Health Care

New Orleans is in the midst of a troubling public health crisis. Charity Hospital has historically served New Orleans' most vulnerable citizens and its continued closure further jeopardizes the city's uninsured population, stretches limited government services to the their breaking point, and puts unnecessary strain on the region's private hospitals and care providers. The current LSU/VA plan condemns the residents of New Orleans to years of inadequate medical resources while their proposed facility is built. Since Charity Hospital can be renovated at least four and a half years faster than the LSU/VA proposal for a new medical complex, the work of attracting top flight medical personnel to provide critical public health services can begin sooner by rebuilding Charity.

Below you will find a collection of articles pertaining to the preservation issue:

LSU's Cerise: "We're going to have to step back"

In a candid admission to the Appropriations Committee in Baton Rouge, the Associated Press reports that LSU Vice Chancellor Fred Cerise conceded that the proposed LSUAMC faced major hurdles and may have to be completely reexamined.

Just a week after LSU agreed to participate in the Department of Homeland Security's special arbitration process to determine whether the state has honestly represented the damages incurred at Charity Hospital during Katrina and how much the state should be reimbursed by the federal government, Cerise conceded that the entire project could be in jeopardy depending on the result.


"If we don't get the money from FEMA, then we're going to have step back and say, 'OK, now what is the plan? What can we iron out?'"

A lack of reimbursement money is not the only problem that could force LSU to reexamine their proposal and in fact, might an unfavorable arbitration decision could only serve as LSU's scapegoat for other hurdles threatening the viability of the controversial medical complex slated for Lower Mid-Cty.

Even if LSU gets every penny they've demanded, they will remain hundreds of millions of dollars short of the money they need to proceed with construction on the proposed $1.2 billion medical complex.

Because of the crippled credit market, uncertainty over how states will be reimbursed for medical costs after healthcare reform, and LSU's incomplete business plans, State Treasurer John Kennedy has consistently argued since last Spring that LSU stands little chance of impressing Wall Street enough to obtain the necessary loans.

The dispute between FEMA and state officials over the extent of the damages sustained at Charity Hospital during Hurricane Katrina could be resolved within months. State officials have claimed Charity Hospital was completely destroyed by the storm. FEMA has countered by pointing out that much of the damage claimed by state officials resulted from years of poor maintenance and the failure of the Department of Facility Planning and Control to properly secure the building since Katrina. Only the basement of Charity Hospital flooded after the failure of the levee system. Military and medical personnel quickly decontaminated parts of the building but work halted after state officials ordered the building closed. Pictures obtained by SaveCharityHospital.com demonstrate the condition of the building at that time and would seem to indicate that the state's case to the special arbitration panel appears tenuous at best.

Advocates for Charity Hospital and residents of Lower Mid-City maintain that LSU could build a state-of-the-art medical facility faster and for less capital than their current controversial proposal by building within the facade of historic Charity Hospital.

President Obama: VA Will Build Hospital Downtown

Just in case there was any lingering notion that by advocating for a smarter, cheaper, less destructive plan for new hospitals in New Orleans, one might be jeopardizing the VA hospital, President reiterated his commitment again during an appareance in New Orleans yesterday.

 

We remain committed to building a new VA medical center in downtown New Orleans so we can better serve and care for our veterans.

 

The only item left open to interpretation here is whether the President and the Department of Veterans Affaris might consider moving the VA Hospital to a site that is actually in downtown New Orleans and not on top of a residential community in Lower Mid-City.

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National Trust: Obama Team Can Use New Orleans Hospital Controversy as a Test Case

Obama Team Can Use New Orleans Hospital Controversy as a Test Case

Written by Jack Davis

New Orleanians meeting with President Obama Thursday will be asking, as usual, for more federal money – for hurricane protection, to keep Louisiana’s wetlands from vanishing, to make housing affordable. This fragile city, in its fifth year of recovery from Hurricane Katrina, has no shortage of urgent needs.

But one critical need already has ample federal money – more than $1 billion to support the construction of two major hospitals. The problem is that state and city officials are planning the hospitals so ineptly that patients, especially the poor patients who need them most, might not get inside for five or seven more years.

See the full piece after the jump or at PreservationNation

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New Orleans City Business fails to disclose important conflict of interest

For years, New Orleans City Business, a weekly publication in the metro area, has provided glowing editorial support for the proposed LSU/VA medical complex in spite of a broken process, numerous funding hurdles, and a series self-inflicted delays. However, it has failed to disclose to its readers a blatant conflict of interest involving its president and publisher, D. Mark Singletary.

Mr. Singletary has used his publication to laud LSU Medical School and the controversial LSU/VA medical complex. However, New Orleans City Business  neglects to mention that Mr. Singletary was named to the Board of the LSU Health Sciences Center Foundation, a major stakeholder in the proposed LSU/VA in December of 2006.

Though the paper reported on the appointment when it originally occurred, numerous commentaries published since then, some attributed directly to Mr. Singletary and others to the editorial board in general, have not remarked on the conflict. This is an unavoidable violation of the standards to which purportedly unbiased news organizations adhere.

Consider several examples.

One commentary by Mark Singletary from February, 2009, is called LSU/VA complex set for Mid-City - end of story.

Another from June of 2009 came after moves to protect Lower Mid-City homeowners and businesses from exproriation because of LSU's inability to produce a workable funding mechanism for construction and is called Delays for teaching hospital slow economic pulse.

This one is especially vitriolic and was published just days ago. It is not attributed to Singletary but to the editorial board in general, it would appear. It excoriates State Treasurer John Kennedy for pointing out, accurately, that LSU may be in trouble when it comes to raising money for their proposed medical center because it's operating model relies so heavily on DSH (disproportionate share hospital) funding, a revenue stream that will be eliminated if Congress passes healthcare reform legislation. Kennedy endorses the alternative plan that would build a new facility inside the facade of Charity Hospital because it is less expensive and can be brought online sooner. Kennedy argues this model would be more attractive to lenders because LSU would have have to carry less debt to construct the facility. For this, the City Business editorial says Kennedy's criticism "trashes" New Orleans.

Editorials are opinion pieces. There is nothing objectionable about Mr. Singletary expressing his opinion or publishing his analysis regarding the LSU/VA. However, it is fundamentally misleading when his commentaries are published without disclosing Mr. Singletary's relationship with a major stakeholder in the controversial medical center proposal. Without that conflict noted, readers are implicitly lead to believe that Mr. Singletary is an unbiased observer, which he clearly is not.

We have written to Mr. Singletary for a response and will post it in entirety should one arrive.

Public meeting called for Wednesday evening

On Wednesday, October 7th, at 6:30 PM, there will be a public meeting to discuss the status of several lawsuits affecting the potential destruction of Lower Mid-City to make way for the proposed LSU/VA medical center at Grace Episcopal Church, 3500 Canal St.

The event will feature speakers including Sheila Joseph of the Childrens' Defense Fund, Maureen Steffek of the Stop Cold Storage campaign, Leon Bradford of Lower Mid-City, and Thomas Milliner, a former city attorney who is among those leading a lawsuit against Mayor Nagin challenging the legality of the city's agreement to surrender private land in Lower Mid-City.

It is being co-sponsored by the Committee to Reopen Charity Hospital along with Holy Cross Neighborhood Association, Faubourg Marigny Improvement Association, United Teachers of New Orleans, New Orleans Pax Christi, National Lawyers Guild (Loyola Chapter), and the Social and Economic Rights Advocates (Tulane).

The lawsuit against Mayor Nagin, brought by residents of Lower Mid-City, argues that Mr. Nagin repeatedly violated City Charter in signing agreements offering Lower Mid-City for forced eviction without public hearings from or the approval of City Council and the City Planning Commission. For more background see here.

For even more context, check out our own analysis that contrasts how the law was followed as city leaders considered moving City Hall this past Spring but circumvented and ignored in the case of the controversial LSU/VA proposal.

State will go for secret special arbitration with FEMA on Charity Hospital

In the ongoing dispute over the extent to which Charity Hospital sustained damage during Hurricane Katrina, state officials have decided to use a special arbitration panel to adjudicate the matter instead of the traditional appeals process.

We here at SaveCharityHospital.com are supportive of efforts to speed up this final determination of FEMA's obligations to the city of New Orleans. This process, however, should be open to the public and inclusive of all stakeholders. Unfortunately, according to the Department of Homeland Security's press materials, it appears as though the special arbitration is being set up as a secret proceeding.

State officials have long maintained that Charity Hospital was completely destroyed by Hurricane Katrina, over the 50% threshold that would require FEMA to reimburse for the full cost of replacing the hospital. FEMA has disagreed, pointing out over the course of the appeals process to date that much of the damage claimed by Secretary Jerry Jones of the Department of Facilities Planning and Control, was caused by years of the state's own deferred maintenance and a failure to secure the building after the storm to prevent further deterioration.

Members of the group of medical and military personnel who helped clean and decontamine the first three floors of Charity Hospital in the weeks after the failure of the federal levee system have said that only the basement of the building flooded and witnessed it being pumped completely dry. This website obtained photographs of Charity Hospital taken after the cleanup, supporting up claims by members of the cleanup crew that the facility was ready to receive patients when state officials shuttered its doors. For instance, here's what the first floor Emergency Room looked liked on September 21st, 2005, three weeks after the storm:

And here's what the first floor Emergency Room looked like nearly four years later, on June 1st, 2009 when Congressman Cao visited Charity Hospital:

 

New Orleans residents filed a lawsuit against the State of Louisiana for the closure of Charity Hospital without the approval of the Legislature as required by law. Lawyers in that case filed an intervention in the original FEMA appeals process to ensure that relevant facts from the lawsuit would be heard.

It remains unclear whether or not parties on the intervention will be a party within the special arbitration process and the arbitration panel proceedings will be entirely closed to the public. Given the badly flawed processes behind the decision to close Charity Hospital in the first place and the largely unpopular decision to build an expensive and expansive medical complex on top of a struggling residential community since then, it is upsetting that federal officials have negotiated yet another closed-door setting in which yet another far-reaching decision will be handed down.

In related news, this Wednesday, October 7th, the Committee to Reopen Charity Hospital is co-sponsoring a special forum to update attendees about the current status of a few ongoing legal  challenges along with Holy Cross Neighborhood Association, Faubourg Marigny Improvement Association, United Teachers of New Orleans, New Orleans Pax Christi, National Lawyers Guild (Loyola Chapter), and the Social and Economic Rights Advocates (Tulane). The event begins at 6:30 PM and will be held at Grace Episcopal Church, 3500 Canal St.

State Treasurer John Kennedy offers a compromise to LSU on WWL Radio, LSU refuses to appear

Moments ago on Garland Robinette's show on WWL Radio, State Treasurer John Kennedy offered a compromise proposal to LSU administrators two days after his subcommittee on the Commission on Streamlining Government unanimously endorsed the FHL/RMJM alternative plan to gut and rebuild Charity Hospital over the stalled LSU/VA proposal.

Treasurer Kennedy's compromise offer involved using $100 million of the estimated $280 million saved by selecting the FHL/RMJM plan instead of the LSU/VA medical complex proposal to help LSU recruit top flight research and teaching talent to New Orleans.

Kennedy reiterated that it is not his intention to "fight" LSU but that he has growing concerns over whether the $1.2 billion LSU/VA medical center proposal will be able to cash flow if it is forced to take out a significant number of loans to complete construction. The Treasurer's concerns stem from the likelihood that the healthcare reform bill being debated in Congress will result in the elimination of Disproportionate Share Hospital (DSH) reimbursements, a revenue stream upon which the LSU business plan relies. (See yesterday's post)

Garland Robinette told listeners that LSU representatives declined invitations to appear on the show to have a discussion with Treasurer Kennedy about his proposal and his concerns regarding LSU's ability to finance their proposed medical facility.

Analysis: The Commission on Streamlining Government and Charity Hospital

Yesterday, a key subcommittee on the Commission for Streamlining Government unanimously approved a resolution endorsing the FHL/RMJM alternative plan to gut and rebuild Charity Hospital. The move signaled the first time in this running controversy over medical facilities that an official body has explicitly endorsed the alternative plan to build cutting edge facilities in less time, for less money, and without destroying a residential neighborhood.

This begs an important question: Why does the Commission for Streamlining Government, a body charged with the task of recommending areas of waste and inefficiency to eliminate or reform, care about the hospital controversy in New Orleans?

Though the details are complicated, the core answer to that question is quite simple. Burdened by a tight economy and a voter mandate to improve state governance, the Commission for Streamlining Government was created to identify areas where spending doesn't yield sufficiently positive outcomes for the public. While exercises in identifying areas where spending can be reduced often devolves into a typical partisan battle over the role of government, there are sometimes instances where waste is so unambiguous that politicians from both sides of the aisle can reach a consensus.

The proposed medical complex project came under the scrutiny of the Commission not just because it is a controversial issue but because the State of Louisiana earmarked $300 million in state taxpayer funds toward the LSU/VA medical complex back in 2007 and has not yet seen results. Work on the project has not yet begun because LSU administrators have not been able to secure the additional funding needed to begin work, which they say will come from some combination of loans and a reimbursement from FEMA.

The FHL/RMJM plan, which to this point has never been seriously considered by public officials as an alternative to the stalled LSU/VA proposal, has been estimated to save taxpayers at least $280 million in land acquisition and construction costs because the plan does not rely on the expropriation of private property in Lower Mid-City or the forced eviction of neighborhood residents.

Though it would seem obvious that a panel whose mission it is to identify areas in which Louisiana can save money would take a look at the two competing hospital plans, it was not a sure bet. State Representative and Senators have had many opportunities to reexamine the proposal to build the LSU/VA medical complex and to order a side by side cost-benefit analysis of the two competing plans. They have failed to do so. As recently as June, the State Senate Education Committee even declined an opportunity to protect homeowners in the Lower Mid-City footprint of the proposed LSU/VA medical complex by refusing to pass a measure that would have required LSU to earn legislative approval of their business plan before proceeding with land acquisition.

What's different now? Why has this subcommittee unanimously endorsed the FHL/RMJM plan to save Charity Hospital and what are the chances the resolution will pass when it goes before the full Commission on Streamlining Government?

Though it's true that the subcommittee that unanimously passed the motion endorsing the alternative plan was headed by a longtime skeptic of the LSU/VA project, State Treasurer John Kennedy, it's also true that state leaders are becoming increasingly concerned about the business rationale for the project.

At issue is how the anticipated healthcare reform measures being debated in the US Congress will change DSH payments, or reimbursements for Disproportionate Share Hospitals. These federal reimbursements go to hospitals that serve a high number of uninsured low-income patients who are not covered by other government programs such as Medicare, Medicaid, or SCHIP. Congress is currently planning to cut DSH payments as part of the healthcare bill under the assumption that as insurance is extended to more Americans, hospitals won't require reimbursement money for treating uninsured patients.

Because the high price tag of the proposed LSU/VA medical center will require so many loans, the anticipated absence of DSH funding will make it harder for hospital administrators to meet debt obligations. Therefore it is less likely that bond companies will be willing to loan the required money to pay for building the hospital in the first place.

Conversely, because the FHL/RMJM plan to gut and rebuild Charity Hospital is less expensive, less loans will be required. Additionally, because the FHL/RMJM plan promises to a faster construction time, hospital administrators will be able to begin repaying those loans sooner. This is the point Treasurer Kennedy has been making since last Spring and the point he reiterated at yesterday's subcommittee hearing. Thankfully, the members of the Commission on Streamlining Government are beginning to get the message.

Breaking News: Good Apples Found In Louisiana State Government?

Earlier today, State Treasurer John Kennedy and the efficiency and benchmarking subcommittee on the Commission for Streamlining Government unanimously endorsed the RMJM/FHL plan to gut and rebuild Charity Hospital!

It turns out not all of our public leaders are blindly accepting an expensive, wasteful, and destructive medical complex without considering more viable alternatives.

The unanimous resolution is not just a call for more studies or hearings, it is an explicit endorsement of the alternative plan to save Charity Hospital and Lower Mid-City, something no state body has had the fortitude to do before today.

 

The Louisiana Streamlining Government Commission recommends to the governor and the Louisiana Legislature that the existing but currently unoccupied “Big Charity Hospital” building be rehabilitated and used as a public teaching hospital if the State of Louisiana decides to go forward with its plans to construct such a hospital in New Orleans.

 

This marks the first time in the history of this controversy that a state body has officially endorsed the RMJM/FHL alternative plan, which proposes gutting Charity Hospital and building a state-of-the-art medical facility within its historic facade. This plan would save at least $280 million compared to the LSU/VA proposal. It would also take years less time to complete and would prevent the unnecessary demolition of the Lower Mid-City community currently marked for expropriation to make way for the sprawling LSU/VA.

The motion will go before the full Louisiana Streamlining Government Commission soon.

We hope the rest of the Commission will be as open-minded as the subcommittee was today.

Inside the Footprint

Some enterprising young bloggers, Brad V and Curtis P, have started a new website called Inside the Footprint, dedicated to documenting the neighborhood threatened by the proposed LSU/VA medical complex. The state is readying the wrecking balls even though financing for the project remains very much in doubt.

Their mission? 

We seek to document the "footprint" of the proposed LSU-VA Hospital slated for construction in Lower Mid-City in New Orleans, Louisiana.

We believe locating the hospital(s) in other downtown locations, such as the vacant Charity Hospital, represents a better plan for moving forward - one that does not involve the eviction of numerous individuals and families who returned after Hurricane Katrina, the destruction of viable businesses, and the elimination of many historic structures.

While much of the footprint is in tough shape by a number of measurements, we hope to focus on the many aspects that nonetheless show that the neighborhood's wholesale elimination to make way for vast swaths of parkings lots, for example, is unwise and should be avoided.

 
They've already got several photographs of neighborhood life. If you've never been to Lower Mid-City, you should check it out. It's a real community.

 

 

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