Politics more than need explains plan for N.O. hospital
It’s not so much that it’s a matter of one hand of government not knowing what the other is doing, but a complex interplay of genuine need and political wants which explains why the state and City of New Orleans both are building hospitals just miles from each other.
That what essentially are two replacement hospitals now are rising in the city that will increase beds available, more than ever as with the coming new Big Charity if a new hospital beyond the present urgent care clinic must be built, it should be pared back. But as with the planned Big Charity, this seems unlikely, providing a double hurt to the New Orleans citizenry – paying for a portion of Big Charity’s building and of the operating subsidy, and footing the entire bill for the New Orleans East facility and for its management fee, when neither need to be as expansive as contemplated.
The state continues with its effort to build a brand new charity hospital in New Orleans to replace the in-the-breach interim facility just west of the building site. This new facility has faced criticism over its size in a market already above the national average in beds per thousand population (about 10 percent higher at 3) and consequent cost. Yet simultaneously the city is building a facility in New Orleans East around the site of the old Methodist Hospital, to be operated by a nonprofit religious organization but governed and funded through the Orleans Parish Hospital Service District A, a state-created entity but a component of New Orleans.
The legal structure of this district intends to operate a hospital as an enterprise, without use of taxpayer funds other than a city payment to run it. To date, its funding has come from grants or in-kind contributions and revenues from opening an urgent care clinic. But the intent is for the creation of a full-service hospital even though it would create even more beds in the New Orleans metropolitan area and with 80 beds ridiculously over-bed New Orleans East at about 10 per thousand. The compelling argument, claims the city, is that no emergency services presently cover in the area without having to go over a major patch of water – six traffic spans to the west to other New Orleans/Jefferson hospitals, two east to the Slidell area, and one south to St. Bernard. Thus, potential bottlenecks exist that could cost lives in an emergency situation.
In reality, this kind of situation is not one that is considered an absolutely intolerable hazard. In south Bossier City, for example, only the two-lane Jimmie Davis Bridge connects that area to south Shreveport and two hospitals not far away. If the bridge is blocked, even with sirens screaming and swerving driving it will take an ambulance at least 15 minutes to weave through street traffic to north Bossier or to go over the more northern Shreveport-Barksdale Highway Bridge and then head south or further west to get to a hospital. Yet this is not considered to be an unconscionable threat to life. In New Orleans East, with realistic seven options west and south, even at high-trafficked times of day enough exist for successful emergency rides with odds hardly worse if at all than heading to Read Blvd. on or off I-10.
Nor does that reasoning require establishment of a full-service hospital. Setting up an emergency room with some satellite beds does not require the full infrastructure planned. Admittedly, more beds are better than less, but the problem comes in paying for them. The city will issue debt to pay for the $130 million worth of construction, which then becomes taxpayers’ responsibility along with the management fee. Moreover, given the over-bedded nature of the market, with more to appear soon with the building of the new Big Charity, it’s quite questionable whether the hospital can operate in a way that would make it worthwhile for a contractor to make money without the city raising its incentive.
So politics more than genuine need explain why the city has plunged forward with the plan in its present form. Mayor Mitch Landrieu has made a major effort to getting the facility as planned in order to curry favor among mainly black political elites and residents in the area, given the heavy concentration of blacks living there – an important consideration as a white mayor in a majority-black city. Also, as the state continues to reshape its public hospital system into a more efficient model with greater non-government involvement that should reduce those kinds of beds, Landrieu with future political ambitions in mind can claim he is doing the opposite and expanding public beds, hoping enough of the voting public buys the facile argument that these truly are needed without considering the costs to taxpayers. Already his surrogates are taking veiled jabs at the state’s strategy.
Posted by Jeff Sadow at 09:25