Forlorn Odyssey of AIDS Sufferer Prompts Inquiry

A psychiatric patient, infected with the AIDS virus and bleeding from his arms and legs, spent last weekend wandering through central Orange County after he was turned away from a state psychiatric hospital and then refused readmission to a private hospital in Anaheim.

The 37-year-old psychotic man, who has been declared a ward of Orange County, reappeared at his guardian’s office in Santa Ana on Monday and is now hospitalized at UC-Irvine Medical Center in Orange.

Orange County health officials said the saga began Oct. 23, when Western Medical Center-Anaheim tried to transfer the patient to Metropolitan State Hospital in Norwalk for long-term psychiatric care, and Metropolitan declined to accept him because he was infectious. Returned to Western Medical, where doctors said he no longer met their standards for admission, the patient walked out a back door when a social worker assigned to watch him went to the bathroom, hospital officials said.

Dr. L. Rex Ehling, county public health director, said the confusion in this case exemplifies the lack of treatment facilities in the county and around the state for AIDS carriers who also have serious medical or psychiatric problems.

Orange County health officials also expressed concern that the state appears to have no coordinated policy for how county, state and private hospitals should care for a psychotic and infectious AIDS carrier with acute medical problems.

“We have gotten very little help. They’ve given us AZT monies (money to buy an experimental drug for AIDS patients) but we have gotten little or no policy direction from the state Department of Health,” said Ehling, who, as president of the California Conference of Local Health Officers, lodged a protest with state health officials last week.

Added Timothy P. Mullins, Orange County mental health director, “The problem . . . is there are no places, or at least only a few places, in the entire United States that are equipped to handle the medical and psychiatric needs of the severely mentally ill person who has AIDS or AIDS Related Complex. . . . Programs for those are not currently in place.”

Thelma Frazeiar, chief of the state’s Office of AIDS, said Friday that a state task force would investigate the case. “I think there are some gaps in the system,” she said.

Her boss, Dr. Alexander Kelter, a deputy director in the California Department of Health Services, said he did not know if any policy changes were necessary but added: “To me this is a microcosm of a much larger problem that doesn’t have anything to do with (the AIDS virus) but with (psychiatric patients) who are medically acute or sub-acute and nobody wants them.”

Important Factor

But Orange County officials said they believed the man’s AIDS infection was an important factor. From time to time, as in the case a year ago of an Orange County prostitute with AIDS--no hospital will take an AIDS carrier with serious medical or psychiatric problems, they said.

“This is another big catastrophe,” said Pearl Jemison-Smith, infection control nurse-epidemiologist at UCI Medical Center and chairwoman of a county advisory group on AIDS called ACTION.

State, county and private agencies must resolve the problem soon, she warned, because until they do, “we’ll be seeing more people like this” on city streets.

Though hospital and health officials provided details of the latest case, they declined to name the patient. As a ward of the county, his privacy is protected by strong confidentiality laws.

Officials agreed to discuss the situation, however, because of the dilemma it posed--and because of the ethical issues involved when both the state psychiatric hospital and the private hospital in Anaheim refused to admit the patient.

Their problems began July 7 when police picked up a psychotic transient and brought him to Western Medical, officials at the 248-bed nonprofit hospital said. For 17 days, he was acutely psychotic, hospital officials said.

Diagnosis Changed

After that, the man still was mentally ill but was no longer acute, they said, and because his diagnosis had changed, Medicare no longer automatically covered his $552-a-day costs for psychiatric nursing in an isolation room. So the private hospital began looking for another placement.

For three months--and with increasing desperation--Western Med officials and the patient’s county conservator looked for a long-term locked psychiatric bed among the overloaded mental health institutions in Los Angeles, Riverside and Orange counties.

But because of his psychosis and because he carried the AIDS virus, no one would take him, said Sharon Gerdes, who is in charge of discharging patients at Western Med.

Although the man has not developed a full case of the deadly acquired immune deficiency syndrome, he could infect others if his blood came in contact with their’s, health officials said. And because of his psychosis, Gerdes said, the patient for 20 years has scratched himself until his arms and legs bled. But three weeks ago, 750-bed Metropolitan State Hospital in Norwalk agreed to accept him when its next bed became available, Gerdes said.

On Friday, Oct. 23 the bed came open. At about noon that day, Western Med officials said, they discharged the patient and put him in an ambulance for Norwalk.

But during the ambulance ride, the patient became agitated, scratching his arms and legs until they were raw and bleeding, Orange County AIDS coordinator Penny Weismuller recounted.

When he arrived at Metropolitan at 1:50 p.m., admissions staff immediately noticed the “weeping sores,” on his arms and legs, Metropolitan executive director Dr. Bill Silva said. Greeted by a bleeding, AIDS-positive patient who appeared both “medically unstable” and infectious, Metropolitan could not possibly admit him, Silva said.

Western Med attorney Patrick Moore contended Friday that Metropolitan had “welshed, if you will, on their agreement” to take the man and said “his condition had been fully disclosed to them.”

Silva called that account “totally inaccurate.”

California’s state psychiatric hospitals do accept patients with the AIDS virus and currently have about 30, at least 12 at Metropolitan, said Dean Owen, a spokesman for the California Department of Mental Health.

But Metropolitan cannot accept patients who are sick with AIDS or anything else that makes them “medically unstable,” Owen and Silva stressed. State law prohibits hospitals from discriminating against AIDS patients, but if a hospital lacks proper treatment facilities for an ill AIDS patient, it may reject the patient, state mental health officials said.

All referring hospitals are well aware of Metropolitan’s medical criteria for accepting a patient, Silva stressed, for at Metropolitan there is no medical ward or isolation room. “If he had leprosy, he wouldn’t be admitted,” Silva said.

By mid-afternoon that Friday, Silva and his admissions staff notified Western Med that their patient would be returned to them, and at 3:50 p.m., put him back in the ambulance to Anaheim.

At about 5 p.m. Friday, the ambulance returned the patient to the rear lobby of Western Med, Gerdes said.

Doctors there reexamined him and found him mentally ill and in need of long-term placement, but not acutely psychotic and so no longer an appropriate candidate for their hospital, Moore said.

At that point, “he’s really no one’s patient,” Moore said. “We couldn’t admit him” for without a physician’s order “we legally cannot take that patient back. We’d be subject to liability for--in essence--involuntarily detaining the patient.”

Late Friday, Gerdes said she telephoned officials from the county conservator’s office to ask where the patient should go, but got little help.

“I got (an agent from the conservator’s office) once, but I couldn’t get her back again. (The agent) said ‘What I want to know is, ‘Is my conservatee going to have a roof over his head tonight?’ It was just a big mess,” Gerdes said.

Citing confidentiality laws, officials from the county conservator’s office declined all comment this week.

Meanwhile, Western Med officials assigned one of their social workers to sit with the patient while they figured out what to do with him. All his clothes and other belongings were with him in the small room, Gerdes said. One of the ambulance drivers gave the patient a quarter and the social worker fed him dinner, Western Med officials said.

At about 7:30 p.m., “we were trying to get some guidance from the patient conservator and the patient walked out the door while the social worker went to the toilet,” hospital attorney Moore said.

What the patient did next is unclear. There are reports that he went to a local park or a mission over the weekend as he wandered the 10 miles from Anaheim to Santa Ana.

Also unclear is how much of a danger he posed to his fellow transients.

Jemison-Smith said she didn’t believe he would have posed “a tremendous threat” unless he had sexual contact or injected drugs with them.

At any rate, on Monday morning, he showed up at his conservator’s office in Santa Ana, Gerdes said. From there, he was taken to an emergency mental health treatment facility in Santa Ana, then transferred to a medical ward at UCI Medical Center.