Monday, January 05, 2009

Who's Who: Unmasking the LSU/VA Team

In 2009, the fights to reopen Charity Hospital and save Lower Mid City from demolition will come to a head. The proposed $1.2 billion plan to remake Lower Mid City into a biomedical district anchored by an LSU teaching hospital and a renovated VA hospital has been in the works for many moons.

High profile officials have infused massive amounts of political capital into realizing this project and would lose big if this project were to go down.

The Mayor, his recovery director Ed Blakely, and the New Orleans City Council worked in concert to allocate some $79 million of the 2009 budget toward acquiring land in the LSU/VA footprint.

The New Orleans business and university elite have invested considerable resources into developing the Greater New Orleans Biosciences Development District via the Downtown Development District and the New Orleans Regional Biosciences Initiative.

State leaders such as Governor Bobby Jindal and LRA Director Paul Rainwater have made obtaining full FEMA reimbursement for Charity in order to fund the new LSU hospital the state's number one priority heading into the new year and the new Obama administration's proposed infrastructure bill.

That the process for realizing these plans has been so slow in spite of the massive political firepower behind them is a testament to the salience of the arguments against put forth by housing activists, preservationists, public health advocates, and other reasonable progressives alarmed by official refusal to reopen the existing Charity Hospital and by a site selection process that favors the demolition of a residential neighborhood over more cost-effective, less destructive alternatives.

Stay tuned to WCBF over the next several weeks, as I attempt to shed some light on the forces behind the plan and the interlocking relationships therein.


In today's episode, a brief profile of Donald Smithburg.

Until the Summer of 2007, Smithburg served as the CEO of the LSU Healthcare Services Division, acting as the head of the state's system of charity hospitals.

Public health advocates long viewed Smithburg as one of the key obstacles preventing the reopening of Big Charity. After Charity was evacuated during the storm, it was Smithburg who refused to allow it to be reopened, even though teams of medical and military personnel had already decontaminated the first three floors.

See Richard Webster of City Business:

After the last of the patients were evacuated, Moises and a team of nearly 200 doctors, nurses and military personnel spent a month cleaning and decontaminating the first three floors of Charity, intent on returning at least a portion of the hospital to operational status.

Moises said their work came to a screeching halt when a representative with Louisiana State University Health Sciences Center arrived at the campus and ordered the group to immediately leave the premises or be charged with criminal trespass. Moises has been fighting to return ever since.

LSU officials contend the building is beyond repair. Moises said the first three floors could be ready for patients within months, providing hundreds of hospital beds to a city in desperate need of them.

He believes the independent assessment team will reach a similar conclusion.

"The mental health crisis goes away tomorrow if you open the first three floors," Moises said. "We can get emergency services, specialty clinic services and psychiatric services up and running.

"But LSU doesn't want to do this even on a temporary basis because they're worried if they open the first three floors, they'll lose their FEMA dollars and their shot at building their new $1.2- billion hospital. Meanwhile the people of New Orleans are dying."

Way back in 2006, the Louisiana legislature passed a resolution demanding that an independent team of inspectors be permitted to survey the hospital to determine the feasibility of reopening the first three floors of Charity as an interim stopgap while new hospitals were planned and constructed. However, LSU chose not to enforce the measure until 2007, at which point the Foundation for Historical Louisiana was finally permitted to enter the premises. In 2008, the architecture firm that toured the facility, RMJM Hillier suggested not only that the first three floors of the hospital could be reopened on an interim basis, but that the whole structure could be renovated and reopened as a state of the art facility cheaper and faster than building new.

Smithburg and other proponents of permanent closure continuously pointed to the damage assessment conducted by Adams Management Services in November of 2005, which found that Charity was beyond repair. (available as PDF) But even habitual doofus John Neely Kennedy believed that Adams impartiality was compromised.

Louisiana State Treasurer John Kennedy toured Charity last year and backs Moises, saying while the hospital was "a little dirty, it looked like it could accommodate patients."

The state owes taxpayers an independent assessment to determine whether Charity can be reopened, if only temporarily, Kennedy said.

"Adams is a fine company, but they've worked for LSU for a long time. I've asked for and never received an independent study of what it would cost to reopen the old building. Before you spend $1.2 billion, that seems to be the rational thing any businessman or woman would do," Kennedy said.

One major reason critics became skeptical of the findings of Adams Management Services is that the same Adams Management Services was hired in assess Charity way back in 2003. Their findings then? (available as pdf)

At a kickoff luncheon in the University Hospital Auditorium Walter R Adams, President/CEO of Adams Project Management, revealed that his associates had recently completed a full assessment of both the Charity and University campuses and have recommended to the LSU Health Sciences Center leaders. . . the replacement or relocation of the Charity Campus and a full relocation of the University Campus for an alternate use.

So it was not as if Adams was brought in as an impartial outsider.

Smithburg, for his part, began to utilize the Katrina-as-opportunity meme made popular by so many businessmen hoping to "reimagine" New Orleans after the storm. He spoke to Adam Nossiter in December, 2005 about the future of Charity.

Don Smithburg, chief executive of Louisiana State University Hospitals, which runs Charity, said any replacement for the hospital should be based on a ''new model, less reliant on public dollars,'' with a ''new mission'' -- one serving both private and indigent patients. ''This storm has told us you can't rely on government resources,'' he said.

Hmm. That sounds like an ideological agenda totally unrelated to facilities management, does it not? Sounds to me more like a plan to cut holes in the city's social safety net, to shrink government by partially privatizing what were once public health services. Shockingly doctrinaire, no?

In that Nossiter article, Smithburg admits that it was his decision to halt the volunteer remediation work being done by Dr. Moises and others:

''We were naïve enough to believe people would want to do the right thing by the community, and ensure health care,'' Dr. Moises said. ''On numerous occasions they ordered us out. They said, 'we want you out, stop cleaning the building.' ''

State officials said the doctors were told to get out for their own safety.

''I ordered that be stopped, based on the environmental assessment reports I was getting from the consulting engineers,'' said Mr. Smithburg, the Louisiana State University executive. ''We had guys in there who were very well-meaning. But we had to keep telling them and telling them.''

A series of photographs taken by doctors and military personnel, after most of the cleanup effort had been completed, appear to show the emergency room and other rooms in the hospital in clean condition. No trash is visible; the floors look scrubbed.

At any rate, Smithburg was abruptly fired in 2007. No reason was given at the time, though it later came out that Smithburg improperly obtained a credit card without LSU's permission and then used it to loan himself $2,000 in cash advances. This article from the Baton Rouge Business Report paints a more comprehensive picture of- oh let's call it the weakened structural integrity of LSU Medical Services administrative infrastructure.

Within a couple of months, Smithburg found a fresh employment at Phase 2 Consulting, a health care management and economic consulting firm.

Just months prior, Smithburg's future employer had been Smithburg's employee. Phase 2 Consulting was hired along with the familiar Adams Management Services to draw up the $1.2 billion business plan that was eventually adopted. (available as pdf)

Quite the web to untangle. Stay tuned.


jeffrey said...

That the process for realizing these plans has been so slow in spite of the massive political firepower behind them is a testament to the salience of the arguments against put forth by housing activists, preservationists, public health advocates, and other reasonable progressives alarmed by official refusal to reopen the existing Charity Hospital and by a site selection process that favors the demolition of a residential neighborhood over more cost-effective, less destructive alternatives.

That's a bit optimistic, no? I prefer to see it as indicative of the general incompetence of the "political firepower" regardless of its mass.

Which is perhaps my favorite thing about life in New Orleans. Even the evil can't really get its act together.

Christian Roselund said...

An important point to this story is that Smithburg and LSU _illegally_ closed Charity on September 19, 2005. State law is pretty clear that you need an act of the legislature to close a hospital. However, the LA legislature has been pretty gutless about actually enforcing its authority on this matter.

mominem said...

I'm glad you mention the previous report which have found which recommended closing Charity and replacing it.

Charity before Katrina was an enormous money pit. Sucking resources that could have been used to develop a community health care system, something LSU wanted to do but couldn't as long as Charity was consuming all of the resources.

I seem to recall that when LSU bought Hotel Dieu, one of the justifications was that it could be used as an interim facility while a replacement facility was developed as part of a comprehensive community based system.

Jeffrey said...

This is indeed a Gordian Knot.

I think it is plain that LSU is pushing its own agenda, and--like many institutions--has used Katrina as a means to advance their agenda. My ideal situation--and I think almost everyone (preservationists, neighborhood residents, planners, etc. alike) agrees--would entail LSU renovating Charity per the RMJM scheme, and for the VA to open on the proposed LSU site.

But I think the problem is really larger than LSU's obstinance. I don't agree that LSU is pushing a conservative agenda; in fact, this would be a massive investment in public infrastructure that flies in the face of Jindal's (and Levine's) harebrained schemes to privatize of a lot of public health functions in the state. It would also represent a turn towards a community-health based system, where primary and preventive care occurs in neighborhoods, and the more intensive and tertiary care takes place in a central hospital. The LSU hospital would also represent an investment in public (and private education), where again 70% of this state's doctors would be trained at Charity.

And I also don't buy the fact that the FHL/RMJM proposal to reopen Old Charity would cost any less or take any less time that building new--that building needs to be massively remediated and shored, and removing asbestos and doing structural work on a building of that size will certainly take a lot of time and a lot of money.

So for argument's sake, let's assume that the cost and time of building are about equal for renovating and building anew, and let's assume that LSU and the LA legislature are not going to dramatically change course.

The crux of the problem then for me lies in the fact that saving Old Charity and 'saving' Lower Mid-City are separate (but linked) issues. If LSU is ultimately hell-bent on never going back into that building (and in spite of their past transgressions, however onerous), we need to be thinking about the impact of these hospitals on Lower Mid-City. We ('progressives'?) need to be focusing our attention on how the people and built environment of the immediately surrounding neighborhoods benefit from these developments.
-The hospitals need to be designed from the outside-in, taking into account their urban context (not suburban crap--these buildings should be at last 6 stories high in parts, and should have entrances at all the major thoroughfares, especially Canal, Claiborne, Galvez, and Tulane).
-Every house that can be moved should be moved, rather than demolishing (if we're paying $75M of public money to buy these homes, why not just move them to vacant NORA lots instead?).
-Massive workforce development programs to help all of our residents partake in these new high-paying jobs.
-Equity & inclusion and community benefits agreements and provisions, modeled after the East Baltimore Development Initiative.
-Light rail expanded down Tulane Avenue and better public transit throughout the surrounding area.
-Significant rehabilitation funds for the existing homes (much more the $1.4M bone that the VA is currently throwing to the neighborhood).
-Create other amenities, such as parks, sidewalks, and landscaping.
-Guarantees about structures like McDonogh, Dixie Brewery, and Deutches Haus (amongst the others). There is no reason why Dixie couldn't reopen as a mixed-use building that brings amenities to the neighborhood as well as the doctors, students and researchers at the hospital. This is opposed to the current VA proposal to save the Dixie facade and use it to mask the VA hospital powerplant.

The list goes on and on.

And I am afraid that hits on a larger theme: we need to be thinking about the larger importance of these projects to this city. Yes, LSU has performed a number of unconscionable and probably illegal actions in order to get its new hospital. But we need to be pragmatists.

So while I am aware that similar justifications were probably the rationalizations of past Urban Renewal projects--Robert Moses' projects and Boston's destruction of its West End, or putting I-10 over Claiborne and through the Treme--I am also aware of the potential that the LSU/VA hospitals bring to the city, and I am afraid that we are missing our opportunity to guide this larger conversation about how the new hospitals are going to affect New Orleans by getting stuck on issues which are incredibly important but which are in all likelihood ships that have already sailed.

What do you guys think? I am intrigued by what WCBF will dig up on LSU and Old Charity in the coming installments, and certainly would like all of these storylines and relationships to be aired. If we can force LSU to rehab Old Charity rather build a new structure without compromising the building a new hospital complex altogether (I hope it never comes to that), then I am all for it. But if it comes at the expense of spending our efforts at guiding how we want healthcare and the biosciences industry to impact our neighborhoods and our people, then I think we should be aware of that, too...

E said...

That's a great comment Jeffrey, and yes I think that ultimately we should be honest about the utility of working on some sort of overall plan for walkable urbanism around whatever is built or renovated. That ought to be a top priority.

What I think you'll find, however, as my series unfolds, is that LSU is just one leg of the stool.

GentillyGirl said...

Jeffery has covered many good points... I can't refute his thoughts on this matter.

The VA hospital I can speak about since I do talk with folks who do know some things concerning the issue.

The VA needs a larger space than the old building. We need to have more Rehab space for our kids returning from the Afghan and Iraqi wars. This are the central hub for Veterans' care on the Gulf Coast.

This is all about LSU, Nagin and the Jindal Administration.

Stop holdpng the Veterans hostage to this money ploy with LSU and State Government.

Anonymous said...

You got it all wrong in your profile. Smithburg was fighting LSU himself because the University and in particular its medical school wanted to use Katrina as a way to get out of the Charity business altogether. And he had no choice but to believe the reports from consultants hired by the state engineers rgarding the building's apparent dangers at the time. Smithburg wanted to replace her with a modern facility to care for the uninsured, but also have a financial plan to reinvest in the facility since the State and LSU obviously wouldn't do so (check your history and you'll see that is a fact). As a result, LSU concocted the credit card scam and forced Smithburg's hand. Another fact: LSU eventually had to pay Smithburg for defamation of character. You picked the wrong guy to be your scapegoat. He wanted a better Charity building more than anyone could ever know, and fought like no other to get it done. LSU didn't like that...

Dan_Lion said...

Obviously, "Anonymous" (May '09 post), is/was the only person with a functioning brain. You people really do love jumping on the bandwagon- which, ultimately, is why Louisiana healthcare is STILL-5 years after Smithburg's departure- as horrible (& in some cases much worse than)as ever before. I love living in Louisiana, but the in-bred politics and unethical tactics these people do to keep the upper hand has already proven detrimental to all of us. Take your blinders OFF and look around- NOLA could have Big Charity replaced by a safe & BETTER than before building, and up and running by now- wouldn't you agree that'd be better for the people than the alternative..? It's pathetic to see how a few great men have been made out as the bad guys, when in REALITY they were doing everything in their power to save you all. Maybe Mr. Smithburg should have just let you open Charity- it could have saved him his job until you all started dropping dead from the horrid conditions that were Charity BEFORE and ESPECIALLY after Katrina. Everyone that inspected the building had to wear HAZMAT suits & helmets- & oh yes, fishing waders to get through the feet of water filled with dead bodies in the morgue. The really disappointing thing is that Louisiana will never change. Anyone brought in to do a job such as run the LA charity hospitals (or any position with the power to make a difference in the state, really) has been either ousted, or had their hands tied by red tape until being forced to back down. Luckily, most other states don't behave like this; therefore when the good ones get away from Louisiana's hell of a mess, there are 49 other states eager & willing to hire them.

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Anonymous said...

After doing research for a book, including "the facts" referenced by Anonymous, I learned that long before Katrina hit there were efforts to replace Big Charity... for the benefit of the city. There were multiple and independent engineering firms who said the building was unusable. Not safe. Every engineering firm said that. In early 2006 at a major press conference hosted by Governor Blanco and the Undersecretary of the Dept of Veteran Affairs, the original post-Katrina replacement plan was announced as a Charity/VA combo to open on 11/11/11; that's Veterans Day this year! And look how far along it is? I also researched the efforts of those who fought the plan and conclude that New Orleans should be ashamed of what happened-- or didn't let happen. Smithburg and his team had a plan, but they were disbanded by political forces and the vocal local opponents played right into those politicians' hand. And while opponents weren't looking, they also allowed the charity hospital in Baton Rouge to rot so that it will actually be closed soon and the one in Alexandria was signifcantly downsized. While so many were fighting to reopen the condemned Big Charity building, they took their eye off the ball and let decision-makers deftly dodge the bullet here and elsehwhere in the state where uninsured Louisiana citizens (also Saints fans) get their care. It didn't have to be this way. Those are the facts of recent history. Yuri

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