Byline: LIZ SZABO THE VIRGINIAN-PILOT\
NORFOLK -- Doctors at Eastern Virginia Medical School have rejected the city's latest offer for treating indigent AIDS patients.
Norfolk officials, who administer AIDS-treatment money in the region from the federal Ryan White CARE Act, cut off the medical school's funding under that program April 11. The action followed months of wrangling with EVMS over billing methods and other issues. Funds from Title I of the Ryan White program pay for the care of AIDS patients with no other insurance.
EVMS officials described the city's most recent offer, which they received Monday, as unworkable.
Dr. Edward C. Oldfield said that Norfolk's plan would dismantle the medical school's system of 11 clinics, which had allowed AIDS patients to get ``one-stop shopping'' and obtain medical care and social services in one appointment.
About 350 patients formerly treated at EVMS under the Ryan White program must
now find new primary-care doctors. Medical school doctors treat about 1,000 other AIDS patients in the area, including those served by Medicare and Medicaid.
``I've treated AIDS patients for 21 years, and I've suffered through many deaths, but I've never suffered through the death of a comprehensive system of care,'' said Oldfield, director of the EVMS division of infectious disease.
``It's hard enough to fight AIDS in a community as a team, but when you have another group of people trying to sabotage your work, it's impossible.''
Norfolk City Manager Regina V.K. Williams said she regretted that the city and medical school couldn't reach an agreement. In an April 16 letter, the city had offered EVMS about $750,000. The offer would have allowed EVMS to resume seeing patients even before a formal contract was signed, Williams said.
``I thought we were headed in a pretty good direction,'' Williams said. ``Having personally intervened in this, I think I have been responsive to Dr. Oldfield and wish he would have met us halfway. . . . I hope to get back to the table.''
She said she hopes to involve Norfolk Mayor Paul D. Fraim and EVMS' president, Dr. J. Sumner Bell, in future talks.
In a letter to Williams, Oldfield complained of ``inordinate administrative burden and lack of customer service'' caused by the city.
Patients say they're already having trouble.
A local AIDS patient who used to go to EVMS said she has been referred to the Norfolk Health Department. But the public health clinic can't see her until the end of May, she said. In the past, EVMS doctors or nurses never made her wait more than a day or two.
``I can't imagine this is being done to so many lives,'' said the woman, who asked that her name not be used. ``I know it's political, but this is unbelievable.''
In his letter to Williams, Oldfield said those who run the Title I office in Norfolk have failed to recognize ``the true costs of delivering HIV and AIDs care'' and have no ``plan to improve customer service.''
In rejecting the city's offer, Oldfield cited several examples of critical problems. For example:
The latest plan provides for no outpatient care in James City, Williamsburg and York County.
Physicians are no longer allowed to treat AIDS patients for sexually transmitted diseases or perform PAP smears, Oldfield said. Instead, patients would have to seek care at the health department.
City officials have not yet found a replacement for an experienced nutritionist, whose Ryan White funding recently was eliminated.
Ryan White patients may receive prescription drugs from only one pharmacy, which is closed nights and weekends, Oldfield said. That pharmacy does not deliver outside of Norfolk, making it difficult for patients on the Peninsula to obtain critical drugs, especially if they lack private transportation.
Williams said many of Oldfield's complaints are not directly related to EVMS funding.
Williams said part of the philosophical gulf between Norfolk administrators and medical providers stems from different interpretations of the purposes of the Ryan White program.
The act's stated intent is to meet the ``unmet health needs of persons living with HIV disease by funding primary health care and support services that enhance access to and retention in care.''
Williams said Ryan White funds were intended to provide emergency medical care only and to serve as a last resort, not a lasting provider of health care. She sees the goal of the program as largely serving short-term needs.
``We need to find the funding for a comprehensive medical system, but I don't think that Title I is it,'' Williams said. ``We have to step back and say, `Are we trying to do something with these grant funds that they were never intended to do?' ''
Reach Liz Szabo at 446-2286 or lszabo@pilotonline.com
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Dr. Edward C. Oldfield of Eastern Virginia Medical School says Norfolk's funding offer would dismantle EVMS' AIDS-treatment network.
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