The state's new health secretary took exception Tuesday to the size and projected cost of the new teaching hospital Louisiana State University hopes to build downtown, perhaps signaling that Gov. Bobby Jindal will decide in the next few months to redraw the ambitious plans developed under the previous administration.

LSU has tried since the storm to persuade the public of the hospital's importance, arguing that it would revive charity care in the city and serve as a powerful recruitment tool for medical students, residents and physicians. Hospital executives from the private sector have called its $1.2 billion price tag excessive, however, and they appear to have found a sympathetic ear in Jindal.

Alan Levine, the new health secretary, told a Senate panel Tuesday that the cost per bed to build the new hospital -- $2.5 million -- was more than twice the national average. He also challenged some of the assumptions in the business plan, which predicts the hospital will attract patients with private health insurance while serving as the main caretaker of the region's indigent population.

"I'm not aware of any hospital that's been built for $2.5 million a bed. That's very high," Levine said.

State Sen. Derrick Shepherd, D-Marrero, pressed Levine several times to settle on a size for the new hospital by early June. Levine refused to accept a deadline, saying only that he would need at least two to three months to scrutinize the existing business plan, which calls for 484 beds.

He did, however, affirm that Jindal supports the concept of a new hospital, even if the governor is unconvinced about its size.

Lawmakers from New Orleans have fretted in recent weeks that the new administration might not support the hospital where it counts: with the public purse. As the state nears its debt ceiling, talk has flown around Baton Rouge that a $225 million noncash line of credit, approved by the Legislature last year to support the development of the new hospital, might be bumped from the capital outlay budget in favor of other spending priorities.

Charles Zewe, a spokesman for the LSU system, said the university could not wait until June for Levine to give the business plan a once-over. By then, the Legislature will be out of session and the university will have little recourse if money is removed from the capital outlay budget.

LSU is planning its new hospital in partnership with the U.S. Department of Veterans Affairs, which also plans to build a new medical center to replace the one it lost to Hurricane Katrina. The conjoined hospitals would share laundry, parking, laboratories and possibly an emergency room, but not clinical space. It was unclear whether possible delays with the LSU hospital might alter the VA's plans.

"We continue to work very closely together as if this project is going forward," Zewe said.

Treatment trends

As Levine signaled Tuesday that he might want to reduce the hospital from 484 beds, he was joined for the first time by the new dean of Tulane's medical school.

Benjamin Sachs, who took the helm of the medical school only four months ago, affirmed Tulane's support for the hospital. However, he said medicine is evolving in such a way that many procedures that used to require complex surgery can now be performed by precision instruments. That means many procedures no longer require lengthy hospital stays.

He said the hospitals of the future might be only a third of the size of hospitals today.

"With new innovations in the way medicine is being provided, you won't need as many beds as you need today," Sachs said. "Instead of focusing this conversation on inpatient beds, we should think about how sophisticated our outpatient side is going to be. That's very different from the conversation I think has gone on so far."

Tulane and LSU both trained their doctors at Charity Hospital before the storm, and both would use the new public hospital as their main teaching venue. Zewe said he was taken aback at the remarks from Sachs, because Tulane had heretofore marched in step with LSU about the number of beds needed at the new hospital.

"His statements were a dramatic departure from Tulane's previous stance, and a very disappointing turn as far as LSU is concerned," Zewe said.

Advocates for Charity

Since Katrina, a small but persistent group of activists has argued that the state should renovate Charity, a Huey Long-era landmark that was flooded during the storm, instead of spending more than a billion dollars to build a new hospital from the ground up. This group includes James Moises, the former head of Charity's emergency department, who helped fellow physicians and military personnel clean up the hospital after Katrina. He and other activists claim LSU used the storm as a pretext to close a viable building.

Sen. Julie Quinn, R-Metairie, took up their cause at Tuesday's hearing, questioning Levine on whether the state had fully vetted the cost of rehabilitating Charity versus building anew.

"I was there during Katrina when Charity was 'closed,' and I'm sure these fellow senators heard just what I was hearing from the ER doctors inside. There was no reason this place couldn't stay open and treat patients," Quinn said.

"That's what's being said underneath," she continued. "We can no longer not be brave enough to bring it to the surface, because this is a lot of money we're talking about. . . . The speculation and the cynicism are panning out to be accurate that LSU wants a new hospital, and keeping Charity open would further hurt their chances."

LSU had planned to replace Charity even before the storm, and its leadership has argued since that it would be a waste of public money to rebuild a hospital that was antiquated and perpetually risked losing its accreditation because of its poor condition.

Sen. Cheryl Gray, D-New Orleans, looking exasperated, said there was little use in resurrecting the argument that Charity should be reopened when the state had determined before Katrina that the building had limited life in it. She asked, however, whether a few floors of Charity might be temporarily put back into service while LSU makes plans for a replacement hospital.

"Certainly at this point we're not questioning the new hospital," Gray said. "There is a debate, I think, about the use of the current Charity building in the interim, but we're not confusing that with the need for a new hospital."

Dwayne Thomas, Charity's chief administrator, said the hospital could not be partially opened because all of its mechanical systems had failed and mold had infiltrated most of the building. To occupy only a few floors, he said, the building would have to be gutted from "stem to stern" -- an effort he said would not be worth the expense to taxpayers.

Interim measures

Thomas said that Charity's sister facility, University Hospital, is open with 225 beds. That hospital is providing nearly the full complement of services offered at both hospitals before the storm -- just with fewer total beds.

LSU plans to close University when the new teaching hospital eventually opens. Thomas said it would not be efficient to operate two hospitals because basic diagnostic services would have to be duplicated at both.

As early as next week, LSU plans to open an outpatient clinic with 99 treatment rooms that will serve indigent patients. It will be located inside the former Lord & Taylor building on Poydras Street, which LSU converted into a temporary emergency room after Katrina. That facility closed when LSU reopened the emergency room at University in November 2006.

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Kate Moran can be reached at kmoran@timespicayune.com or (504) 826-3491.