NEW ORLEANS — After Hurricane Katrina, the shrunken medical staff of the state-owned Charity Hospital worked out of tents, an abandoned Lord & Taylor department store and eventually a cramped interim hospital with scaled-back services. As best they could, they continued Charity’s centuries-old mission of caring for poor and uninsured residents, mostly black, whom other hospitals typically turned away.  Nearly a decade after the storm, the staff made one last move on Saturday, into a $1.1 billion replacement hospital with a pointedly different name, University Medical Center New Orleans. Built largely with federal disaster funds, and run by a private operator under contract with the state, the hospital is being held up as the centerpiece of a much-improved health care system for the poor here.  But while University Medical Center is taking Charity’s place as the city’s main trauma and safety-net hospital, its ambitions go far beyond that, to providing high-end specialty care to privately insured patients from around the state and beyond. For that and other reasons, concerns that began when the state shuttered Charity immediately after Katrina — unnecessarily, critics still say — persist.  “There is a perception that U.M.C. wasn’t built for the population that Charity served,” said Jacques Morial, a community organizer whose father and brother are former New Orleans mayors, and who helped lead a lawsuit over Charity’s closing. “That’s because there’s been no urgency to either replace what Charity represented or rebuild the trust that those who relied on Charity had in it.”  The new high-tech hospital is part of an expanded medical district, spanning parts of downtown and the Mid-City neighborhood, that will also include a new Veterans Affairs hospital and a new rehab hospital. And with 446 beds that are mostly in private rooms, 19 state-of-the-art operating rooms, waiting rooms that resemble boutique hotel lounges and 4,300 pieces of art, including a Dale Chihuly sculpture and a video installation of a blooming magnolia, it is a far cry from the open wards, leaky ceilings and dated equipment at Charity.  “Finally, the quality of care we provide is going to match our physical space,” said Dr. Jennifer Avegno, an emergency department doctor who was completing her residency at Charity when Hurricane Katrina hit. “We have never treated our indigent patients as second-class citizens, but in such a rundown building it was easy for them to think, ‘These people don’t really care much about what they’re doing.’ ”  Two other major changes have affected New Orleans’s safety-net system since the storm. Gov. Bobby Jindal turned over six state-owned charity hospitals to private managers starting in 2013, an arrangement that has shown signs of improving access to care but has proved financially shaky. The hospitals had previously been run by Louisiana State University, which along with Tulane University will provide University Medical Center’s physicians and use it as a teaching hospital.  At the same time, dozens of new community clinics have opened, providing desperately needed primary and mental health care outside the hospital setting. The clinics occupy 60 sites in Greater New Orleans today, compared with a handful in 2004, largely due to federal funds awarded after Hurricane Katrina. Many poor adults get free primary and mental health care at these clinics under a temporary Medicaid waiver program that began here after the hurricane, although it does not cover specialty care.  “Care today is better than what it was in August of 2005, there’s absolutely no question,” said Calvin Johnson, a retired criminal court judge who was involved in the suit to reopen Charity. “People would go to the Charity E.R. and literally stay there for days waiting to see a doctor. So when we talk about how much we miss Charity Hospital, we sometimes forget what the reality of that was.”  Unlike Charity, where many a New Orleanian was born, University Medical Center will not deliver babies — another hospital run by its private operator, Touro Infirmary, offers that service. And it will have far fewer beds for psychiatric patients than Charity, which had nearly 100 inpatient beds plus a 40-bed crisis intervention unit. The new hospital will have 60 psychiatric inpatient beds but will use only 38 to start, transferring patients from a facility that had been housing them since the storm.  “I think it’s grossly inadequate,” said Janet Hays, a community activist whose group, Healing Minds NOLA, has put in a bid to repurpose the old Charity building as a mental health care and research center. “You see people in psychosis on the streets of New Orleans all the time, especially since Charity was closed, and the jails have become the repository.”  Other proposals for the landmark Huey Long-era building include apartments and retail space. The state and L.S.U. insisted that the building was unusable and unsafe after the storm, even after doctors, nurses and military personnel cleaned it and pumped out the floodwater.  Charity was part of Louisiana’s unique system of state-run public hospitals for the poor and uninsured, many of whom relied exclusively on its emergency department for health care. In 2005, more than 60 percent of the patients at Charity and a much smaller sister hospital were uninsured. This year at Interim L.S.U. Hospital, the temporary replacement for Charity, the number of uninsured has been 37 percent and the number on Medicaid has risen to 36 percent, partly because the private operator has carefully screened patients for eligibility.  Mr. Jindal, a Republican running for president, has refused to expand Medicaid to cover more low-income adults under the Affordable Care Act.  Under its contract with the state, LCMC Health, the private nonprofit operator of University Medical Center, is obligated to provide free or reduced-cost care to all indigent and uninsured patients, “subject to the receipt of the required funding.”  Some question whether University Medical Center will be sufficiently focused on that requirement while it is trying to build what its leaders call destination programs to draw more privately insured patients. Even more, they question whether the hospital — whose chief executive, Cindy Nuesslein, resigned last week to take a new job — can succeed in drawing in more affluent patients.  “Obviously they’re going to try to rebrand it, but many people will still look upon it as the charity hospital and I’m sure its competitors will remind people of that,” said John Kennedy, the state treasurer, a Republican. “We’ve got to make it work. We don’t have a choice. Is it going to be easy? No.”  But Dr. Peter DeBlieux, the hospital’s interim chief medical officer, said diversifying the patient mix was crucial to being able to carry on the mission of caring for the indigent. With the Affordable Care Act soon to decrease federal funding for uncompensated care, he said, finding new sources of revenue is imperative.  “The core of this hospital will remain the same,” said Dr. DeBlieux, who was among those protesting Charity’s closing. “But to do it fiscally responsibly, then what you should add to that is destination services. We’ll be able to compete, and everybody wins.”  Charity traced its origins to a grant from a French sailor and shipbuilder, Jean Louis, who died in New Orleans in 1735 and left money in his will to finance a hospital for the indigent of the city, then a colony. Charity opened a year later and carried on that mission in a number of different buildings, the last one of which opened in 1939. The new hospital was built with about $642 million in federal emergency management funds, $279 million from the state and $143 million from LCMC. Greg Feirn, LCMC’s president and chief executive, said he expected to fill about 250 of the new hospital’s 446 beds at first, and to gradually increase the patient population as it develops new lines of specialty care.  Officials at LCMC say it will cost $525 million a year to run the new hospital — up from $430 million for Interim L.S.U. — and with no Medicaid expansion here and a precarious state budget, funding will be an annual concern, Mr. Feirn said. The state faced a significant budget shortfall this year, and it initially provided $113 million less than LCMC said it needed to open the new hospital.  The money came through in the final budget passed by the Legislature in June, but problems remain elsewhere in the system, including a bitter contract dispute between L.S.U. and the private operator running two state hospitals in northern Louisiana. A bigger problem, Mr. Kennedy said, is that the agreements between the private operators and the state rely too heavily on the federal uncompensated care funds that will soon be cut.  “I’m very worried about the costs,” he said.  Mr. Kennedy and others here still regret that Charity’s huge Art Deco building was not quickly reopened after its basement flooded in the days after the hurricane to at least temporarily serve traumatized residents. Dr. DeBlieux said it was “despicable” that people had to seek care in tents long after the storm. But with the new hospital, he said, “we have an opportunity now to do it infinitely better” than at Charity.  “Is this worth the price our patients had to pay?” he said. “That’s far too complex a question for me to answer.”  A version of this article appears in print on August 2, 2015, on page A12 of the New York edition with the headline: Hospital Is Replaced, With Hope of Preserving Its Mission. Order Reprints| Today's Paper|Subscribe
Charity Hospital, which was ruined by Hurricane Katrina, has been replaced with a $1.1 billion hospital, but there are concerns over whether it will continue its history of serving the poor.