STATE IGNORED HIV LAW, JUDGE SAYS

Gov. Arnold Schwarzenegger’s administration flouted a six-year-old state law by failing to enact a program intended to provide medical care to impoverished Californians with HIV, a Los Angeles County Superior Court judge ruled in a decision made public Thursday.

Writing that the state “has not fulfilled its statutory obligation,” Judge James C. Chalfant ordered the state Department of Health Care Services to carry out the program, which is supposed to help people with HIV -- but not AIDS -- obtain treatment through the state’s Medi-Cal program for the poor. Medi-Cal already covers people once their illness fully develops, when the cost of care is often much higher.

Hundreds or possibly thousands of people with HIV have lost out on healthcare because the state resisted enacting the law, said Michael Weinstein, president of the AIDS Healthcare Foundation, the Los-Angeles-based nonprofit that brought the lawsuit.

Weinstein said the healthcare department “never had any intention of enforcing this law because they thought they had a right to determine which laws they enforce or don’t.”

Department officials said they hadn’t fully reviewed the ruling or decided their next step but reasserted that they had acted appropriately and that the law would not work.

More than 1 million Americans are HIV-positive and about 56,300 annually contract the infection, according to the federal Centers for Disease Control and Prevention. About 15,000 Americans die of AIDS each year. Some of the largest concentrations of people with HIV and AIDS are in the Los Angeles and San Francisco areas.

The 2002 law, signed by then-Gov. Gray Davis, ordered the department to encourage AIDS patients to voluntarily switch from expensive fee-for-service treatments to more cost-effective managed care, with the goal of using the savings to help cover people with HIV. At the time it was hailed as a major step in combating AIDS.

But the judge ruled that the healthcare department failed to take some of the steps required by the Legislature and made lackluster stabs at completing others.

The ruling faulted the department for a minimal effort in reaching out to AIDS patients to encourage them to move to managed care. Chalfant wrote that without evidence, the department assumed that federal medical privacy laws would prohibit it from contacting people.

The state’s outreach efforts were limited to holding meetings with activists and medical providers who treat such patients and distributing fliers to patients in only three counties on one occasion, according to the ruling.

The judge wrote that it was “clear” the department “simply has not done the necessary outreach and awareness activity to encourage AIDS patients to adopt managed care.”

Norman Williams, a department spokesman, said officials continue to believe that the law will not work because the state’s managed care programs for AIDS patients -- which now enroll about 1,800 patients -- cost the state more than fee-for-service programs do. The law explicitly said the state could not run up extra costs to extend Medi-Cal to HIV patients.

“Our analysis of that bill was it was not possible in a cost-neutral environment,” Williams said.

But the judge found that the department never tried very hard to make the program work. The department didn’t determine how much it would pay Medi-Cal providers to treat people with HIV, as required by AB 2197, the ruling said. Officials also failed to calculate how much it saved when people with AIDS moved into managed care, another explicit requirement of the 2002 law, Chalfant ruled.

And the department made no effort to find other ways to pay for the healthcare of HIV patients, even though the Legislature gave it that option, the judge concluded. The department “did not look for any other source of additional revenue, and it actively rejected the option of seeking out potential sources of revenue brought to its attention,” he ruled.

Weinstein said the department’s resistance undermines the basic structure of a democracy, where lawmakers set a policy and the executive branch executes it.

“We know what to do, but we can’t get this bureaucracy to move and do what the Legislature and the governor want them to do,” he said. “The governor has had a sterling record on AIDS and he’s being very ill-served by the department.”

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jordan.rau@latimes.com