The Future of Charity Hospital

Charity Hospital has risen, phoenix-like, from decimation in the past. It has been destroyed by hurricanes and fire. Charity may yet rise again. And yet perhaps Katrina’s catastrophic flooding was simply the final, tragic step in Charity’s slow decline. Much has changed in the healthcare environment since Jean Louis founded the hospital for the city’s poor. What ultimately happens to Charity Hospital is predicated on three questions: What is the best way to provide health care to those who are too poor to afford health insurance? How best to educate future physicians? And what is the best way to model the city’s hospital capacity based on actual need? The answers to these questions have only begun to be addressed by federal, state and local officials.

The debate over whether to reopen Charity is less about Charity and more about how the poor and uninsured should receive medical care in the city. There are two currents of thought on this matter. The first feels that there will always be a large poor population in New Orleans and therefore a large uninsured population. For this reason, a safety net must exist to care for those persons when ill. This view holds that a large, public financed hospital is the best way to ensure this. The other view feels that rather than concentrating federal and state money into a separate charity budget that funds an ageing and inconvenient hospital, that money is better spent in some way following the patient. That is, if money is tied to a particular patient, a patient can obtain care wherever he or she chooses. With the closing of Charity, many uninsured patients are now seeking care at private hospitals such as Ochsner and Tulane. These hospitals feel strongly the state or federal government needs to reimburse them for uninsured care.

Federal officials have indicated Louisiana’s archaic two-tiered system (that is, one tier for those with insurance, and one for those without) must be changed. Much of the current debate is over how to shape that new system.

At the same time, LSU officials feel their educational mission has been severely compromised with the loss of Charity, and that a new hospital must be built with state funds. Perhaps this hospital would address many of the problems the old Charity had: inadequate facilities, lack of proper infection control, a dwindling emphasis on research. In this way a new LSU hospital, perhaps part of a joint venture with the VA, could be a boon to the city in terms of innovative patient care and new opportunities for research. At the same time, two potential problems exist. The first is whether New Orleans’ smaller population warrants another large hospital, or if current facilities can be better utilized to meet healthcare needs. The second is how this hospital fits into a state financed charity system, if that system continues to exist. In contrast, Tulane’s educational mission was much better positioned after the storm, due to its private hospital and affiliation with Ochsner and other city institutions.

Tulane’s rich and storied history with Charity continues. The mission of service to the poor and needy continues unabated within the student body and faculty of Tulane. How that mission becomes reality, whether through a new Charity hospital or through new and existing relationships with other healthcare facilities in the area, remains to be seen. Tulane and Charity have endured many upheavals throughout their history, and current times are no exception.

Adapted from the following sources:

Salvaggio J. New Orleans' Charity Hospital: A story of physicians, politics, and power. Baton Rouge: Louisiana State University Press; 1993.

Kostmayer HW. The Tulane School of Medicine: 1834 - 1960. The Bulletin of the Tulane University Medical Faculty. 1961; 20(4):219-239.

A Short History of the Ambulance Corps. Jambalaya, the Tulane University Yearbook, 1905.

Ochsner J. The complex life of Rudolph Matas. J Vasc Surg 2001;34:387-92.

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