Tuesday, March 24, 2009

Cowen's Concerns Indicative of Swirling Skepticism

In a letter to the editor responding to James Gill's passionate criticism of LSU's entrenched stance in the debate over whether to restore Charity Hospital, Tulane President Scott Cowen asks the following questions:

-- Given the current health care reform movement, do we remain comfortable that the proposed hospital meets the medical needs of our wider community and its citizens, especially those who are under- or uninsured?

-- Do we have sufficient funds to build and operate the hospital without it being a drain on the state's future resources, especially in these economic times?

-- How can any new facility best meet the educational, research and clinical care needs of the institutions that rely on it to support and advance their academic missions? Some of these institutions include Xavier, LSU, Dillard and Tulane.

-- Given the importance and wide impact of this hospital to our community, who should own, govern and manage it to ensure that the proposed facility meets the needs of its various stakeholders while being operated in the most cost effective, efficient and transparent manner?

These are the issues that have been flagged at every turn by proponents of Charity. It is about time that LSU, the GNOBEDD, and the DDD be forced to provide legitimate answers. There has not been one public hearing in Orleans Parish on the matter. Not one. Not in front of the City Council. Not in front of the City Planning Commission.

Goody Clancy, the firm that just released a master plan draft online, was told not to evaluate the GNOBEDD or the LSU/VA footprint.

But it is clear as you're browsing the draft plan, that the issue of Charity Hospital was simply unavoidable. The public health challenges examined by Goody Clancy clearly underscore Mr. Cowen's first question above. Check out Chapter 9 on Health and Human Services (pdf)

What else?

And more still:

Given the distubing public health crisis, why are we so convinced that the LSU/VA complex is the way to go when there's another proposal on the table promises the same first rate medical care without nearly the same wait. LSU does not have the funding to proceed with their plan but they've blocked any and all attempts to evaluate it side-by-side with the alternative from RMHM Hillier. It could take another decade if we continue to subject our health care emergencies to their incompetent guidance.


DAMIAN said...

I totally agree. LSU has stymied debate on this question. I'm not opposed to the VA hospital as currently envisioned, but how can we say whether it's superior to other plans if we muddy the water?

Asking the Planning Commission not to look at this question is obscene. Obviously, given that their document will have force of law, it makes sense that their conclusions should have been stated as non-binding recommendations, but they should have clearly been included in the process. Very frustrating.

Anonymous said...

I'm glad the Times-Picayune and Tulane have flipped on rebuilding Charity--but let's not forget who left the sick and the dying in the streets the last three years. The Times-Picayune never breathed a word about Charity being re-opened only three weeks after Katrina--until Lolis mentioned in one of his last columns (maybe that's why he's a reporter now). Tulane was a founder of COLLAH with Blue Cross and rest of the folks to keep Charity closed and divert most of the money for the remaining charity system to private health insurance. Their concern for the uninsured is suspect and the main beef they have is that LSU wont put them on the board of the new hospital. See the co-conspirators at:

Richard P. said...

Yes, that's right. The Times-Picayune is generally pro-business above all. It would be a major surprise to see them calling for re-establishment of the use of the Charity Hospital building as a major hospital facility or to be very enthusiastic about the LSU teaching hospital proposal or about any kind of state charity hospital system. Rather, one would expect them to line up with David Vitter and the pro-business Republican contingent and to endorse sending the traditional Charity Hospital patients to all of the various other non-state hospitals and for there only to be a very small teaching hospital, if any at all. As for Cowen, yes, exactly, his interest is in getting a seat on the board of the new hospital even though it would be competition to the Tulane Hospital.

Anonymous said...

Chapter 9 is interesting, but what about Chapter 10?

"Finalize planning process and expedite construction of LSU and VA medical centers."

Let's be at least a little honest, University was renovated and reopened in November 2006. University is accredited as a Level I trauma center and is seeing inpatients and outpatients. Community and school based clinics are operating in many locations.

There have been hearings before the LRA, the state legislature, and meetings with the city of New Orleans. You are correct that that these hearings did not take place in New Orleans.

Further, this debate is what has delayed the project. If the project had commenced when approved by the legislature, the New VA and LSU hospitals would be under construction and would have opened in October of 2012.

I am still not sure I understand your opposition to the new medical centers, can someone explain?

E said...

"Let's be at least a little honest, University was renovated and reopened in November 2006. University is accredited as a Level I trauma center and is seeing inpatients and outpatients. Community and school based clinics are operating in many locations."

This is true but represents only a drop in the bucket in terms of addressing our public health needs. The neighborhood clinics are just simply nut capable of providing for all the care required by the disadvantaged population of New Orleans.

"Further, this debate is what has delayed the project. If the project had commenced when approved by the legislature, the New VA and LSU hospitals would be under construction and would have opened in October of 2012."

This is factually inaccurate. The construction delays are 100% the result of LSU's funding shortfall. In fact, if those raising reasonable questions about the project were to simply disappear, LSU would still not be able to begin construction. They just don't have the money.

And that's a good place from which to segue into briefly summarizing why it is that I'm opposed to LSU's proposal.

Given that there is this progressive plan out there that would bring world class medical care to New Orleans by reusing Charity Hospital that would be built faster and cost less, I think we owe it to ourselves to actually examine it side-by-side to that brought forth by LSU.

And given that the alternative proposal also saves a residential neighborhood while maintaining occupancy in our downtown...

And given that LSU has refused to back up their stuff with documentation and the other side has...

To me it seems like LSU is the obstructionist side. They don't have the money to move forward and they're hemorrhaging public support, but they refuse to even entertain the idea that there might be a better plan out there.

Anonymous said...

I guess you lost me with your first comment. In Hillier's plan, where are the clinics? I understand where they are in LSU's plan, but I don't see it addressed in the space program or estimates in the Hillier plan. I also see approximately 40 inpatient beds less and no clinical research unit.

I also see parking addressed in both plans, but much less parking in the Hillier plan. Also parking under the building is not allowed by federal standards, so maybe that should not be considered.

Your second response also confuses me. The original LRA funding included $300M toward a new hospital. However, in the May 2007 legislative hearing the legislature decided to approve $228M for planning and land acquisition for the new hospital and allow the $300M to be used for other purposes. I believe the financial plan proposed by LSU shows a FEMA contribution of $100M, the LRA contribution of $300M, and at that the project cashflows. I admit it is not a great cashflow but it services its debt and provides funding for repairs and replacement of equipment. By the way, if you were to compare apples to apples and apply the correct contingencies and escalation to the comparison (new versus renovation) provided by Hillier, you would determine that the projects cost about $50M different without adding in the land. I guess the question to you, is where is the fully loaded business plan that shows that services will cashflow in your proposed solution.

Further, you need to read "New Orleans Charity Hospital" by John Salvaggio. The foundation issues concern me most of all and though mentioned in the Hillier report were not thoroughly investigated.

I guess you "segue" is even more confusing. I have a copy of the proposed business plan for LSU. It is a public document and was and may still be posted. I also have the pre and post Katrina assessments of the Charity facility, again public documents.

Spend the time and take advantage of the public documents.

E said...

We're not communicating well here.

I'm not sure that is the responsibility of either hospital to provide for neighborhood clinics. Rather, the key here is getting a legitimate full service hospital online as fast as possible that can take some of the burden off of these neighborhood clinics in terms of indigent care. This is one of the reasons I support the RMJM Hillier Plan.

Anonymous said...

You are right, we are not communicating.

Completely renovating a building on a congested site usually takes longer than building a new building.

Designing the renovation usually takes as long or longer than designing a new building because of the destructive and non-destructive testing which has to be done in order to finalize construction documents.

Delays may be experienced in obtaining structural members and other materials required as these are only made on a specific schedule at a specific mill. Of course these member may be available at a higher cost from a steel yard.

The building may need to be jacked up in order to facilitate replacement of foundations, but that won't be known until studies are done.

Of course, in this case, I expect Hiller's intent is to completely gut the interior and remove the exterior of the building. Then perform the testing and finalize design of the solution. However, there is not a schedule in their study so I can not tell.

As I stated before the foundation system greatly concerns me. The hospital was constructed on wooden piers. These piers were designed to be sunk to 70 feet but were only sunk to 40 feet. The building has experienced settling over the years as was documented even before it opened.

In the mean time, there are the clinics and University Hospital. The renovation of University Hospital allows it to accomodate up to 350 beds. To that you add the psychiatric beds at DePaul. Of course this is not a long-term solution, as according to FEMA, this is a temporary facility. Further, the electrical distribution systems was left in the basement to expedite the renovation so this problem was not mitigated as required by FEMA for all permanent facilities.

LSU spent eighteen months jumping through all of the hoops put in from of them. LSU has put together study groups which included many outside entities and presented their plans at all levels of the government.

The truth is you don't like their plan and what I would really like to know is why you don't like their plan. Not about not feeling included, but the real reasons why you oppose the plan.

E said...

I don't know what to tell you. I've enumerated the "real" reasons I oppose LSU's plan on a number of occasions.

I believe that LSU perpetrated a great injustice on this community by failing to reopen Charity after Katrina after Dr. Moises and the national guard rehabbed the first three floors immediately after Katrina. I don't believe that the building is structurally unsound. I don't trust the firms that LSU brought in to examine the building. (For instance they claimed that the metal connectors had rusted and needed replacement when in fact the building wasn't constructed with the connectors in the first place.) I don't think it makes sense to build a sprawling parking-lot heavy complex on top of a residential neighborhood so close to a downtown area that ought to be seeing more density going forward, not less. I don't think that we should be expropriating people's land for a project that isn't even fully funded. And this significant obstacle is why it would appear that LSU's plan can't bring us a hospital until closer to 2020 than 2010.

These are, to me, real and serious reasons to be skeptical of LSU's plan. I think these are real and serious rationales to consider the RMJM Hillier plan and to start treating it as a legitimate alternative proposal.

Anonymous said...

I guess that is one point we really disagree on. What Dr. Moises and the National Guard did was not rehab. In the basement of the building was the electrical distribution system, the boilers, the chillers, the medical gas distribution systems etc... Those systems were submerged for over a week.

Further, this compromised the integrity of the water, medical gas, and air distribution systems. In order to provide a safe environment for patients those system would have needed to be cleaned, replaced, decontaminated, etc...

The power which was run into the building was run through windows directly to power panels. In some areas, these were run down the hallway and IV poles were used to support these electrical lines. A more permanent solution was later implemented, which eliminated some of these hazards.

Further, black mold was growing all over the place. That is not a safe environment for patients. To eradicate that you would need to gut the facility back to its steel members and clean and disinfect before rebuilding.

That is what had to be done at University in order to rehabilitate it. Have you been in the basement where the cafeteria is. You can still smell that dank moldy smell down there.

I understand what you are saying about the metal clips even from Hillier's report, I am not sure how those panels are attached to the building.

As for the site, the commercial buildings are mostly unused and some have burned. There are a couple of historically significant buildings which should be preserved. The houses which are structurally sound could be moved to infill in the adjacent neighborhoods. The other houses could be deconstructed and salvageable materials could be reused.

On top of that, if LSU uses FEMA funds, they have to follow the agreement which is in place, so relocation assistance, etc... will have to be part of the deal.

As for density, and maybe this is where we disagree also, the final buildout would be pretty dense. Maybe you don't think LSU can grow research, biotechnology, etc... I think that there are too many examples of academic medical center around the country which have done it to count them out.

Further, and even Hillier admits it in there response to the state, they only considered the hospital, not the other 23 buildings which supported Charity.

Anonymous said...

What will happen to the University site in the LSU/VA plan?

E said...

That's kind of the brilliance of the Hillier plan. Their plan is to do a whole gut job and build from scratch within the Old Charity shell. So you'd really only keep the historic facade and the grand entrance but have an entirely new hospital from top to bottom inside.

Anonymous said...

In the LSU/VA plan there is no stated plan for reuse of Charity. Previous plans have looked at possible reuse for Charity however, most were not financially viable.

The building itself is a state asset and the state would have to determine whether to repurpose the building or possibly sell it.