Big Charity: The History of Charity Hospital
by Robert D. Leighninger Jr.
Louisiana is the only state in the Union with hospitals providing medical care to those who cannot pay for it. The original New Orleans Charity Hospital was built in 1736 with an endowment from a French shipbuilder. The institution wore out or lost to fire four buildings. The fifth, built in 1832, was falling apart in 1933 when its board of administrators asked that the Public Works Administration (PWA) fund a replacement. The PWA was one of many New Deal agencies established under President Franklin Roosevelt to invigorate the American economy during the depths of the Great Depression. The federal agency made contracts with private firms for construction of public works. In order to cover its 70 percent of the project, the hospital board proposed adding paying beds.
Paying beds in a charity hospital? Betrayal of a tradition almost 200 years old? The idea provoked a howl of protest from members of the Orleans Parish Medical Society. They could not deny that many of the buildings being used by Charity Hospital were in bad shape. The leaking roofs, termite-eaten walls, and caving floors were obvious to casual inspection. Nor could they ignore the overcrowded wards where patients slept two to a bed, in chairs, and on floors. They could, however, argue that the overcrowding was unnecessary.
One problem was that patients came to Charity from all parts of the state. They often, argued the Medical Society, stayed after treatment was completed, while transportation was being arranged. If the patient was a child or an elder, a family member might be staying with him or her in the hospital. This could be dealt with, the Medical Society suggested, by adding charity wards to other hospitals throughout the state. Another cause of crowding, alleged the society, was widespread abuse of Charity facilities by people who could afford to go elsewhere. These were people with political connections, particularly friends of Governor Huey Long.
An underlying reason for the Medical Society’s rush to find explanations for overcrowding other than genuine need was probably fear of competition for paying customers. Charity Hospital historian John Salvaggio reports that “Southern Baptist Hospital and Touro Infirmary claimed that paying wards would put them out of business.”
Alfred Danziger, head of the board of administrators, replied that patients at Charity stayed on average 16.6 days, no longer than those at other city hospitals. He agreed that some prominent people and their relatives had been treated at Charity, but said they were emergency cases. He denied widespread abuse. He noted that the hospital had an average daily occupancy of 2,185 patients in 1932 and had beds for only 1,756. At the time of writing, November 1933, the hospital housed 2,400 patients. In the preceding five years, he said, the number of people served had increased 70 percent.
Squabbles Over Funding
The proposal was rejected by the PWA in December 1933. The financial arrangements were judged inadequate even with the paying beds. The PWA was not sure Charity had the authority to issue revenue bonds. Nor was it sure the state would back the bonds if the revenue did not meet expectations.
The board then made a second attempt. It tried to mollify the opposition by scaling down the size of the proposal, cutting back from $9.85 million to $8 million. The board had originally asked for 2,930 beds; this was reduced to 2,370. The Orleans Parish Medical Society replied with a list of 48 abuses involving treatment of those unqualified for charity. It included Huey Long’s niece, Governor O.K. Allen and his nephew, the son of House Speaker Allen Ellender, a police captain, and a variety of state and Louisiana State University employees. A new charge was added: hospital use figures had been inflated by mass tonsillectomies given to schoolchildren.
In June Huey Long entered the dispute. He marched into a state Judiciary Committee hearing and took over the microphone. He announced that he had a new plan to finance the hospital. The pay beds would be withdrawn, and in their place the state’s corporation tax would be raised from $1.00 to $1.50 per thousand dollars of income. He drafted a committee of doctors, lawyers, and labor union officials and told them to get busy on a new proposal. Long then prodded national PWA director Harold Ickes, assuring him that the loan to the hospital was now “gilt-edged and so secure that there should be no difficulty.” He claimed that the opposing physicians were now converted because he had withdrawn the plan for paying beds.
But the Medical Society had not withdrawn from the field. It saw in the situation an opportunity to gain some control over Charity Hospital. The society announced that it would be willing to accept a total of 2,300 beds, including 360 in the units that would not be replaced. However, there were conditions. The society wanted two members of the hospital board of supervisors appointed from a list approved by the state medical society and two appointed from the Orleans Parish Medical Society. It also wanted to deny the hospital the right to enter into any contracts for medical services.
Ickes’ staff was inclined to favor the project and found little substance in the medical establishment’s opposition. State Engineer Orloff Henry met with the Orleans Parish Medical Society in August 1934. He found “few, in any, of its members have given serious study to the proposed plan.” Orloff noted that although the argument for decentralizing Charity and dispersing beds throughout the state had merit, the Medical Society had done nothing to realize this proposal. He could find no evidence to support the charge of mass tonsillectomies and other abuses. The 48 alleged political favors covered six years.
Henry concluded that the Medical Society membership was “entirely incompetent to express an opinion.” He said their opposition was motivated by fear of “state medicine” and a threat to their financial interests. Their concern with the possible competition was clear enough. The threat of “state medicine” was less clear.
Unlike other states, Louisiana had a tradition of charity hospitals extending back to 1793. Its physicians had lived comfortably with this. Perhaps the expanding of federal and state government during the early New Deal raised the prospect of greater socialization of health care.
However, the arguments between the hospital and the Medical Society were no longer the main issue. The political situation in the state was near the boiling point. Long had ordered the National Guard to occupy the voter registration headquarters in New Orleans, and its machine guns now faced 400 city policemen across the street in city hall. Long’s battle with the city’s entrenched “Old Regulars” political base had reached the point of possible armed conflict. This was not a situation into which the PWA wanted to pump millions of dollars.
Huey Long Versus the New Deal
The election of September 1934 was held without violence, however. The factions negotiated a truce and presided over a relatively fair election. Long’s forces overwhelmed the Old Regulars. The troops went home.
Some hope remained for approval of the hospital proposal into 1935. The legislature had authorized Charity to issue bonds. This authority, said the PWA, had to be tested by the state supreme court. The court test was arranged, and the hospital’s authority was upheld on March 22, 1935. But in the following month Long created the state Bond and Tax Board, and Ickes embargoed new Louisiana projects. Even though Long wanted the hospital, he wanted even more to be able to keep federal projects out of the hands of his enemies.
Delos Smith, an attorney for the hospital, paid a visit to Colonel Horatio Hackett, PWA assistant administrator, to promote the project. During their conference, Hackett told Smith not to expect PWA money as long as Huey Long controlled the state. Smith tried to get Hackett to confirm this in writing, but Hackett replied that “the political activities of any one man have nothing to do with PWA actions.” He did, however, say that he couldn’t approve projects where “a situation of legal uncertainty exists such as has been created in Louisiana.”
After the assassination of Huey Long and the reestablishment of the state’s relationship with Roosevelt in 1936, the laws Long had passed to keep federal agencies at bay were repealed. The way was cleared for a third Charity Hospital proposal. This time only a grant was requested, which freed the PWA from concerns about hospital bond issues. Matters were further helped by the new regulations increasing the size of the grant from 30 to 45 percent. For the state’s share of the project, the Charity administrators could rely on funds from the corporation franchise tax that had been dedicated to it and which, a newspaper noted as early as March 1935, had been “piling up in the banks and … not doing anybody any good.” The project was approved on September 14. The contract went to the state’s favorite firm: Weiss, Dreyfous, and Seiferth.
A Monument to Public Health
The new hospital was to be the second largest in the country. It would rise 20 stories, the tallest building in the city. With it came a 15-story nurses’ building along with an ambulance house, laundry, incinerator, repair shop, and power house addition. The approved cost of the project was $8 million. It soon appeared that it would actually cost $12.5 million. Governor Richard Leche got the legislature to come up with the additional $4.5 million. Weiss, Dreyfous, and Seiferth wanted their fees increased accordingly. After some consultation with well-known architects around the country, the PWA decided to stick to the original contract allowing six percent on the $8 million. It argued that all the work was done before construction costs went up. However, it had no objection if the state wished to pay the architects more out of its own funds. The state did.
The growing cost of the project emerged gradually. The ambulance house and laundry were built first with some cost overruns. It got worse when bids were let for the main building. Orloff Henry decided it was time for a “showdown.” He stopped the bidding until the state assured him that additional money would be available.
The finished building was a grand monument to public health, but it had feet of clay, or, more accurately, sand. No one had attempted to erect such a huge building on New Orleans’ spongy soil. So it was not altogether a surprise when Big Charity began to sink. By January 1939 it was nine inches below its starting point, more than two and a half times the average settlement in the city. Cracks, separations, and distortions proliferated, and the PWA regional engineer Alexander Allaire became concerned that the building’s structural steel frame might be damaged. Allaire, PWA chief engineer Harry M. Brown, and Resident Engineer-Inspector Edmund B. Mason met with architects Weiss and Seiferth. Brown found them “quite complacent.”
Consultants were sought. Karl Terzaghi of Harvard University was retained at $75 an hour. Weiss agreed to pay the fee, probably gnashing his teeth. Allaire wanted a “structural man” so Hardy Cross of Yale University was hired. His services were secured for a lump sum of $6,000. Test borings cost another $4,651.50.
Terzaghi concluded that the architects were not at fault. Longer pilings, which some critics said should have been used, wouldn’t have helped. The gradual consolidation of material under them would have happened in any case. Cross affirmed that the structural steel was undamaged. It would, however, require another $70,000 to repair the building. By the end of 1939, the building had sunk 12 and three-quarter inches and was still going. Terzaghi had originally thought that 80 percent of settlement had occurred. In his final report, he revised it to 70 percent and predicted it might continue until 1950. He was right about the percentage but overly conservative about the time. The building would continue to sink for another three and a half years, coming to rest almost 18 inches down. Rumors that the second story had now become the entry level were a slight exaggeration.
The Ivy League experts did not impress everyone. Charles Fowler, an engineer who had been among those originally recommended for the inspection, called their reports a whitewash and proclaimed himself willing to straighten things out (for only $2,500). He claimed experience on more than 4,000 projects from 1886 to 1939 and to have authored 30 books. Had he known what he was doing, it would have been a bargain. We’ll never know. Despite his impressive credentials, the PWA declined the offer. Another volunteer fixer was a young Tulane graduate named Claiborne Perrilliat. He was no more successful than the veteran Fowler. The crisis passed, the experts were paid and went home to New England, and the hospital opened for business.
A Clean Bill of Construction
Though Huey Long was not able to get Big Charity built before he died, the structure contains a tribute to him and his system of government. Sculptor Enrique Alferez designed an aluminum grille over the main entrance to the hospital. In the center is a flying duck. It is a reference to the deduction, or “dee duct,” box into which state employees put cash “contributions” to Long’s campaigns. They were required to remit a percentage of their salary on designated paydays. When this was called for, the word was passed that “de ducks were flying.” Governor Richard Leche continued the practice and was not amused at Alferez’s reference. According to Alferez, a man with a hacksaw was sent to excise the offending bird. He was intercepted by Times-Picayune reporters who told him that since the PWA had helped pay for the building, his duck hunting would be a federal offense. The duck remains.
Alferez had another interesting story about the building of Big Charity. He claims that Leon Weiss was asked “almost every day” to take money in amounts of $2,000 to $10,000 out of hospital funds to pay off people who were owed money by Governor Leche. He alleges that fire escapes were omitted to save money. In one case, Weiss is said to have approved the omission of one of the six screws in each door hinge at a savings of $5,000. It’s a good story, and it might well have happened on one of Weiss’s other buildings. But it probably didn’t on this one. This project was inspected and audited in excruciating detail. Anything that might have escaped notice or been willfully overlooked during construction would have been caught in the postconstruction investigations.
There were at least four investigations of the bidding process, most having to do with equipment. When the PWA decided that the bidding for the contract to provide sterilizing equipment was improper, its cost ($101,800) was eliminated from the grant. The most serious bidding irregularity involved the contract for the pilings undergirding the main building. It was discovered that the competitors for this contract had all included an “estimating fee” in their bids. This was paid by the winning contractor, Farnsworth and Company, to the New Orleans chapter of the Associated General Contractors of America, which divided it among the losing contractors. This led to the prosecution and conviction. of Farnsworth and the association.
As of the end of 1939, 357 change orders had been submitted for approval. The PWA analyzed 339 of them. Their total cost would have been over $850,000. Almost $150,000 of this was disapproved by the PWA; the rest were withdrawn. In the final reckoning, all these change orders had added only $17,732.50 to the total cost of the $12 million project. The investigation noted that Weiss authorized numerous changes himself without the knowledge of the PWA or the hospital. Many of these were due to the architects’ “inadequate research or investigation of conditions to be encountered, lack of coordination of the respective technical staffs of the offices of the consulting engineers and the office of the architects, … and a situation approaching incompetence with respect to the mechanical layouts and analysis of substitute costs involved in the reissue of pile layouts.” Investigators found various corners cut by contractors, for which the contractors had to reimburse the hospital. However, they found no “evidence of graft in connection with the actions of the Owner, its architects or other officials …”
Not only were the architects and contractors scrutinized, subcontractors were audited as well. Even those who had been eliminated from the project or paid directly by the hospital rather than through the PWA were audited by the PWA. They included some projects as low as $1,400 as well as those of several hundred thousand dollars.
The building itself was gone over thoroughly by PWA special agent Gilbert B. Carter. His 12-page report goes into great detail, listing things like aluminum trim omitted in phone booths. Consistent omission of hinge screws would most likely have been noticed in an inspection at this level.
In another study of the hospital’s finances covering this period, Stella O’Conner concluded that “despite wholesale scandals which later resulted in prison sentences for high state officials as well as contractors and architects associated with the project, comparatively little fraud was connected with the hospital construction.” She notes further: “A force of 30 Federal Investigators was unable to find factual evidence of graft.”
Though it took years of struggle within the state and between the state and the federal government, Big Charity was built. It became “one of the world’s great hospitals” and continues to stand (though a bit lower than intended) as “a model of health care for indigents years before modern federal health-care programs were put into effect,” according to Dr. John Salvaggio, author of New Orleans Charity Hospital.
How long it will continue to stand, however, is an open question.
Because of damage from flooding and subsequent infestation of mold, officials of the Louisiana State University Hospitals, which now runs Charity, want to replace it. After Hurricane Katrina, doctors, nurses, military personnel, and civil engineers from Germany worked with hydraulic pumps to clean up the building. But once the first three floors were scrubbed and the doctors pronounced them ready for use, the medical personnel were ordered out of the building. Dr. Juliette Saussy, director of emergency medical services for New Orleans, believes the building is usable.
Hospital officials have declared it unsafe.
New construction is always appealing, but its apparent financial advantages over renovation may be deceptive. Bringing down such a solid building may be more difficult and costly than it first appears. Whether Big Charity comes down or survives to continue its service to the city, its three-quarters-of-a-century contribution should not be forgotten.
Excerpted with permission from Building Louisiana: The Legacy of the Public Works Administration (University Press of Mississippi, 2007) by Robert D. Leighninger Jr., faculty associate in the School of Social Work at Arizona State University. For more information, log on to www.upress.state.ms.us.
“… to succor the sick” The origins of Charity Hospital
Nothing being more certain than death, and nothing more uncertain than its hour, being stricken with a dangerous bodily malady, but sane of mind, I desire to settle my affairs, explaining how I intend that my last will be carried out by testamentary executor…a sale shall be made of all that remains, which, together with my small lot, I bequeath to serve in perpetuity to the founding of a hospital for the sick of the City of New Orleans, without anyone being able to change my purpose, and to secure the things necessary to succor the sick.
These words written more than 250 years ago are part of the last will and testament of Jean Louis dated November 16, 1735. Jean Louis, a French seaman who built boats in New Orleans, bequeathed his holdings to the founding and maintenance of Charity Hospital, a hospital for the indigent sick of the colony of New Orleans.
Charity Hospital opened it doors at Chartres and Bienville streets on May 10, 1736. It is the second oldest continuing public hospital in the United States. The oldest is Bellevue in New York which opened its doors on March 31, 1736, one and one-half months before Charity. Charity Hospital was initially called Hospital of Saint John or L’Hopital des Pauvres de la Charité (Hospital for the Poor).
Charity Hospital outgrew its first location and was moved to a second building in the year 1743 near a ship-turning basin at the edge of town now known as Basin Street. In 1779 this structure was nearly destroyed by a hurricane. Only the kitchen and storehouse were left standing and served as the hospital quarters holding six beds.
Charity was rebuilt a third time in 1785 in the same location and was called the San Carlos Hospital in honor of King Charles III, King of Spain. (The Isle of Orleans was ceded to Spain in 1763.) The new structure had 24 beds but was lost to fire in 1809. Three patients died in the blaze and a fourth died soon after from “fatigue of removal.” After the San Carlos was destroyed, patients were housed in the upper gallery of the Cabildo (then serving as City Hall) for one month; following this they were moved to the Jourdan residence in the Faubourg Marigny for six months until Madame Jourdan reclaimed her home; finally patients were moved to the dilapidated De La Vergne plantation for five years while awaiting the building of a new hospital.
In 1815, the fourth Charity Hospital was erected. The site was on Canal Street where the Fairmont Hotel is now located, then a remote, swampy area of the city. In only three years the conditions were so deplorable that a group of visiting citizens reported to the governor that Charity “served no purpose than to confine the wretched and compel them to die in a place contrary to their choice.” Patients were found almost abandoned. The hospital was dirty, and with a lack of blankets, sheets and laundry facilities, it was deemed a “deep disgrace to any civilized or Christian country.” Chickens roosted in the hospital rooms and their offal covered the furniture. Patients slept on mattresses on which “were the visible marks of the putrid discharges of those who had died on them of the most pestilential diseases.”
The fifth Charity Hospital was built in 1832. In 1834, the Daughters of Charity assumed control of operations. Charity enjoyed a time of skillful nursing care. The Daughters of Charity opened their own hospital, Hotel Dieu, in 1859. After more than 100 years of service in the same building, the sixth and current hospital was built in 1939. At the time it was the second largest hospital in the United States with 2,680 beds.
– Excerpted from the Web site of the Medical Center of Louisiana at New Orleans: www.mclno.org.