Campaigning here in 1936, President Franklin D. Roosevelt visited Sister Stanislaus, the revered nurse-administrator of Charity Hospital. Painting a dire portrait of a 1,800-bed facility teeming with 2,700 patients, the nun begged Roosevelt for money for a new public hospital. Three years later, thanks to $3.6 million from the federal government, Sister Stanislaus opened a new 20-story hospital, the most modern of its day.
It became one of the Unites States' most storied health care institutions, a place where Michael E. DeBakey -- pioneer of the first artificial heart -- trained, military surgeons learned how to treat gunshot wounds amid urban crime, and Mayor C. Ray Nagin, hip-hop star Master P and Democratic consultant Donna Brazile were born. But today, Charity is padlocked, another victim of Hurricane Katrina.
Some suggest the Charity complex -- including the main "Big Charity" hospital, its sister University Hospital, research labs and offices -- should be razed. Others demand it be rebuilt. And because any public hospital here -- new or old -- would be built with federal dollars, every U.S. taxpayer has financial a stake in the fight.
But the debate over Charity, once the linchpin in this city's health care system, has come to symbolize much more than a battle over a cherished relic. Providing medical care is one of the most daunting challenges for New Orleans as it rebuilds, and the choices made now will determine whether one of the nation's poorest cities can adequately care for its legions of uninsured.
Katrina damaged more than a dozen hospitals and uprooted thousands of private physicians. Now, nearly three months later, health care remains scarce. The last military medical unit in the city is gone, leaving only Touro and Children's hospitals partially reopened.
At the emergency room at Oschner Clinic Foundation in neighboring Jefferson Parish, visits are up 35 percent over this time a year ago, the number of uninsured patients has tripled and some wait as long as 10 hours for care, emergency chief Joseph Guarisco said.
But for most of the 25,000 clean-up workers -- many of them uninsured -- and an estimated 75,000 residents, health care is delivered in military tents that recently moved from a parking lot to the concrete floor of the convention center.
"Now my fear is the entire country will think it's appropriate to care for our patients in a tent," said Peter DeBlieux, director of resident training at Charity. "I don't think the rest of the country appreciates we are seeing people in a tent."
Even with the city deserted, his team sees about 150 patients a day. Many end up in the tents even though they have insurance, because they cannot find their personal physicians or cannot bear the longer waits in Jefferson Parish.
The complex dubbed "Spirit of Charity" has a lab, a pharmacy, an intensive care unit and dental stations. Charity, which had 325,000 outpatient visits last year, has even relocated its rape crisis unit, a specially trained team that stays with a patient through court proceedings -- an approach DeBlieux said increases prosecution rates threefold. Still, the makeshift operation does not meet federal standards, so Charity has been unable to bill Medicaid or Medicare.
The lack of health care -- and the ripple effects on medical education and the local economy -- prompted three House Democrats to write Comptroller General David M. Walker, warning of a "potentially catastrophic public health crisis." In the immediate term, a single bus crash or influenza outbreak would instantly overwhelm the limited number of health care providers in the city, they warned.
Over the long term, "no one's going to come [to New Orleans] without access to medical care," said Rep. Bart Stupak (D-Mich.), who signed the letter. "You will never get the reconstruction until you get some basic services like health care. If we can rebuild Iraq, we should be able to rebuild the Gulf."
With a population that swells to 250,000 on weekends, when many residents return to make repairs, the city is well short of the nearly 600 hospital beds it needs, said city health director Kevin Stephens.
Engineers hired by Louisiana State University, which manages the hospital, say "Big Charity" and University are not salvageable. With no revenue coming in, all but 250 of the hospital's 4,000 employees have been placed on leave without pay. Headhunters are swarming in, and several of the medical school's top researchers have warned that if they cannot resume work by year's end, they -- and their $7 million in grants -- will go elsewhere.
"We're out of cash," said Don Smithburg, chief executive of LSU's Health Care Services Division, after his fifth lobbying trip to Washington. Smithburg hopes to use hundreds of millions in federal disaster-recovery money to finally erect a hospital that has been on the drawing board for more than a decade. He contends it is an opportunity to provide more efficient, modern care.
Charity's supporters, including many of the doctors who have patrolled the wards for decades, counter that although it is dilapidated, the hospital Roosevelt helped build is needed today more than ever. Abandoning it would mean bidding farewell not just to an institution but to the region's only Level 1 trauma center -- capable of handling multiple life-threatening cases -- and the only major safety-net hospital in a city with high poverty and crime rates.
"From a structural point of view, it's totally sound," said Dave Rivard, a construction engineer and volunteer with the nonprofit relief group Airline Ambassadors. "The key to this whole story is that the decision to demolish this building certainly was not done after an exhaustive study. And it will take three to five years to build a new indigent hospital in New Orleans."
LSU officials are negotiating to lease space from Oschner Clinic Foundation for a temporary trauma center, Smithburg said. But he believes it would be a mistake to rehab "Big Charity."
"It's really not a good use of taxpayer dollars to renovate," he said, estimating that reconstruction would cost $250 million, compared with $350 million "for a more efficient, modern facility." Others, such as Rivard, dispute the cost estimates.
Regardless, much of the money will come from the Federal Emergency Management Agency, which provides funding for repairs to return public buildings to pre-storm condition. FEMA infrastructure chief David Fukutomi said federal rules also allow that money to be applied toward the cost of a new building. "This is a fantastic opportunity to implement a vision for the future," he said.
For decades, Charity and New York's Bellevue Hospital Center -- both opened in 1736 -- have squabbled over which is the longest-running public medical institution in the nation. What is indisputable is that through 270 years, a citywide fire, hurricanes, the Civil War, smallpox, yellow fever and AIDS, Charity has always been open to New Orleans' neediest patients. The prospect of that rich history coming to an end, in a city already reeling, is almost eerie to some here.
"The disaster is not over in New Orleans," said Oschner chief executive Warner Thomas. "The silent disaster will be when we get into wintertime with not enough personnel and not enough health care beds."