How a community cares for the sick and those in need is often complicated. The idealistic hopes and moral questions are mixed with cold financial realities. In the end, it becomes a question of saving lives. Into that mix, Austin’s Brackenridge Hospital, one of the most respected public hospitals in Texas, was born.

Austin went for many years after its founding without a public hospital, meaning that residents with little money often had nowhere to go when faced with life-threatening conditions. The plan for a hospital came as the capital was being moved from Houston to Austin in 1839. Edwin Waller, a surveyor, set aside a city block in what is now the downtown area for a hospital. However, it failed to materialize. Political fights at the state and local level pushed the issue off the political radar screen for years.

After the Civil War, city leaders began discussing the need for a hospital as city leaders pushed to improve the image of the city. By the 1880s, Austin was the only state capital in the nation without a public hospital. A series of epidemics that had ravaged the area only heightened the need for a hospital.

City leaders and Travis County officials began working to raise money for the project. On July 3, 1884, a new two-story, 20-bed facility opened in the downtown area, initially called the City-County Hospital. In 1907, Travis County withdrew its support for the hospital, which simply became called City Hospital for the next several years.

Dr. Robert Brackenridge came to serve of the board of trustees near this time. Brackenridge was a Confederate veteran who became a physician after the war. After his arrival in Austin in 1874, he became a banker and eventually president of the Frontier Telephone and Telegraph Co. as well as president of the Austin Bible Society. Seeing the need for an expanded hospital, he quickly organized financial and electoral support for a bond issue in 1912 to build a new, larger building. With his support, the bond passed.

The new 45-bed hospital was completed in 1915. That year, trustees organized the city’s first nursing school, giving them a direct learning experience with patient care.

In 1929, 11 years after the death of Dr. Brackenridge, the hospital was renamed for him, and the hospital continued to expand.

After World War II, Brackenridge reorganized as a teaching hospital, a training center for young doctors and nurses. With this change, the hospital became a more state-of-the-art facility. The first open heart operations and the first kidney transplants in Central Texas were performed at the hospital. An intensive care unit opened in 1960, followed by a cardiac care facility a decade later.

Modern medicine was increasingly expensive and few middle-and lower-income residents had health insurance to offset the costs. Additionally, an increasing number of University of Texas students used the hospital — students who often did not have insurance themselves. The hospital gradually expanded to nearly 400 beds to meet these needs with a new $43 million building in the 1970s. As Brackenridge was the only facility available for these residents, they came to the hospital in increasing numbers, overwhelming its resources. The city was shocked when the hospital ran a deficit of $6 million in the 1975-76 fiscal year. Controversy surrounded the hospital’s management, and the prospect of turning over control to an outside management group was raised.

By the 1980s, Austin Community College took direct control of the nursing school and the hospital operated a separate 82-bed children’s hospital. However, financial problems continued to bedevil the hospital. The hospital saw an average of 70,000 patients at the emergency room each year by the early 1990s. In 1995, Brackenridge lost $21 million, and city leaders turned over management of Brackenridge to Seton Healthcare Family. Seton had begun as a Roman Catholic charity hospital in Austin in 1902, and the financial situation for Brackenridge stabilized.

Brackenridge expanded into several different facilities across Austin. In 2011, Seton entered into a partnership with the University of Texas system to expand medical offering and medical education at Brackenridge. Today, it is one of the few top-level trauma centers in the state.

Ken Bridges is a Texas native, writer and history professor. He can be reached at drkenbridges@