HEALTH CARE IN JEOPARDY : DISPUTE MAY FORCE AIDS PATIENTS OUT HUNDREDS TREATED AT EVMS TOLD THEY MAY NEED TO FIND NEW DOCTORS.(LOCAL) - The Virginian-Pilot (Norfolk, VA)

Byline: LIZ SZABO AND MEREDITH KRUSE THE VIRGINIAN-PILOT

NORFOLK -- A contract dispute between the city and doctors at Eastern Virginia Medical School could force hundreds of impoverished AIDS patients to find new doctors within the next week.

The crisis stems from the way health care for uninsured patients is administered. Public health officials say the region's network for treating people with HIV is in ``immediate jeopardy.''

Hampton Roads is hit harder by the disease than any region in the state. Because of the high number of people infected, the region is eligible for money provided by the federal Ryan White Act, which pays for medical care for patients with no other insurance.

Shirley Tyree, the city employee in charge of Ryan White funds, said EVMS uses a billing method - in which doctors receive a set fee per patient - that's not allowed by the federal government. Norfolk officials say they would like to keep working with EVMS, but the school needs to follow specific rules.

Dr. Edward C. Oldfield III, director of the infectious disease division at EVMS and the physician who built its system of satellite clinics, said he has been billing the city the same way for three years. He said there is nothing in federal law that prohibits billing this way.

EVMS sent letters to its patients Monday notifying them that care may no longer be available. EVMS treats about 1,200 AIDS patients, including 400 through the Ryan White program.

Many local AIDs patients are upset at the prospect of losing treatment at EVMS clinics.

``I've been HIV-positive for 14 years and never been sick a day, and part of the reason for that is the care I get at EVMS,'' said Gerard Mills of Newport News. ``I'm living proof that this system works. I can't believe that we have this kind of clinic network in place and they are going to destroy it.''

Local doctors uniformly praise the medical school's system of 11 clinics - located as far away as Gloucester and the Eastern Shore - which provide one-stop shopping, including case management, primary care physicians and HIV specialists. Doctors and nurses at EVMS have worked to procure tens of thousands of dollars in free, life-saving AIDS drugs to hundreds of local patients before the medications are officially approved by the FDA.

Integrated care is essential for people with AIDS because many are homeless, extremely sick and have no transportation, Oldfield said.

Iris B. Jessie, an assistant city manager for Norfolk, said federal officials told her that the region's overall costs for medical care were too high and needed to be reduced.

Oldfield, one of Virginia's leading infectious disease experts, said his costs are about average.

Norfolk officials offered to allow EVMS to care for AIDS patients in South Hampton Roads, but wanted to close the medical school's clinics in Williamsburg, Hampton and Newport News. Tyree said it's more cost effective to send AIDS patients from those clinics to the Peninsula Institute for Community Health in Newport News.

Oldfield is concerned that Peninsula patients won't receive top-quality care. The Peninsula Institute for Community Health has no infectious disease specialists on staff, but its doctors can refer patients to other offices.

Norfolk officials said not all AIDS patients need care from an infectious disease specialist.

``The majority of our patients are not sick sick,'' Tyree said. ``They may only visit the doctor once a quarter. They don't have to see an infectious disease expert every time.''

Oldfield said he refused to provide services only in South Hampton Roads, arguing that it's unethical to provide top-quality care to patients here but force Peninsula patients to shuttle between offices. One of Oldfield's patients lives north of Williamsburg, suffers from AIDS-related diarrhea and can't tolerate driving to Norfolk - which takes two or three hours roundtrip.

Lenore Drewry, executive director of the Williamsburg AIDS Network, said she's concerned that a successful medical system is being dismantled piece by piece.

Patients who live far from the few remaining clinics will have to spend money on taxi cabs or bus fare, Drewry said. They often are also forced to travel to pick up medications.

Jessie said city officials simply want to spend grant money efficiently to reach as many patients as possible. The grant now pays for about 500 patients, only about 10 percent of the estimated number of HIV-infected people in the region.

Tyree said AIDS patients will be seen not only at the Peninsula center, which also operates a clinic in Suffolk, but at the Norfolk Health Department and by Dr. Angela Mercer, a Norfolk internist, and her partner. She said they could also be seen by the Chesapeake Health Department.

But the Norfolk Health Department is already ``at capacity'' and can't handle an influx of new patients, said medical director Dr. Valerie Stallings. She and other local health directors wrote a letter to Norfolk Mayor Paul D. Fraim about their concerns.

``HIV services to our respective populations are in immediate jeopardy,'' the doctors wrote.

``We can't provide AIDS care if it's not in conjunction with EVMS,'' said Dr. Nancy Welch, the Chesapeake Health Director. ``They have the hospital care and the infectious disease expertise. We've never been set up to handle this.''

The physicians who treat HIV patients at the Norfolk and Chesapeake health departments also lack hospital admitting privileges.

Because the Ryan White Act does not cover hospitalization costs, EVMS doctors traditionally have taken care of patients in the hospital for free, Oldfield said.

Dr. Angela Mercer, who said she and her partner have agreed to see 100 Ryan White patients, said she plans to refer patients who need infectious disease care to a Norfolk specialist. She still hopes to work with EVMS.

``We're hoping that this will be a partnership,'' Mercer said.

Lynn Earle, a nutritionist whose Ryan White funding has been cut, said she is worried that patients will go without care or medication.

``There are going to be patients with nowhere to go,'' she said. ``What is that going to do to this pandemic?''

Reach Liz Szabo at 446-2286 or lszabo@pilotonline .com and Meredith Kruse at 446-2164 or mkruse@pilotonline.com

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Color Photos

L. TODD SPENCER/THE VIRGINIAN-PILOT

Dr. Geraldine Stott examines an AIDS patient at the Eastern Virginia Medical School on Tuesday. A contract dispute between Norfolk and EVMS doctors could force hundreds of impoverished AIDS patients to find new doctors within the next week.

Shirley Tyree, right, the Norfolk city employee in charge of Ryan White funds, is looking for ways to cut costs for medical care and still reach as many patients as possible.

Dr. Edward C. Oldfield III, right, director of the infectious disease division at EVMS, said his costs are average. He questions why AIDS care is being singled out for cost cutting.