New Orleans: ‘The Platinum Lining’

Hurricane Katrina and the floods that followed in 2005 ruined thousands of lives and caused billions of dollars worth of damage. It also provided an opportunity for much of New Orleans to start over. Central to that opportunity was an early commitment of emergency federal funds to construct a new VA medical center.

Catastrophe proved to be the mother of reinvention. The VA hospital complex now rising from a 72-acre footprint between Tulane and Canal Streets is the centerpiece of a biomedical corridor in the making, with a new Louisiana State University Medical Center separately under construction on the same footprint across the street, along with a growing number of research facilities, clinics and other pieces of the puzzle coming into place all around the site.

"The window of opportunity doesn’t come open very often," said American Legion Past National Commander Bill Detweiler, one of many New Orleans veterans who has been actively involved in the project since the storm destroyed all but the top two floors of the former VA medical center, forcing veterans to seek inpatient care elsewhere. "You have this one chance."

A New Orleans VA medical center was not among the highest priorities identified by CARES. The commission instead recommended new community-based outreach clinics (CBOCs) across southeastern Louisiana in an attempt to put VA services within a half-hour’s drive of any veteran in the area. And while the storm and its effects led to an exodus of many area residents, VA patient demand ultimately increased after Katrina.

"Many believe that because there is a catastrophic event, people just leave," said Liz Failla, project coordinator and engineer for the VA hospital project. "Well, people return. It’s your home. People who were not eligible (for VA enrollment) before became eligible because of job losses, income and catastrophic losses."

Prior to Katrina, southeastern Louisiana veterans were served by the VA medical center in downtown New Orleans and two CBOCs east of it, one in Houma and another in Baton Rouge. The need for clinical services was already growing prior to the storm, and seven new CBOCs were recommended in CARES. "What Katrina did was accelerate the plan," Failla said. "We received approval to proceed (with the additional clinics) right after the storm. One thing CARES did not recommend was a new hospital. That was the platinum lining that came out of that awful, awful gray cloud that came over us."

Eleven years will have passed between Hurricane Katrina and the opening of a new, fully operational New Orleans VA medical center. The project is coming together in phases, with its first building – an employee-recruitment center "for the 1,100 people we will need when we open our doors in 2016," Failla said – set for completion late this year. Altogether, the medical center will have an employee base of about 2,400 to serve approximately 70,000 VA enrollees.

The hospital has been slow to materialize for a number of reasons, said Stephanie Repasky, assistant director for the Southeast Louisiana Veterans Healthcare System. "No one had done this before," she said. "They miscalculated how long it would take to process."

As for a $370 million difference between the initial estimate and actual expected cost of completion, Repasky added, "Everyone knew that nothing had been fleshed out. There were no workload projections. It was June of ’06 when that appropriation was set." The initial estimate was $625 million. The new estimate is $995 million. The completed hospital is scheduled to open in 2016.

From the very beginning, the project has included a number of players, including federal, state and local government agencies. LSU and Tulane universities, whose medical schools have had long affiliations with VA, were in the mix. The construction site also had to be cleared of approximately 75 existing structures, many of which were badly damaged by the storm. Historic building preservationists fought the removal of the structures – many of them small houses and rentals – and some property owners put up resistance.

"People, once they found out the government was buying their property, had a different idea about what it was worth," said John Claiborne Baye, Jr., a Vietnam War veteran and Legionnaire who has been involved with the project since the beginning. "There were battles over that."

"A great deal of effort went into working with the neighbors and dealing with the preservationists in the city who didn’t want that site touched at all," Detweiler said. "You were taking 72 acres total between the VA and LSU systems. Change in New Orleans is a very tough thing. That was a problem. (VA) very wisely started meeting with the neighbors once a month. It was touchy. As the meetings went on, the neighbors began to understand what they were trying to do. Even after we got to the point where they started to work on the site, they had monthly meetings to update the neighborhood."

Like the other three VA medical centers in progress around the country, the New Orleans project was delayed by debate about where to locate it and, like Denver, how best to connect with its med-school affiliates.

"Day 1, we put together a command team and an executive advisory team," Repasky said. "The executive advisory team consisted of not just VA. It consisted of a representative of the City of New Orleans, a representative of the regional planning commission, the deans of both LSU and Tulane Medical Schools… it included veteran representation, and it included the VISN (Veterans Integrated Service Network) to make sure we were integrating missions and services across the region."

Baye said the decision to build downtown, rather than another option uptown near the Ochsner Medical Center, was better for veterans. "One thing about the placement of the hospital is that it’s in a position where most of the users can get to it," Baye said. "We have public transportation on both sides, on Tulane and Canal. It’s right near the I-10. It’s very, very convenient to the end user. This was veteran-centric from the very beginning. We were included on every decision."

Once the medical center is finished, more time will have been spent in meeting rooms than on the construction site. "We believe this was about building teams and relationships," Failla said. "What we learned more than anything with the storm is that it’s not about bricks and mortar. It’s the people. We took that philosophy when we came into design. It was not the storm that forced those relationships. It was the leadership and the vision, the philosophy behind it, that if we are going to do this, we need to do it based on people and those relationships.

"We had over 100 veterans and their families involved (in focus groups)," Failla said. "We had a lot of input during the design, and as we continued into construction, we expanded the team. The lines of communication are very, very strong."

A commitment to communicate did not ensure perfect harmony. "Like anything else, you just work through the issues," Failla said. "It’s a huge project. We know there are going to be disagreements. We know there are going to be issues. But it’s a lot harder to let it go down the drain if you and I are having contact and discussions on a daily basis, and have a relationship. We’ve got to work together, mutually, toward solutions."

A combat medic who was wounded three times in the same leg and later had to have it amputated, Baye said VA sought veteran feedback early and often as plans became designs and as designs became work. A wheelchair user until he was recently fitted with a robotic foot, Baye was able to offer one suggestion VA put to use: tilting mirrors in patient rooms so those who use wheelchairs can see themselves.
"That’s a very small thing, but when you have 200 rooms, those small adjustments make big differences," Repasky said. "By bringing someone in in a wheelchair, we were able to pick that up."

"We wanted to make sure we got it right," Failla said. "We had different groups coming in at different times to get their input on everything in the model room – the layout, getting in and out of the bed, going to the bathroom, those sort of things." Each of the 200 rooms is identical in design and will be built to provide close proximity between the nurses and patients.

Initial plans for a single hospital structure shared by VA and LSU were scrapped, affecting time and cost alike, over differences between state and federal design standards and the unique missions of the two facilities. The two facilities will share some specialized care services and maintain, as with VA and Tulane, their med-school affiliation.

New environmental regulations and post-9/11 requirements from the Department of Homeland Security had to be met, without a recent VA hospital project to serve as a model, and with involvement of the public and the veterans community. "We really complied not just with the law but with the intent of the law," Failla said. "We actually modified our designs after public input. I am really proud of that."

Examples of changes made after public hearings included the creation of a buffer zone between the streets and the structures, the procurement of an arborist to design the medical center around mature oak trees that could be saved from the chainsaw, and the incorporation of four existing houses, to serve as models for wounded warriors to adapt to independent living, in the overall site plan. "I really am proud of the way we listened to the community and incorporated, as best we could," Failla said. "In the long run, I live here, too. This is my city. These are my neighbors. After construction is gone, we will all live with this, for the next 100 years or however long (the new hospital) lasts."

The new medical center is designed to withstand southern Louisiana’s often-turbulent climate. It will be built to operate for up to a week, with the air conditioning running and every light turned on, even if every other utility in the city is knocked out. All the drainage systems and water lines around the hospital were also upgraded to handle the area’s heavy rains and possible floods.

As actual work began on the VA medical center, an unexpected problem was the uneven settling of soil at the foundation. Approximately 15,000 truckloads of earth had to be hauled to the site from a spillway along the Mississippi River, further delaying construction.

Once all the meetings, negotiations, structure removal, drainage enhancements and soil problems were handled, actual construction has moved along at a reasonable clip, Failla said. "I think it’s a visual issue. You have to start looking at it from the time it starts coming up from the ground. Guess what? We’re going to be three years."

"It’s going to be wonderful for veterans, for people like me," Baye said. "I’m still a patient. I still use the rehab clinic. Rehab is going to have its own area that is easily accessed from the parking lot. We won’t have to walk a mile to get there, or roll a mile in wheelchairs. Everything is designed around making it convenient for us to get the care that we need."