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Hospital flees patients By Erica Black Grubb San Antonio Good community organizers know that letting a hot issue get to court is risky. Too often a lawsuit allows attorneys to shift the focus from human needs to legal arguments, killing off grassroots activism. On rare occasions, though, litigation may be the only tool left to a community group. And if it is wellcrafted and sensitively handled, a lawsuit can complement rather than eclipse the community’s battle. The case of Guerra v. Bexar County Hospital District, which was decided on February 11 by U.S. District Judge Adrian Spears in San Antonio, is a good exampleeven though the community group lost the suit. It was a challenge by low-income Mexican-American and black women to the impending move of inpatient maternity and nursery services from the inner-city Robert B. Green Hospital \(known as “the Green” to San Hospital. The women filed the case in December 1978 after community organizing and political action failed to change the hospital district’s relocation plan. They claimed the move to the suburbs discriminated against the low-income minority population that the public hospital district is supposed to serve. Putting obstetrical and newborn services so far away from their neighborhoods would have disastrous health consequences, they said. The women also charged that the plan broke a host of promises the hospital district made to the community when it first opened Bexar County Hospital 11 years agopromises that the Green’s inpatient services would be preserved at all costs. The city of San Antonio and various health organizations joined the case on the side of the women, and all claimed that the hospital district’s action violated the U.S. Constitution, the 1964 federal Civil Rights Act, and the Texas Civil Rights Act. The Justice Department filed a companion case, alleging that the hospital district was violating the federal Revenue Sharing Act. Although Judge Spears ruled against the plaintiffs as soon as he’d heard the closing arguments, community involvement remained high throughout the three-week trial, and neither the legal maneuvers nor the institutional coplaintiffs overshadowed the plight of the low-income women. More than a dozen testified during the first two days of trial. They were typical members of the Green’s patient population, which is 80 percent Mexican-American and 7 percent black. The 1978 median income for this population was only $379 per month, and families are lucky if one member secures work at the minimum wage. Most of the women plaintiffs have difficulty reading and writing in English, and even those who speak Spanish cannot read and write it. One of the plaintiffs dropped out of school in third grade when her mother died, and another dropped out after sixth grade to get married. Such women are not frequently parties in federal court proceedings. Seven of the 15 who were slated to testify had not owned a dress for years and were bound to break an unwritten rule that all women must wear dresses in San Antonio’s federal court. Their legal aid attorneys made, a formal motion to waive the rule for all these low-income plaintiffs, but Judge Spears would only do so if the lawyers certified in writing that each woman, after making good-faith efforts, had been unable to borrow a dress. The picture the women painted was one of brake failures, flat tires, and vehicles borrowed barely in time to get to the hospital when they are in labor problems with which they already contend in using the Green. They also spoke of what would happen if they had to travel an additional 11 miles to Bexar County Hospital: more births en route, unattended by a physician .; more births at home, for sheer lack of transportation to the northwest suburbs; fewer visits from friends and relatives of those who could manage to have their babies in the hospital. The strongest message was that many women in labor just could not use Bexar County Hospital. They would still turn up at the Green’s emergency room \(which will remain open but will not be fit to provide even routine maternity parteras birth. This prospect led plaintiffs’ witness Dr. Sheldon B. Korones, professor of pediatrics and director of newborn service at the University of Tennessee, to conclude that “the incidence of perinatal misadventures will increase significantly.” Translated, this means that there will be more complications for both mothers and infants, in a patient population already at risk because of its poverty. Despite the plaintiffs’ eloquent presentationwhich Judge Spears acknowledged to be among the best he had ever seenSpears concluded that the hospital district’s decisions “have been dictated by . . . the best interest of the indigent and all other patients . . . with no intent whatever to discriminate. . . .” The judge totally accepted the district’s explanation that the modern, spacious, and technologically advanced facilities at Bexar County Hospital outstrip what is available at the Green. Unfortunately, testimony from the other side may have buttressed his conclusion, for the women plaintiffs conceded on cross-examination that Bexar County Hospital is “bigger the Green. But this testimony did not simply slip out by mistake. The plaintiffs tried to show that the hospital district intended for the Green to fall into disrepair. They argued that the district’s neglect of the inner-city hospital caused its current deficiencies and was in fact part of a pattern of discrimination against lowincome minority patients. The women also denounced the way the district eased its relocation plan through obscure official channels, failing to give realistic notice to the community when the plan was at the proposal stage. But the district claimed that its small, fine-print announcement in the legal notices section of San Antonio papers is all that the law required. It is not surprising that patients, community representatives, and sympathetic elected officials never saw the notices and never registered opposition at a “public hearing” before the Texas Health Facilities Commission in Austin. After all, they were still relying on the hospital district’s earlier assurances that inpatient obstetrical and nursery services would remain at the Green. \(More telling, perhaps, was testimony from San Antonio attorney George Korbel that he did read the notice at the time it was published but did not understand its turgid wording to mean that maternity and newborn services at the Green would be In any event, Judge Spears took the view that the tiny notices were legally sufficient. And he accepted the district’s tale that budgetary constraints justified allowing the Green to deteriorate, even though the plaintiffs’ medical and engineering witnesses testified that it THE TEXAS OBSERVER 9