-year lease to Seton. She’s more interested in looking at other health care providers.

Mayor Pro Tem Jackie Goodman was among the minority that pushed for a hospital authority in 1995, but said the combination of bad management, high deficits and low returns on Medicare claims killed the idea. Even as the city signed the contract with Seton, Goodman said, she had concerns about some of the possible problems that could arise—problems like those the city is facing right now.

The bigger opposition to a hospital district, however, may come from outlying counties’ unwillingness to split the bill. As attorney John Boehm of Fulbright & Jaworski explained to the Council, Travis County could agree to create a countywide hospital district to be governed by a board appointed by county commissioners. Garza expressed some doubt at the support for that, given the fact commissioners had so quickly yanked $1 million in funding for the Del Valle rural health clinic when the City of Austin decided to annex the area into the city.

The county could also create a health care district or a multi-county hospital district, Boehm said. The health care district would be a cooperative, where participating governmental agencies could agree to underwrite the cost of health care. A hospital district could be formed under Chapter 286 of the Texas Health and Safety Code if 100 registered voters of each county petitioned for a hospital district election, Boehm said. A majority of the voters in each county would have to approve participation in the hospital district. The hospital could be underwritten with property taxes, sales taxes or both. The sole purpose of the hospital district would be to serve the medically indigent. It could also, at some point, take over the management of Brackenridge Hospital on behalf of the city.

Dunkerley is hopeful the multi-county task force might come to its own conclusion that it’s time for the outlying counties using Brackenridge to pay their fair share of the cost.

Anderson Mill Road, Southeast Metro Park among top priorities

Travis County staff told Commissioners this week that high profile projects approved under the recent Travis County bond issue—sections of Anderson Mill Road and the Southeast Metropolitan Park—will be some of the first to be completed.

The $185 million in projects approved by county voters in November are expected to roll out over the next five years. Popularity or importance did not determine the completion order of projects. Instead, county leaders chose to prioritize those projects where engineering design and right-of-way acquisition is already underway.

Pct. 2 Commissioner Karen Sonleitner said she was pleased by the order of the projects in the preliminary plan. For Sonleitner, that means the design of Anderson Mill from Spicewood to RR 620, Cypress to FM 1431 and FM 2769 to Cypress this fiscal year.

“The stacking of the projects is based on which things had a lot of preliminary work done. Those projects that had already gotten preliminary engineering were stacked sooner,” Sonleitner said. “The four commissioners, I think, felt this schedule met their needs and their priorities, and I’m quite thrilled to get Anderson Mill underway.”

What complicates the issue somewhat for Sonleitner is that Anderson Mill is no longer in her precinct, which was redrawn under redistricting. Sonleitner is now in Precinct 2. Anderson Mill is in Precinct 3. But commissioners have agreed to share oversight of the projects, which continue to be bundled under “old” precinct lines.

That means that cost savings on projects will be shared with projects in the former precinct, Sonleitner said. If cost savings are realized on Anderson Mill Road, that money will be moved to other projects in the former Precinct 3. Both Sonleitner and Pct. 3 Commissioner Margaret Moore will attend neighborhood meetings on the Anderson Mill project when those meetings are scheduled next month. Travis County will issue almost $25 million in bonds this year, $15 million next year, $23 million the following year, $12 million in 2005, $8 million in 2006 and $4 million in 2007. That does not include the $100 million needed for right-of-way acquisition for SH 45, SH 130 and FM 1826.

Pct. 4 Commissioner Margaret Gomez was also pleased with the order of projects. The second phase of Southeast Park is a priority for the precinct, as well as the Perkins/Mozelle drainage project. Design and field studies for the drainage project were approved under the 1997 bond issue—the 2001 bond issue provided the funding to complete construction. “We’ve had these drainage needs identified for years now,” Gomez said. “All we were waiting for was the money from this bond election to go ahead and do the work.”

Moore too was happy with the project order. She called the Anderson Mill project “one of our highest priorities,” but was also pleased with the site selection for Southwest Metro Park. No recreational parks are located in the precinct. The improvements to Westbank Road up to Westlake High School also are an important safety concern for the precinct, Moore said. “I would say these projects are prioritized just as I would prioritize them,” Moore said. Commissioner Ron Davis was out of his office and could not be reached for comment.

How ‘bout them cowboys? . . Council Member Will Wynn skewered the Dallas Cowboys’ organization yesterday with a three-page analysis of the team’s proposal that the city construct a new training camp, plus two NFL regulation-sized football fields and kick in up to $500,000 for food, lodging and other expenses. While pointing out that it might be a major source of revenue to certain sectors of the Austin economy, namely the hospitality industry, a projection based on 1997 attendance at the camp showed a return of less than $780,000. City tax revenue generated by tourists and day trippers to the camp from 1997 was only about $60,000. So, Wynn writes, “I strongly discourage this investment and recommend that the city respond accordingly to the Cowboys proposal.” Council Member Beverly Griffith, who disagrees with Wynn on many issues, heartily agreed. She told In Fact Daily, “People were outraged about their proposal.” Come back with a painless plan, boys, or enjoy that West Texas heat . . . Study for sobriety center . . .The Austin Travis County Mental Health Mental Retardation Center will have a press conference at 9:30am today to announce formation of a team to develop and make recommendations on the implementation of a Sobriety Center for Austin. The press conference will be at the 15th Street entrance to Brackenridge Hospital. Preliminary research indicates an Austin sobriety center should have between 20 and 30 beds . . . Hyde Park again . . . The continuing battle between the Hyde Park neighborhood and the Hyde Park Baptist Church is scheduled for its final vote today. It is just barely possible the two sides will reach agreement or agree to continue talking. Otherwise, the Council will have to choose between the desires of the parties . . . Regional Visioning Funding . . . The Council is scheduled today to consider funding the new five-county transportation planning mechanism called the Regional Visioning Project from funds previously set aside for Congress Avenue Bridge. The $925,000 from Capital Metro was to be used for improvements on the bridge, but cannot be done without matching funds from a federal TEA-21 grant. The city lost out on the federal portion and would like to shift the money to the new group . . . Time Warner still a monopoly? . . That’s what the city thinks. The cable company has asked the FCC to determine that there is enough competition in the Austin area to allow Time Warner to stop providing certain services. The city is opposing Time Warner’s request.

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