Critics wary of Catholic teaching hospital for new UT medical school
Plans to establish a medical school at the University of Texas and train its students at a Catholic-owned teaching hospital have rekindled debate over public health care services for women and the impact of Vatican rules against birth control.
Local health and university officials said they don’t see a problem with a partnership between UT, the Seton Healthcare Family and Central Health, Travis County’s hospital district. Services for women will continue to be offered in the same way they are being provided now, officials said.
But critics in Austin and elsewhere are concerned about the relationship between public bodies and a religious organization, along with the extent of training that medical students and recently minted doctors will get.
Controversy over women’s reproductive services has surfaced periodically since 1995, when Catholic-owned Seton agreed to start running Brackenridge Hospital, the oldest public hospital in Texas and the region’s highest-level trauma center. Over the years, religious strictures required certain medical services, such as voluntary sterilizations, to be increasingly segregated — and eventually outsourced beyond the hospital’s walls.
Now, under a plan whose details are being negotiated behind closed doors, Seton would pay for, own and operate a $250 million replacement hospital for the cramped and outdated facility. It will be the main clinical setting where UT-Austin medical students and residents — new doctors in training — learn to practice. And, though the land beneath it will still belong to taxpayers, public ownership of the hospital that has served poor and rich alike for 128 years will end.
University officials said Friday they didn’t know of another public medical school whose primary teaching hospital is Catholic.
Central Health, a public entity, along with the women it serves and doctors it works with, already has had to jump through hoops to accommodate the church, said Meghan Smith, domestic program associate for Catholics for Choice, which supports women’s access to contraception and abortion.
Ian Smith, a lawyer with Americans United for Separation of Church and State, said future doctors will have to jump through similar hoops. “You have the University of Texas sending public school students to a hospital where … they have to tell their students they are bound by Catholic religious doctrine,” he said.
But backers of Proposition 1 — the voter-approved property tax increase that will help pay for the medical school, the teaching hospital site and health care for indigent people — see a partnership that respects patients’ rights and offers full training for doctors while honoring Catholic doctrine. That’s already the case, they say: Third- and fourth-year students from the UT Medical Branch at Galveston, known as UTMB, and residents under the auspices of the UT Southwestern Medical Center in Dallas receive most of their clinical instruction at UMC Brackenridge but go elsewhere in Austin to learn procedures the Vatican forbids, such as sterilizations and abortions.
“Seton has long understood that increasing access to great health care for all requires cooperation with non-Catholic organizations, and that tradition of cooperation will continue with the new UT medical school,” said Greg Hartman, a Seton executive who is president and CEO of UMC Brackenridge.
Until this year, voluntary sterilizations, or tubal ligations, took place on the fifth floor of UMC Brackenridge at a “hospital within a hospital” operated by UTMB. When UTMB closed the facility in February because of financial losses, those procedures and the associated training moved a mile north of the Brackenridge complex to St. David’s Medical Center under a contract with Central Health, which oversees care for low-income and uninsured Travis County residents.
Training on abortions is available to medical residents at Planned Parenthood clinics, said Patricia Young Brown, president and CEO of Central Health. The arrangements with Planned Parenthood and St. David’s are expected to continue after the medical school opens in 2015 or 2016, officials said.
“I think it’s an issue we need to pay attention to and hold Central Health accountable for, but I am confident they are aware of that,” said Regina Rogoff, CEO of People’s Community Clinic, which serves poor and uninsured patients.
Juggling public health, religion
Seton, the largest hospital system in Central Texas, was founded by the Daughters of Charity and is part of the Roman Catholic Church-affiliated Ascension Health, the nation’s largest nonprofit health system.
Seton spends $45 million a year to train about 220 residents sponsored by UT Southwestern. Seton plans to increase its spending to cover 300 to 350 residents during the next few years. Once the new medical school is operational, UT Southwestern residents will become UT-Austin residents, and incoming residents will also be sponsored by the Austin flagship, said Sue Cox, UT Southwestern’s regional dean for Austin programs.
Under its agreement with UT Southwestern, Seton pays residents $52,000 to $60,000 a year, plus benefits, to work in a hospital, Hartman said. But he added that when they perform procedures at St. David’s, the agreement “actually states that the resident is under the auspices of UT Southwestern and UT Southwestern is covering that cost — a protection to make sure we don’t violate those (Catholic) directives.”
A similar arrangement is expected to be worked out with UT-Austin.
“We recognize there may be things they have to learn in order to receive their medical education,” Hartman said. “We’re not paying for the procedure — we’re paying for their time as a resident or faculty member.”
Such juggling of public health care responsibilities with religious restrictions has grown more complex at UMC Brackenridge over the years.
By the time Seton agreed to operate Brackenridge in 1995, elective abortions were no longer done at the hospital. But voluntary sterilizations were, prompting the Vatican to send several letters to then-Bishop John McCarthy of the Diocese of Austin, instructing him to end the practice. Seton contracted with a private company to perform the procedures at the hospital without using Seton employees.
Ultimately that didn’t satisfy the Vatican’s point person, Cardinal Joseph Ratzinger, who is now the pope. Finally, the Austin City Council approved the creation of the “hospital within a hospital” for maternity and contraceptive services, including sterilizations. Called the Austin Women’s Hospital, it opened in 2004 with its own elevator entrance, procedure rooms, computer network and staff.
An analysis of sterilization practices within various Catholic hospital systems based on 2007-2009 data from the National Center for Health Statistics found that 45 percent of the women who had babies at UMC Brackenridge did so in the fifth-floor women’s hospital, and nearly one-third of those — 1,514 — had tubal ligations after giving birth. That was more tubal ligations than took place in any Catholic-run hospital in Texas during that time frame, according to the dissertation by Sandra Hapenney, who has a doctorate in church-state studies from Baylor University.
Bob Ozer, an activist and retired lawyer in Austin, said that outsourcing those procedures to St. David’s is an echo of “separate but equal” segregated treatment.
“You couldn’t tell blacks they have to go over to St. David’s because they’re black, but here women want to exercise rights to reproductive health care guaranteed by the Constitution and they’re being sent over to another health care provider,” Ozer said. “It’s problematic to have this kind of segregated system that’s segregated just to accommodate the Catholic Church.”
Christina Sebestyen, an obstetrician-gynecologist on the staff of St. David’s, said she hasn’t seen problems with the current arrangement and isn’t anticipating any with the new plans.
“Having a medical school here in Austin will be beneficial to women’s health and, I think, beneficial to all” residents of Central Texas, Sebestyen said, no matter where the training takes place. “Going to multiple facilities, you learn how to do things in multiple different ways. That broadens their clinical knowledge.”
Lori Stafford, a fourth-year UT Southwestern resident in obstetrics-gynecology, said tending to patients who need sterilizations and other care prohibited by Catholic directives was easier when the Austin Women’s Hospital was in UMC Brackenridge. “It was just an elevator ride away,” she said.
Now medical residents must drive to St. David’s Medical Center and other sites to provide such services. Despite that inconvenience, the residency program provides “an excellent training experience,” she said.
St. David’s HealthCare opposed Proposition 1, calling the flow of money to support the medical school “a shell game.” Nonetheless, it intends to continue cooperating with Central Health and Seton to train residents after the medical school opens, Senior Vice President Mark Clayton said.
“The national standard for graduate medical education is very prescriptive,” Seton’s Hartman said, “and the standard of care that has to be taught is very robust. We live within those rules and will continue to live within those rules.”
‘Don’t ask, don’t tell’
Hospital mergers and health care reform have accelerated conflicts across the country between Catholic doctrine and public health care. In the Pacific Northwest, Swedish Health Services stopped offering elective abortions after teaming up with Providence Health & Services, one of the nation’s largest Catholic systems, according to the Seattle Times. In San Francisco, Catholic Healthcare West severed formal ties to the church and changed its name to Dignity Health to help the hospital system’s growth plans, its chief executive officer said in a news release. However, it broke off negotiations on its first acquisition, a community hospital in Oregon, after local concerns were voiced about Dignity’s restrictions regarding abortion and assisted suicide, the Associated Press reported.
Catholics for Choice, whose members disagree with the Vatican on sex, family life and other matters, said Austin’s situation most closely resembles one in Louisville, Ky. There, some local residents and lawmakers fought to kill a proposed merger between University Hospital and KentuckyOne Health, whose majority owner is Catholic Health Initiatives. Kentucky Gov. Steve Beshear refused to sign off on the merger because he didn’t want the public-owned hospital to become privately owned.
Earlier this month, though, Beshear approved an agreement in which KentuckyOne will operate the University Hospital but won’t own it. Women’s reproductive services will be provided in a new Center for Women and Infants, a part of the hospital that won’t be bound by Catholic religious directives. Louisville’s “hospital within a hospital” will continue to be operated by the public University Medical Center.
“It’s one ‘work around’ after another,” said Peter Hasselbacher, a physician and retired professor of medicine at the University of Louisville School of Medicine. “I call it ‘don’t ask, don’t tell’ medicine.”
Although women’s health is a major concern, so are end-of-life issues, Hasselbacher said. Catholic rules say that a living will — a directive on how much or how little treatment a person wants at the end of life — won’t be honored if it’s contrary to church teaching, which prohibits “euthanasia or assisted suicide in any way.”
But Seton officials said there is a mistaken impression that the Catholic Church requires patients to be kept alive against all odds. Instead, it “teaches that life-sustaining treatment can be withdrawn or withheld altogether under certain circumstances,” including artificially administered food and fluids when patients are near death, said Dave Belde, Seton’s vice president over mission and ethics.
Stem cell research, types of which can’t be done in a Catholic hospital under the Vatican’s rules, can take place elsewhere, said Kenneth Shine, executive vice chancellor for health affairs at the UT System, which oversees the Austin campus and 14 other academic and health campuses.
“Stem cell research can be conducted at a UT-Austin medical school in collaboration with a wide variety of institutions locally and nationally,” Shine said.
The school will ensure that students and residents receive training in the “full array of medical services,” said Steven Leslie, executive vice president and provost of UT-Austin. “Many medical schools operate in cooperation with Catholic hospitals, and they are fully accredited. The key is providing a complete menu of appropriate educational opportunities, as is our intention.”
Although Seton will be UT-Austin’s primary partner in training doctors and providing services, there will be other partners, Leslie said.
Indeed, it’s rare for a medical school to have just one clinical partner, said Barbara Barzansky, co-secretary of the Liaison Committee on Medical Education, which accredits medical schools. To meet the committee’s requirements for classroom and clinical training, schools must show that they have sufficient curriculum, clinical partners and other resources.
“You have to teach women’s health, you have to teach anatomy, you have to teach biochemistry” and a host of other subjects, but the details of classroom and clinical training “are essentially a school decision,” Barzansky said.
Perhaps a larger question is why a hospital receiving public money should operate under the Catholic Ethical and Religious Directives instead of complying with the public, secular policy on health care, which permits sterilizations and abortions.
“We have been disturbed all along that a public hospital district has allowed its hospital to operate in a way that conforms to Catholic doctrine,” said Lois Uttley, director of the New York-based MergerWatch Project, which seeks to protect patient services in religious/secular hospital mergers.
Religious freedom laws allow a hospital operator to exercise its theological convictions, said Ted Jelen, a professor of political science at the University of Nevada at Las Vegas and author of several books on church-state issues. “There’s no constitutional right to be racist — or rather, to act on that — but there is a constitutional right to free exercise of religion,” Jelen said.
Federal law since the 1970s has permitted medical providers to exercise “conscience rights,” meaning they aren’t required to provide abortions or sterilizations if doing so is contrary to their religious beliefs or moral convictions, said Douglas Laycock, a law professor at the University of Virginia who formerly taught at UT-Austin. What’s more, the U.S. Supreme Court ruled in 1989 that public hospitals aren’t required to perform abortions, he said.
“It’s not like they’re refusing to treat a certain class of patients,” Laycock said of Seton. “They’re refusing to provide a certain type of services. I don’t think there’s a constitutional problem.”
Seton’s Hartman said the Catholic Church, while following its teachings, “has a long tradition of doing what’s required for medical education. … Our goal will be to continue to walk that tightrope into the future.”
This article was originally published by the Austin American-Statesman.