Closing the Door

Left Field by Patricia Nell Warren

San Francisco is back in the AIDS news, and the news is not good, according to my friend Patrick Monette-Shaw. The trend is to close ever more doorways to healthcare, especially in the AIDS field.

Since the “City by the Bay” has never seen fit to appoint an AIDS-accountability watchdog, Patrick has appointed himself the ICO/AARI (Independent Community Observer/AIDS Accountability Research Investigator). One situation he’s watchdogging is the project to downsize the city’s Laguna Honda Hospital and Rehabilitation Center. LHH has been a longtime model of skilled nursing for the city’s indigent elderly. “Downsizing” may mean not only 300–400 fewer beds (raising the city’s looming skilled nursing facility bed shortage to perhaps 2,500 beds), but also a narrowed access to the services there. LHH will be admitting more patients with dual or triple diagnoses (meaning two or three different problems or diseases). Indeed, according to Patrick on his Web site, “Increasingly in San Francisco, unless you have multiple diagnoses, your access to public health services is being curtailed.”

Patrick Monette-Shaw feels so strongly about the Laguna Honda downsizing that, in November, he filed a lawsuit to stop it, alleging in addition that $25 million has been misappropriated from the project. The lawsuit was filed by public health and public-interest lawyer Lynn Carman.

Worse, Patrick points out that access to care is being narrowed elsewhere, within AIDS integrated-service programs (ISPs) that are funded with Ryan White money. Patrick notes: “Our CARE Council imposed ISP eligibility requirements to those who are dually- and triply-diagnosed, setting the stage that others with a single diagnosis—say, AIDS without a co-issue of a mental health or substance abuse problem—will be ineligible to receive care at the ISPs, leaving them to fend for themselves.”

Gee, wasn’t San Francisco viewed as a model city of AIDS care at one time? Do we see the San Francisco city fathers out there fighting for sick people? I have to wonder, judging by a recent report by Patrick in which he alleged that the city is stonewalling widespread protest over the LHH downsize. He wrote:

“An LHH Replacement Team’s community Town Hall meeting—long scheduled for November 3rd—was mysteriously replaced by a ‘Community Advisory Group’ meeting on the same date. Then the second meeting was suddenly cancelled. Both meetings were combined with the November 16th Health Commission meeting, but no topics concerning LHH ever appeared on the November 16th agenda. The City is using the tired, old political trick of either canceling completely, or moving, meetings at the last moment to keep the public from knowing what their government is up to.”

But San Francisco isn’t the only place where doors are closing. In Maryland recently, an infectious-disease specialist announced that he will stop treating AIDS patients. Dr. Paul D. Rausch wrote in a letter to his patients at the end of September, “I can no longer assume the additional liability of caring for complex and complicated infectious-disease patients.” With Rausch’s practice closed, just one physician will be left in that entire county to care for over a hundred patients.

Elsewhere, advocates of an alleged “moral right” to refuse medical care are making alarming headway. The last time I reported on this, the so-called “conscientious objectors” were busy passing state laws, notably in Michigan. Meanwhile a federal bill is quietly snaking its way through Congress. The Abortion Non-Discrimination Act (HR 4691) makes it legal for healthcare providers to refuse to participate in abortions on moral or religious grounds. The bill passed the House and is now on the Senate calendar. If signed into federal law, it will open the door in all fifty states to the “moral right” to deny care in other situations as well. We all know that this will include AIDS patients, gay people, transgendered people, and many others.

I continue to be baffled at the shrill rhetoric over “saving people with AIDS in developing countries.” How about saving our own people? U.S. quality of care—especially for PWAs who don’t have bulletproof insurance or a lot of personal wealth to throw at their medical bills—is sinking to the level of that in developing countries. In turn, our decaying AIDS care is only a reflection of deeper decay in our national conscience. In the words of an outraged doctor friend of mine: “I see religious zealots who are more interested in cells which have not yet found their nine-month home in the uterus of a woman than they are about the patients who die every day because of a lack of access to adequate, humane healthcare.”