NEW ORLEANS. The Monday special at Tulane University's Medical Center is red beans and rice. If you don't like it, you can always order a ham and cheese po'boy sandwich or a Reuben.

Other local dishes dot this unusual menu: sausage jambalaya, redfish courtbouillon and stuffed crab. It wouldn't be unusual if it were presented to customers at a local restuarant, but those offerings and dozens more are part of the extensive food choices available to the 300 patients at Tulane.

Hospitals noted for their food are few and far between. Most patients find little cheer when they were forced to subsist on hospital food. It may be nutritionally correct but it is also bland, boring, colorless and served lukewarm on plastic dishes.

Just because the choices sound terrific at Tulane, doesn't mean they taste that way. But some former patients seem to think the hospital puts out a pretty good meal. They occasionally write and ask for recipes and one actually sent a thank you note after she was released: "The food was so good and attractive that I think I gained at least 20 pounds even though ill."

The man responsible for that kind of fan mail doesn't have the usual credentials fora food service director of a hospital. Wayne Sciacca began "out front" as a waiter at Brennan's Restuarant, reknowned for its breakfasts and fancy cocktails. Eventually, he worked his way into the kitchen so he knows both sides of the house."All my training is from Brennan's. We've developed a lot of recipes here ourselves. I've relied a lot on my experiences from the restaurant."

A few of the simpler things he learned include the importance of talking to each person they serve daily to see what their needs are. "It is a big advantage to have our own people deliver the trays instead of the nursing staff."

Sciacca said they make a special effort to "deliver hot foods hot and cold foods cold which makes for general acceptability among the patients." The food is prepared in groups instead of all at once so that the last patient served doesn't get a meal already an hour old while the first person gets one fresh from the oven. The hot food is put on heated china and covered with a special domed lid to keep it hot.

To make certain that what arrives in the patient's room bears some resemblance to what the recipes called for, Sciacca and his head dietitian often fill out a meal order for a vacant room. They they go back at meal time to see what is delivered.

"You know, there are only two things you can control when you are in the hospital: your food and your TV. So it's very important that you can make a choice," Sciacca said.

Even those on restricted diets are given choices instead of being told: "Sorry you're on a special diet and you can't have . . ." As a result there are four sets of complete menus: regular, calorie controlled, bland and soft, and salt: and fat-reduced. Each 10-page menu that is printed on good quality, multi-colored paper is for the entire week. There are multiple choices for breakfast ranging from an extensive list of juices and fruits and assorted cereals to entrees that include eggs in several different fashions, French toast, cottage cheese or a veal pattie.

For lunch and dinner there are two entrees each day with vegetable. There are sandwiches and main dish salad plates as alternatives.In addition there are nine different appetizers from which to choose, a number of salads and dressings plus 16 different desserts. If none of the above appeals, the staff will take the time, for a fee, to go out and fulfill a specific patient request.

Snacks are served three times a day and can be anything from the standard glass of juice to a sandwiches and a malt.

Sciacca is least proud of the desserts because "a lot are frozen and we don't have a bake shop." The-37-year-old food service director gets a gleam in his eye when he talks about having a bake shop some day because "it would be cheaper and we could produce the unique foods we like."

Almost everything else, Sciacca, said, is made from scratch. "If you've ever tried a frozen Salisbury steak, you'd know why," he explains. "It's like corrugated paper.

"Most of the people who want to sell you frozen foods come in and the first thing they say is: 'you can add this to it or put that in it.' If you have to pay the labor to do those things, you're just adding to the cost twice. I don't see how it would save you money to have the food prepared elsewhere," Sciacca said. "Besides, in New Orleans everyone looks forward to red beans and rice on Mondays and I don't think you can find that frozen."

But he acknowledged that lack of skilled labor can be a problem. When the hospital opened its doors in November, 1976, the food service department had the highest number of untrained employes. At Tulane they do their own training. "It's a critical factor," he said.

Starting a brand new hospital has its advantages, however. "I didn't have to undo anything. No one could come along and say: 'Hey, we never did it that way before.'"

"That way" includes the garnishes on the plate, which must be there before it can be put into the rolling thermal cart: a lemon wedge for the fish, an apple slice next to the beef, paprika sprinkled over the rice.

In a city where the restuarants are historic landmarks people may have higher expectations for their hospital food than they would elsewhere. According to Sciacca the patients are used to gumbo, southern baked ham and eggplant stuffed with crabmeat and shrimp - fresh shrimp. Fresh vegetables and fruits when they are in season, too.

He says there's no reason for them not to have what they want "as long as it is nutritionally balanced and meets any special dietary conditions."

Sciacca says they are "trying to teach good nutrition" by what they serve. "We don't promote soft drinks, but if they ask for it we'll supply it. We don't have that many requests but we're realistic." Which probably accounts for Danish pastry as an item on the breakfast menu.

Sciacca says he doesn't buy the theory that you shouldn't try to teach good eatings habits in the cope with a change in eating habits along with their other problems. "Americans traditionally have poor eating habits and we should instruct them in their diets. The health benefits are obvious."

Of course it all comes doen to dollars and cents, or as they say in the business world, "the bottom line." But Sciacca runs a financially acceptable operation, made poosible, he says because the hospital uses the one-week menu cycle, rather than a four-week cycle that would require a much greater variety of food and more extensive stock. Sciacca said the hospital's patient cost for meals is $9.93 a day, well under the national average of $15.

Good food, well prepared to suit the tastes of the patients. It seems to be a matter of commitment more than a set of regulations. Sciacca believes "you can do the best calculations in the world but if the patient won't eat it, what good is it?"