A national nonprofit that advocates for church-state separation is challenging an agreement involving the public Central Health hospital district, the University of Texas and the Catholic Church-affiliated Seton Healthcare Family.
Three lawyers with Americans United for Separation of Church and State sent a letter to Central Health board members and UT President Bill Powers saying that a Central Health-Seton master agreement is unconstitutional because of religious restrictions on some Seton hospital services, such as sterilizations. They asked that the agreement be reworked or scrapped.
Although the letter doesn’t mention a lawsuit, one could follow if Americans United is unable to resolve its concerns, said Ian Smith, one of the lawyers who signed the letter.
Officials with Central Health, Seton and UT, which intends to open a medical school in 2016, defended their plans and said the community would continue to receive Catholic-banned services at locations not owned by Seton.
The agreement deepens the Central Health-Seton partnership by creating a nonprofit collaborative that they jointly run. It says that Seton cannot be put into a position of violating the Catholic Church’s Ethical and Religious Directives — either through the collaborative or in a new $295 million teaching hospital it is planning for UT medical students and new doctors called residents.
That gives Seton unconstitutional authority to “determine what services the collaborative will and will not perform,” the July 9 letter says.
“Although courts have approved the allocation of government funds to certain religious hospitals, they have emphasized that the care provided by those hospitals was not controlled by religious authorities and did not discriminate based on religious teachings,” the letter says. “Central Health can contract with Seton to provide secular services, but it cannot bind itself or any other government entity to comply with religious dogma.” Doing so, the letter says, violates the Constitution’s First Amendment Establishment Clause, which forbids government entities to establish an official religion or unduly favor one religion over another.
Officials with Central Health, UT and Seton told the Statesman that religious directives will not dictate health care services or interfere with medical schooling and training. Services such as sterilizations will continue to be provided to Central Health patients by St. David’s Medical Center, which started doing them last year.
“The master agreement clearly states that Central Health retains the unilateral right in its sole and exclusive direction to make decisions including, ‘approval, support and funding of women’s health projects, or other projects … that Seton cannot participate in,’ ” a Central Health statement says.
“Seton has been a trusted safety net partner in this community for nearly 20 years,” it continues. “Under the Community Care Collaborative, nothing has changed with regard to our service delivery partners. Moving forward, Central Health will continue to fund its network of providers including Seton, St. David’s, Lone Star Circle of Care, Planned Parenthood and others to ensure that our residents receive the full range of services and care they need and deserve.”
Asked if the letter means Americans United is planning to sue, Smith said, “The goal of letters like this is to head off lawsuits.” Central Health and UT are being asked to respond within 30 days, and if changes are not made and discussions fail, “I will pass the relevant information up to the litigation department,” he said.
Seton has operated the publicly owned safety net hospital, University Medical Center Brackenridge, since 1995, first under a lease with the city. It did not take the Vatican long to raise concerns about sterilizations and order that they be stopped. The city responded by hiring a private company to perform the procedures, but the Vatican was not satisfied.
Ultimately, in March 2004, the city opened a “hospital within a hospital” inside Brackenridge that was operated by the UT Medical Branch at Galveston. After that hospital closed last year, the sterilization service moved to St. David’s.
Smith said he could not speculate on why Americans United had not objected sooner.
Bob Ozer, an activist and a retired lawyer in Austin who has criticized the plan to limit reproductive health services at a government-sanctioned teaching hospital, applauded the involvement of Americans United.
“This is a really prominent organization, and they have a lot of credibility,” Ozer said Wednesday. “They are here to protect our freedoms. It is very significant that they would come in and raise these issues.”
Americans United’s letter cites a 1982 U.S. Supreme Court ruling in a case called Larkin v. Grendel’s Den Inc. In that case, the court held as unconstitutional a Massachusetts law that granted churches the power to reject nearby establishments’ liquor license applications, a power normally vested in government agencies.
In the same way, the Seton-Central Health agreement unconstitutionally delegates governmental authority to Seton, Americans United says. As for UT’s involvement, any agreement “that forces its medical students and employees to conform to religious dogma while at the proposed teaching hospital” violates the Constitution, the group contends.
Robert Cullick, a spokesman for UT, said in an emailed statement that the university has aligned itself with Central Health and Seton in the creation of the Dell Medical School and sees no problem with the arrangement. University lawyers will evaluate the legal questions raised in the letter, he said.
“The Dell Medical School will train students in accord with a curriculum approved by the organization that oversees medical education in North America, the Liaison Committee on Medical Education,” Cullick said. “They will get those training opportunities at UT facilities, at the new teaching hospital or elsewhere in the Austin area. Religious directives governing the new teaching hospital will not be an obstacle to the comprehensive education of medical students at UT-Austin.”
He added, “UT-Austin does not express any religious preference by partnering with Seton. Affiliations with religious organizations to provide health care training are common.”
Seton executive Greg Hartman said, “There’s nothing in the agreement that stops UT or Central Health from doing anything they need to do. … If there is a time when we can’t provide certain services, they can work with other providers to meet those needs.”
Smith contends that doesn’t matter.
“When UT sends its professors and its students into the hospital, they will have to comply with Catholic religious doctrine to practice medicine in that hospital,” he said. “Any claim they can go elsewhere doesn’t change the central problem.”