Program History

She couldn’t have known her legacy would be a special place destined to give birth to today’s program in Physical Medicine and Rehabilitation. Her thoughts were surely with the poor of New Orleans, weakened by illness and desperately in need of a caring place to convalesce. With that worthy goal in mind, prominent New Orleanian, Corinne Lapeyre Miltenberger (1862-1930) bequeathed $250,000 to build a convalescent home for the poor on the nationally acclaimed Charity Hospital campus.

In the early 1950s, during the height of the polio epidemic, Dr. Nathan Polmer, a physician who had practiced physical medicine since the late 1920s, joined Charity’s medical staff as Medical Director of the Charity Hospital School of Physical Therapy. Dr. Polmer established Louisiana’s first school of physical therapy in the Lapeyre-Miltenberger Building and admitted the initial class of physical therapists in September 1952.

These events, the pressing need for the employment of rehabilitative skills in the Poliomyelitis Center, the appointment of physiatrist Dr. Nathan Polmer to Charity’s medical staff, the founding of the School of Physical Therapy in the Lapeyre-Miltenberger Building, and the establishment of an EMG service, heralded the very early beginnings of the physical medicine and rehabilitation program in what is known now as the Interim Louisiana Hospital (soon to be University Medical Center).

Later the L-M Building would outdo itself in creating innovative programs. The late 1950s found the L-M Building on the cutting edge of research. After securing a sizable grant, noted Tulane University Medical Center researchers Dr. George Burch and Dr. Adolph Flores had air conditioning installed on the entire third floor of the building in order to have climate controlled quarters in which to study the effects of heat on congestive heart failure. Then in the early 1960s, Tulane’s famed nutritionist, Grace Goldsmith, established the metabolic unit on the sixth floor of the building.

In the mid ’60s visionary administrators in Louisiana Rehabilitation Services, the state department responsible for vocational rehabilitation, promoted the concept of – and prevailed on LSU to staff – a small inpatient unit that would provide restorative services to their more severely physically disabled clients. The program, guided by its first medical director, Norman S. Gilbert, MD, an internist who had a special interest in rehabilitation medicine, was named the Vocational Rehabilitation Institute and commonly referred to as VRI. The goal of this six-bed physical rehabilitation unit was to restore the functional capacities of Louisiana Rehabilitation Services’ vocational rehabilitation clients to a level sufficient to qualify them for vocational re-education. Today’s broad-based clinical program grew out of this modest beginning.

Although Dr. Gilbert’s experience at the VRI solidified his expertise in caring for the survivors of catastrophic injuries and illnesses, the extent of the loss of these patients’ functional capacities, coupled with their abundant medical, social, and economic needs, brought him to the realization Louisiana desperately needed physicians specially trained to care for this widely underserved population. He began working toward the goal of establishing an accredited physical medicine and rehabilitation residency and, in the early ’70s, recruited Dr. Larry McKinstry, a certified physiatrist, to head Charity Hospital’s program. With only three house officers, the program began modestly; however, over time the four-year categorical program, which has enjoyed accreditation since its inception, has grown to its present enrollment of 24 residents.

In 1974 Dr. Gilbert relinquished the directorship of the clinical program to a young rheumatologist, Dr. Joseph J. Biundo, Jr., a former collegiate pugilist who trained under Dr. Gilbert at VRI and received additional training in rehabilitative care at Warm Springs, Georgia, where Franklin Delano Roosevelt, thirty-second president of the United States, recuperated from polio. Shortly after Dr. Biundo assumed the program’s leadership, the physical medicine and rehabilitation residency was folded into the LSU Graduate Medical Education program and found a home in the Department of Medicine’s Section of Rheumatology and Rehabilitation. Dr. Biundo earned certification in Physical Medicine and Rehabilitation and, in addition to managing the administrative and clinical aspects of the program, also directed residency training.

In the ’70s, with a substantial federal grant in hand, Charity Hospital of New Orleans undertook a major renovation of the Lapeyre-Miltenberger Building, air conditioning all floors and converting use of the entire building to rehabilitative care. On completion of the renovations in 1978, this grand old building was renamed the Louisiana Rehabilitation Institute (LRI). It was home to a cooperative effort in physical medicine and rehabilitation between its financial sponsor, Louisiana Rehabilitation Services, and the Louisiana State University Medical Center. Clinically, the physical medicine and rehabilitation program enjoyed its high-water mark in the early 1980s, when inpatient capacity was increased to 48 patients housed in 6- to 12-patient wards on the second and fourth floors of the building. Meanwhile, outpatient services in physical therapy, occupational therapy, speech-language therapy, vocational rehabilitation, and vocational evaluation were in full swing on the first, third, and sixth floors.

The Section of Physical Medicine and Rehabilitation thrived as a blend of specialty skills in PM&R and subspecialty skills in rheumatology until the late 1980s. With faculty pressure increasing within the Section to give more of an individual focus to their efforts, the rheumatologists and physiatrists therein agreed that everyone’s best interests would be served by having separate identities. Administrators at LSU Medical Center heeded that recommendation and in 1989 divided the section’s responsibilities, thereby forming within the Department of Medicine two entities, the Section of Rheumatology and the Section of Physical Medicine and Rehabilitation. Dr. Biundo was selected by the search committee to head the new Section of PM&R, which he continued to do until his retirement in 2002 after 31 years of service. PM&R leadership then passed to Dr. Gary R. Glynn, longtime clinical faculty member and founder of the noted Touro Rehabilitation Center and Touro Brain Injury Program in New Orleans.

Unfortunately, however, hard times were in store for the distinguished old Lapeyre-Miltenberger Building. As the building aged, it was increasingly difficult to maintain. Too, its vertical design, seven stories straight up, with therapies on one floor and patients housed on another, did not facilitate the efficient delivery of rehabilitative care. The Medical Center of Louisiana decided to relocate the inpatient rehabilitation program to a modern, 24-bed unit with semi-private and private rooms located on the Fifth Floor, West Wing of the Charity Campus. The refurbished area incorporated all essential inpatient rehabilitative services. Now patients are housed, receive nursing care, and go to all therapies on the same floor, allowing for easy transport from one area to another. The “new” LRI opened in late December 2003, but that was not the end of the L-M Building’s special role. Indeed, it is still being used for outpatient clinics, physical therapy, and EMG services. It does seem, however, as though the L-M Building is in the twilight of its time. Plans are in the works to refurbish Fifth Floor Center of Charity Hospital and to move the outpatient clinics, physical therapy, occupational therapy, and EMG service next to the inpatient unit, thus forming a contiguous area for all physical medicine and rehabilitation services. Sadly, the devastation of Hurricane Katrina clased the Charity Hospital campus within a year of the opening of the new facility.