In late August 2005 a nearly 250-year-old hospital died. New Orleans' historic Charity Hospital was flooded by a rampaging Mississippi River at the height of Hurricane Katrina, was evacuated, and was never to be used again. The building still stands, however, and is at the center of another storm-this one a political controversy over whether it should be renovated or razed outright. When discussing a structure of this antiquity-the current art-deco building was completed in 1939-the answer to this would seem obvious. But it is not. In fact, the New York-based architectural firm RMJM has joined forces with the Foundation for Historic Louisiana and the National Trust for Historic Preservation to show that Charity Hospital can not only be saved, but made into a modern facility, with all the amenities characteristic of today's healthcare design. After extensively evaluating the structure, RMJM has come up with a plan that could serve as a model for ingenious healthcare facility renovation. Meanwhile the National Trust, for its part, is out to preserve not only Charity, but a large New Orleans neighborhood, Mid-City, that would be largely razed for a new replacement hospital-the course that the city prefers, largely on economic grounds. The controversy of the preservationists and Mid-City dwellers vs. the build-new forces continues at this writing, and no firm decision has been made. But the RMJM plan for restoring the old hospital to life deserves attention in its own right. Recently, R. Stephen McDaniel, AIA, Principal and healthcare design leader with RMJM, and Dr. George C. Skarmeas, Founding Principal of the RMJM Hillier Preservation Architecture Practice Group, discussed the idea with HEALTHCARE DESIGN Editor Richard L. Peck.

Richard L. Peck: What was it about this building that led you to believe that it could be remade into a modern healthcare facility?

R. Stephen McDaniel, AIA: As designed in the 1930s, the building was really ahead of its time in terms of floor-to-floor height, column grid, and the elimination of long, straight corridors. Floor-to-floor height is 17 feet on the first two floors, which allows plenty of room for interstitial space for operating rooms and diagnostic facilities; 13 feet on the third floor, ideal for obstetrical space; and 12 feet, 6 inches, which would work well for the patient floors above. The building has 24 elevators designated for for patients and for freight, specifically, so someone understood the importance of access front and back. Its volumetric composition consisting of a three-story podium supporting 12-story vertical bed towers is a very modern concept for hospitals, and its basic H-type footprint allows for lots of daylighting of patient rooms and corridors. Its masonry exterior would cost a fortune to replicate today and presents with only minor and easily repaired cracks from settlement over the years. Finally, the structure can comfortably accommodate a new, glass-covered atrium to serve as a highly attractive entry for patients from all walks of life, not only on public assistance, traditionally, but private pay, as well.

Dr. George C. Skarmeas: The National Trust has really done the right thing in putting Charity on the endangered list. It is a recognized landmark in New Orleans, with a handsome exterior that can be renovated in several ways-comprehensive repair, where needed; removal of the emergency exit stairs, which were an obvious add-ons and inappropriate to the building; and creation of a new lobby, a glass pavilion that can be viewed as an add-on and be removed at any time, if desired-an approach that is fundamental to historic preservation. If there is any way to renovate this building yet retain the historic exterior, it should be done.

Beyond that, the Trust has a serious concern with the proposed use of the historic Mid-City area for a new hospital. New Orleans is known for its unique architectural scale and history. Mid-City is part of that, and to remove buildings that help give the city its character is not the right thing to do.

Peck: What about the interior of the old hospital-is there anything salvageable?

McDaniel: No, it would have to be entirely gutted. Every wall, pipe, piece of ceiling, ductwork for mechanical equipment, and so forth would have to be removed. The entire power system, HVAC system, and plumbing infrastructure, including potable water distribution, waste water management, and medical gases, would have to be replaced. Essentially it would be creating a new building inside an old one.

Skarmeas: To remove the entire inside of a building and create a totally new replacement hospital-a new floor on every floor-is something that is rarely done. This is a unique opportunity to have the best of the old and the best of the new under one roof.

McDaniel: And another key factor: we can do this with the building totally unoccupied. The sheer savings in time, cost, and effort from working under those conditions are substantial.

Peck: You did a cost comparison of the Charity renovation versus construction of a new replacement hospital and showed a substantial difference, correct?

McDaniel: Yes, in construction costs, we estimated developing the new site at $620 million, compared with $484 million for the renovation. Moreover, another $128 million in tax credits would be available to the project, in addition to the $140 million savings. What's more, the renovation would take two to four years less time.

Peck: That seems to be a strong argument for preserving Charity. How do you think this controversy will play out?

Skarmeas: It is too soon to say. I know that the National Trust is participating in all the meetings and hearings on this and is happy to lend all the weight and consideration it can to these issues.

McDaniel: The fact that there are hearings indicates that people are listening. It is clear that we are in a down economy and have to save every dollar we can, so that might lend considerable credence to our position. But we feel there are sound architectural, healthcare, and historical reasons for moving in this direction, as well. HD

For further information visit Contact R. Stephen McDaniel at, and Dr. George C. Skarmeas at

Healthcare Design 2009 November;9(11):96-102