Avery C. Alexander Charity Hospital in New Orleans: A timeline since its forced closure after Hurricane Katrina

August 30,2005 - Floodwaters from breeched levees and floodwalls by Hurricane Katrina inundate the basement of the Avery C. Alexander Charity Hospital, curtailing most back-up generator power, water and sanitary systems. J

September 4. 2005 - After waiting five days for rescue of its patients the Avery C. Alexander Charity Hospital and University Hospital were fully evacuated after flooding compromised the respective facilities. 2

September 5-19. 2005 - Avery C. Alexander Charity Hospital Emergency Department, LSU and Tulane University residents, U.S. military personnel and others proceed to ready the hospital for reopening, by draining floodwaters from Big Charity's basement; reconnecting its electrical power systems; clearing all 21 floors of perishable refuse; fully cleaning its first three floors (including its Emergency Department and psychiatric Crisis Intervention Unit) and restoring its requisite operating and air conditioning systems. 3

September 19, 2005 - Chief Executive Officer (CEO) Donald Smithburg ofLSU Health Science Center, Health Care Services Division (LSUHSC-HCSD) orders its medical staff and U.S. military units to leave Big Charity, declaring Charity Hospital permanently closed. This is in spite of preliminary clearance from the U.S. Public Health Service, FEMA, and the U.S. Army Corps of Engineers (the latter granting authorization for the U.S. military units to be in Charity) tllat it is ready to reopen. LSUHSC-HCSD instead orders its medical staff, assisted by U.S. military units, to erect a makeshift MASH tent-like facility (which become known as "E-MED" tents) to be located in the once-¬flooded parking lot across from University Hospital. This opens in late September and is dubbed "The Spirit of Charity". 4

Mid September 2005 - The Louisiana Department of Health and Hospitals (DHH) returns all but $8 million ofa $352 million advance grant from the Federal Emergency Management Agency (FEMA); DHH says it could not hang onto the funds because it had not allocated a use for them. By year's end more than 3000 workers would be laid off from Charity Hospital in New Orleans alone. Limited investigation through Louisiana Public Records requests reveals the bulk of the $352 million may have been for the reopening of Big Charity. 5

Late September 2005 - LSUHSC-HCSD's consulting and engineering firm, ADAMS Management Corporation (which had completed a report two months before Hurricane Katrina promoting a new replacement facility for New Orleans' Charity Hospital), assesses both Avery C. Alexander and University Hospitals and declares them to be 65% and 68% damaged respectively, effectively declaring them to be unsalvageable. (Nevertheless a year later LSUHSC-HCSD officials opt to reopen the more damaged yet smaller University Hospital building after repairs begun in me spring of2006, as prompted under threat of Louisiana State Legislative action). 6

October-November 2005 - The USS Comfort, a U.S. Navy hospital ship, is docked at me Poland Avenue Wharf and operates as New Orleans' Level One Trauma Unit because Charity Hospital remained shuttered. 7

Early October 2005 - "The Spirit of Charity" moves its E-MED tents to New Orleans' Morial Convention Center and remains there until eventually forced out because 0 f tlle resumption of convention business. 8

December 17. 2005 - Tile New York Times publishes a report by Adam Nossiter entitled "Dispute Over Historic Hospital for the Poor Pits Doctors Against the State"; exposing to the wider public for the first time the active struggle between LSUHSC-HCSD and its medical staff over the viability of Charity Hospital. By early 2006 LSU-employed medical staff was warned again&t further public protestations, lest they risk losing their jobs and professional credentials. Other newspapers and media, including USA Today and the BBC World Service, feature similar reports. Curiously. aside from a commentary by columnist Lolis Eric Elie, New Orleans' only daily newspaper, The Times-Picayune. has as of late January 2007 yet to feature a report or even a letter to the editor about the dispute. 9

March 1. 2006 -- "The Spirit of Charity" relocates yet again to a formerly-flooded and shuttered department store, Lord and Taylor in the New Orleans Centre next to tlle Superdome. Meanwhile the unflooded yet readied Avery C. Alexander Charity Hospital remains unused and closed, thereby apparently losing its key Joint Committee on Accreditation of Healthc.are Organizations! (JCAHO) certit'ication by allowing it to lapse. 10

January 16, 2006 - A group of former Charity Hospital medical residents march in tlle Martin Lutller King Jr. march from the Lower Nintll Ward, raising their demand to reopen Charity Hospital. They subsequently link up witll activists from the People's Hurricane Relief Fund and Oversight Committee (PHRFOC) and other community groups. J I

January 27, 2006 -- Responding to returning OklailOma National Guard members who had helped clean up Charity Hospital, United States Senator Tom Coburn, MD (R-OK) wrote a letter to LSUHSC-HCSD CEO Donald Smithburg, demanding that Charity Hospital be reopened; and that a real independent evaluation of the facility occur. Following an apparent courtesy letter by Smithburg, the request was ignored. 12

March 25, 2006 - More than 300 former Charity Hospital workers, residents, patients and their families, plus other concerned people rallied outside the Avery C. Alexander Charity Hospital to "Rally to Save Charity Hospital". Amongst those in attendance was Dr. James Moises, who resigned his position as part of the Charity Hospital Emergency Department in order not to be silenced in demanding that it be reopened, and that an independent evaluation of tlle facility be conducted. Medical staff on-hand dubbed themselves "Doctors Witllout Hospitals" in wry allusion to the international group "Doctors Without Borders". The rally was organized in conjunction with the PHRFOC.13

April 6, 2006 - Sparked by the "Rally to Save Charity Hospital", the New Orleans City Council unanimously passed a resolution demanding that the Avery C. Alexander Charity Hospital be reopened. 14

Early April 2006 -- LSUHSC-HCSD opens a Level One Trauma Center in the former Elmwood Medical Center, now owned by Ochsner Hospital, 15 miles from downtown New Orleans. IS

June 8, 2006 - A press conference was held in front of Charity Hospital in support of two Louisiana State Legislative bills that potentially would lead to its reopening. Senate Bill 697, authored by Senator Diana Bajoie of New Orleans (who is also Senatc Pro-Tempore), demanded tlle reopening oftlle Medical Center of Louisiana at New Orleans (MCLNO encompasses both Big Charity and University Hospitals), House Concurrent Resolution 89, authored by Representative Kenneth Odinet of Arabi, specifically demanded Big Charity Hospital's reopening on an interim basis until a new hospital is constructed; as well as calling for an independent architectural and engineering evaluation to be conducted through the state's Facility Planning and Control in conjunction with the Foundation for Historical Louisiana. Though it never was formally passed by the legislature, the threat ofSB 697 is credited with prompting LSUHSC-HCSD to reopen University Hospital after LSU officials originally balked at tlle idea. Meanwhile HCR 89, passed with no opposition, has yet to be implemented. I~

Late June 2006 - As authorized by HCR 127 (authored by Representative Sydnie Mae M. Durand), The Louisiana Health Care Redesign Collaborative was formally launched. Spearheaded in early 2006 by DHH Secretary Dr. Fredrick Cerise, Blue Cross Blue Shield of Louisiana healtll insurance CEO Gerry Berry, and federal Department of Health and Human Services (DHHS) Secretary Michael Leavitt, the Redesign Collaborative held three months of meetings which did not deviate from their pre-ordained outcome of proposing to implement private insurance subsidies for the uninsured, removing fiscal preferences for the Charity Hospital system to serve them. 17

October 17, 2Q06 -- The Louisiana Health Care Redesign Collaborative offers its final report to be submitted to tlle federal Center for Medicare Services which requests a federal waiver of rules on Medicare and Medicaid. If fully implemented, the private insurance subsidy scheme would cost more than $500 million a year in Region 1 ' (Jefferson, Orleans, Plaquemines lind St. Bernard Parishes) and more than $1 billion statewide a year according to state officials - far more than providing Charity Hospital system safety-net healthcarc for the same population. 18

November 13.2006 - Participants in the Region 1 Mental Health Stakeholders Meeting demand the reopening of Big Cbarity Hospital, specifically for its psychiatric Crisis Intervention Unit. Participants, lead by Orleans Crinlinal Court Judges Calvin Johnson and Ernestine Gray, protest an attempt by DHH-conveners to steer participants away from their outcry against DHH's and LSU's unwillingncss to reopen Charity Hospital. 19

November 20,2006 - Despite being originally declared more damaged than its sister and much larger Avery C. Alexander Charity Hospital, LSUHSC-HCSD reopens University Hospital. Absent from tllis opening are pediatric and psychiatric services, as well as an emergency department. The facility is formally dubbed the "LSU Interim Hospital". 20

December 17, 2006 - Despite protestations that LSU lacks a business plan for a new hospital to replace New Orleans' Charity Hospital, as well as demands to reopen Big Charity in the interim, The Louisiana Recovery Authority (LRA), with just two 'no' votes, authorizes $74 million in federal block grant dollars for land acquisition for the new facility. LSU argued that waiting any longer would jeopardize a proposed joint facility with

the Veterans Administration, whose own hospital was also damaged by the storm. The LRA says it will release an additional $233 million to LSU once a formal business plan is presented to tlle LRA for review and approval. 21

Januwy 18,2007 - Shutting out public comment against the proposal, the Joint Louisiana Legislative Committee on Health and Welfare, despite lacking a quorum, approves passage of the full $300 million LRA grant to LSUHSC-HCSD for its LSUN A Hospital project. The Joint Louisiana Legislative Budget Committee rubber¬stamps the proposal the next day. It also spars witll the Louisiana Recovery Authority over the LRA's reluctance to approve the full $300 million in federal block grant dollars for LSU. Senate I-Iealtll & Welfare Committee Chair Joe McPherson notes that the legislature had already approved of $331 million beginning in 2004 for any future LSUHSC¬HCSD hospital to replace Charity and University Hospitals; and the LRA should trust state officials witll the full amount.22

Januwy 31 , 2007 - HHS Secretary Michael Leavitt's latest private insurance subsidy proposal has more than 500,000 people currently served by the Charity Hospital system losing such coverage AND being deprived of replacement private insurance. While state officials say that the plan is not likely to pass, most also suggest that if the federal government picks up the entire tab of private insurance coverage for the uninsured, they would agree to shift preferential funds away from the Charity Hospital system that current provides comprehensive safety-net healthcare. 23

Januarv 31 , 2007 - A group of community activists meet at a Ncw Orleans coffeehouse to revive flagging efforts to reopen the Avery C. Alexander Charity Hospital. The group, which calls itselftlle "Reopen Charity Hospital Committee", begins planning for a press conference February 22 to demand adherence to HCR 89, a state law passed in the 2006 Regular Session of the Louisiana Legislature. which demands that Big Charity be reopened until a new facility is constructed, as well as be independently evaluated by architecture and engineering specialists in conjunction Witll tlle Foundation for Historical Louisiana 24

Februwy I.2007 - Two state legislators have asked Louisiana Attorney General Charles Foti to clarify whether the Louisiana Joint Legislative Budget Committee acted properly January 19 when it added $226 million to a $74 million Louisiana Recovery Authority proposal for land acquisition for a new LSU I VA Hospital. Senator Tom Schedler and Representative Jim Tucker said that the budget committee acted improperly when it voted to steer $300 million in fedcral block grant dollars for the project that is said to replace New Orleans' Avery C. Alexander Charity Hospital. The Attorney Geneml did not comment at tlle time tlle letter by Schedler and Tucker was reportedly submitted. 2

J Conversations with Charity Hospital personnel; Keith VanMeter, MD, "Katrina at Charity Hospital: Much Ado About Sometlling", The American Journal of the Medical Sciences, Nov. 2006, Volume 332, Number 5, PP 251-254.

2 Ibid.

3 Ibid; Tom Coburn, MD, U.S. Senator of Oklal1oma, Letter to Donald Smithburg, January 27, 2006. Ja<;Qn Howard (member, 82nd Airborne U.S. Army Division), statement about Charity Hospital conditions, transcribed spring 2006 by Doctors Without Hospitals.

4 Ibid; Conversations with Charity Hospital personnel; Lolis Eric Elie, "City needs Charity to return", The Times¬Picayune, March 24, 2006.

5 Laura Maggi, "La Agency gives back much of FEMA money", The Times-Picayune, Sept. 27, 2005; Department of Health and Hospitals (DHH) inter-departmental e-mail from Jeff Reynolds to Charles Castille, Sept. 22,2005: excerpt of e-mail text: " ... We did talk with Art Jones of the Military Department, it appears that the Charity Hospitals might also be included in this $350 million dollarrequest ... "

6 Jan Moller, "Temporary hospitals are considered", The Times-Picayune, Oct. 29, 2005; Adams Management Services Corporation invoice to Don Smithburg, Oct. 15,2005; "New Medical Center of Louisiana: A Major Step Toward Reality", This Week at MeL, July 7- 13,2003; "Executive Summary: Site and Facility Masterplan, Consolidation of Charity and University Hospitals, Medical Center of Louisiana at New Orleans", Adams Management Services Corporation, June 2005.

7 Keith Van Meter, MD, "Katrina at Charity Hospital: Much Ado About Something", The American Journal of the Medical Sciences, November 2006, Volumc 332, Number 5, PP 251-254; Primary participant source material.

8 Ibid.

9 Adam Nossiter, "Dispute Over Historic Hospital for the Poor Pits Doctors Against the State", The New York Times, December 17, 2005; Lolis Eric Elie, "City needs Charity to return", ", The Times-Picayune, March 24, 2006; Conversations with Charity Hospital personnel.

10 Keith Van Meter, MD, "Katrina at Charity Hospital: Much Ado About Something", The American Journal of the Medical Sciences, Nov. 2006, Volume 332, Number 5, PP 251-254.; "Executive Summary: Site and Facility Masterplan, Consolidation of Charity and University Hospitals, Medical Center of Louisiana at New Orleans", Adams Management Services Corporation, June 2005. This report cites an JCAHO accreditation extension to December 2005.

11 Primary participant source material; Conversations witll Tulane University Medical School residents.

12 Tom Coburn, MD, U.S. Senator of Oklahoma, Letter to Donald Smithburg, January 27, 2006.

13 Primary participant source material; Press release from LSUHSC-HCSD in response, March 25, 2006. 14 New Orleans City Council Resolution R-06-143, April6, 2006.

15 Keitll Van Meter, MD, "Katrina at Charity Hospital: Much Ado About Something", The American Journal of the Medical Sciences, November 2006, Volume 332, Number 5, PP 251-254; Various press reports.

16 Primary participant source material; Press release from LSUHSC-HCSD in response, June 8, 2006; Louisiana State Legislature website: http://www.legis.state.la.us (see HeR 89 and SB 697,2006 Regular Legislative Session).

17 Louisiana State Legislature website: http://www.legis.statc.la.us (see HCR 127,2006 Regular Legislative Session); Charter oftlle Louisiana Healtll Care Redesign Collaborative, signed July 17,2006; and tlle Louisiana Health Care Redesign Collaborative Members List, both available via the DHH website: http://www.dhh.louisiana.gov

18 Jan Moller, "Cost estimate for N.O.-area healtll plan balloons" The Times-Picayune, November 3,2006.

19 "Louisiana's Plan for Access to Mental Health Care, Region 1 Stakeholders Meeting," November 13, 2006; Primary participant source material.

20 Kate Moran, "Scaled back hospital opens", The Times-Picayune, November 17,2006.

21 Primary participant source material; Louisiana Recovery Authority press release, December 18,2006.

22 Primary participant source material; Resolution of the Joint Louisiana Legislative Committee on Health and Welfare, January 18,2006; Conversation with Senator Joe McPherson, January 18,2006; Louisiana State Legislature website: http://www.legis.state.la.us (see SB 1,2004 Regular Legislative Session).

23 Jan Moller, "Plan to insure poor gets cool reception", The Times-Picayune, February 1,2007.

24 Primary participant source material. Meeting was held at Flora Coffeehouse, New Orleans, January 31, 2007. 25 Jan Moller, "N.O. hospital plan called into question", The Times-Picayune, February 1,2007.

About the researcher: K. Brad Ott is a Charity Hospital system outpatient. He suffered a stroke (DVT,from sitting too long during a trip) in 2003. Though most of the damage was reversed by arriving at the AvelY C. Alexander Charity Hospital within the oft-noted 3-hour "stroke window", he must maintain a steady blood-clotting and medication schedule. He is also awaiting an eventual PFOlheart-hole closure surgery. Ott, a native of Erie, PA and a resident of New Orleans for nearly thirty years since high school, has been a long-time community social justice activist. Following his hospitalization, Ott was Legislative Chair for Advocatesfi>r Louisiana Public Healthcare (2004-2005). He was appointed in 2004 to the Region 1 Health Care Consortium, representing the uninsured in Rl NCC's advisory fimction to Louisiana Governor Kathleen Blanco's "Governor's Panel on Healthcare". Under a partial Louisiana Rehabilitation Services scholarship, Ott returned to the University of New Orleans in .January 2005, and is presently in his senior term in Sociology. He is also a research intern at the University of New Orleans' Center for Hazards Assessment, Response and Technology (CHART). He can be reached at kott [at] uno [dot] edu or bradott [at] bellsouth [dot] net .