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Construction Syndrome

The Coming of A Hospital

John W. Tomac Illustration

ur military has a toolbox of formidable weapons. Two atomic bombs helped end World War II. Sixty years later the U.S. Army Corps of Engineers flooded more square miles in New Orleans than area destroyed by both bombs in Japan. The Corps’ domestic weapons of mass destruction were their poorly designed and defectively constructed levees and shipping channels.

After the military makes a mess, they often ride in on white horses to clean it up. A newly christened U.S. Navy hospital ship sailed into the Nagasaki harbor just over a month after the bombing. James A. Knight was a chaplain on that ship. After his navy hitch, he attended medical school, became a psychiatrist and served as a beloved dean of admissions at Tulane Medical School.

All this comes to mind because Knight’s hospital ship took on surviving prisoners-of-war in about the same timeframe as it took to get electricity restored to the un-flooded French Quarter. Fortunately, a speedier military presence played an integral part in reclaiming New Orleans from forces of human destruction and ruin. The military assistance began with Coast Guard rooftop rescues followed by Army troops to restore order and a Navy hospital ship.

Through every disease outbreak and during every storm and hurricane that came our way, Charity Hospital never closed. The Daughters of Charity ran it for over 200 years. Its imposing Art Deco structure on Tulane Avenue opened with no-lock doors in 1939.

State and federal funds fueled Charity Hospital, and that tank often ran nearly empty. Various state administrative divisions operated it over the past few decades. The state transferred operational leadership to the LSU Health Sciences Center in 1997. Eight years later, LSU used the excuse of a mid-level Category 3 hurricane and a flood to shutter Charity forever.

Military troops along with scores of volunteers pumped the water out of the basement and had the lower floors of Charity clean and “medically ready” to open within weeks after floodwaters receded. LSU put the hiatus on those plans, hired guards to seal the entrances and refused to discuss reopening. Evil operatives slipped past those guards stopping up sinks and turning on water pickets on high floors, flooding the hospital from top to bottom while also wrecking the newly cleaned and stocked patient areas. Even though a team of nationally acclaimed architects later certified the structure as sound and suitable for the build out of a state-of the-art medical center, Charity Hospital was the only major downtown building that never reopened after the flood.

The unfettered trashing of Charity’s hallowed interior after the Army cleanup was more than criminal. It was immoral. The beloved Big Charity, ratty around the edges from state caretaker neglect, became a ticket for a new digs. It is an old story of building something new rather than maintaining and treasuring what you have. “In the story of Charity Hospital, the primary culprit is clear: LSU,” wrote urbanist Roberta Gratz in her acclaimed book We’re Still Here Ya Bastards published earlier this year by Nation Books.

The Huey Long-inspired Charity Hospital opened with 2,700 beds on a few square blocks. The builders for the new complex cleared homes and businesses from 67 acres in lower Mid-City. If fully bedded, the new University and VA hospitals will have a quarter of the beds once in operation inside the Big Charity.  

Fortunately, word did get to state politicos that the tin gods who pulled off this boondoggle just might not have the skill set to run a hospital. The LSU system was displaced from their leadership role, and the state has an operating contract with LCMC, the board that started as Children’s Hospital and now owns Touro.

The vast and misbegotten new public hospital opens this month. It was built for 446 beds, but initially will open just over 50 percent of that. The operators arranged pre-opening Cook’s tours for selected groups and individuals. The accolades for this new facility are non-stop. Press reports refer to its “W Hotel look,” with courtyards, fountains and art. The emergency room alone stretches the length of a football field.

“Building bricks and mortar will not achieve excellency,” said Dr. William LaCorte, an internist who specializes in geriatrics and is a keen observer of the local medical scene. “In the old days at Tulane, Dr. George Burch would send his top residents off to prestigious training programs across the country and then lure them back to New Orleans with top-notch faculty appointments and responsibilities.

“Patient flow follows expertise, not the buildings. I’m afraid that Jindal and LSU spent all their money on bricks and mortar leaving no money to attract top providers and their support staffs. Their entire focus was on the building.”

“Every state has at least one university hospital. Louisiana had only Charity. We lost that,” said Dr. Norman McSwain, a surgeon specializing in trauma care, following the screening of the documentary Big Charity (BigCharityFilm.com). This film is a must-see for anyone interested in the high level malversations of university officials who hoodwinked elected leaders including Kathleen Blanco and Mary Landrieu, who twisted FEMA’s arm into writing an enabling check.


Questions While Waiting

On the debut of the mammoth University Medical Center, I peeled away the mirliton vines encasing my crystal ball. Please join the discussion online.

Does New Orleans have the support staff for additional hospital beds? Nurses are just the tip of the iceberg. Hospitals need certified respiratory therapists, physical therapists, social workers, nutritionists, laboratory technologists, operating room personnel and pharmacists. Available state funding will allow the opening of just a fraction of the available space in the new facility. Current state employees will likely fill most positions initially, but they lose their civil service status under the new operations agreement.

Are their enough physicians? In most teaching hospitals the worker bees are the interns and residents in training. Opening limited beds to start will not overly tax that system. Most topnotch teaching faculty do not make their income from patient billings. It will be difficult to recruit seasoned clinicians likely to attract private pay patient given the state’s financial crisis.

So what else happens when the new VA hospital opens? While our established hospitals are not worried about University attracting established employees, the VA opening will unleash new federal monies. A competition for key employees can escalate into salary wars, a situation that hospitals in the New Orleans area have quietly avoided to date. The VA hospital is also least likely to suffer from physician staffing shortages. Physicians at both LSU and Tulane have always drooled over lucrative part-time clinical appointments at the VA.

What is the impact of these new hospitals on the Tulane Hospital? Admissions to the Tulane Hospital will fall. Tulane will lose some indigent admissions. So-called no-pay patients remain lucrative for hospitals, but the massive federal kickbacks to hospitals for uninsured care are being shifted to fund Obama Care. When Tulane reopened after the flood. The VA Hospital opening will cause the Tulane census to plummet.

Will the Tulane Hospital survive downtown or will its owners move it elsewhere? Portions of Tulane including all its obstetrics and pediatrics have already moved to HCA’s hospital in Jefferson Parish. Is another shifting of Tulane beds to the Northshore in the future? My crystal ball lacks the power to even guess what road Tulane will take.
 

Editors Notes: In July, the city asked for bids for the redevelopment of the former Charity Hospital building. While a winner has not been announced yet, early indications are that among several interested parties the bids will likely favor a mixed use, office and residential, concept.
New Orleans Magazine was one of the few media organizations to openly endorse the new hospital complex proposal. Dr. Lutz raises some very important and valid points and we respect his right to express them. We stand by our position.

 

 

 

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