HIV-Infected Doctor Loses His Medical Practice

Dr. Robert Huse sipped tea, listening to the clapping thunder and pouring rain, watching for signs of leaks from the vaulted ceiling in his Dallas home. The roof had been repaired the day before, and new carpet was to be laid in preparation for putting the home on the market.

Ironically, the past few days had been the first time in five months that the dark clouds hovering over the 45-year-old physician’s life had at least parted, although not totally lifted. Last October, the pediatrician had been forced to close his medical practice after public revelation that he had tested positive for exposure to the human immunodeficiency virus.

Recently, however, Huse was notified that he passed the California FLEX test required for state licensing. His disability payments were approved. And the lymphocyte count that could change his status from HIV carrier to AIDS patient had dramatically risen.

“I am feeling better about it,” he said. “Everything that has happened in the past few days has been good.”

Interviewed just a week earlier, the pediatrician had sat in the living room of his home near the towering glass structures of downtown Dallas and talked of the utter frustration, bitterness, hurt and mind-numbing depression he endured after being forced to close his practice in the nearby blue-collar suburb of Mesquite.

The confidentiality he afforded others’ medical records had not been afforded his own. There, splashed across the city’s newspapers, was notice of his positive HIV test, followed by mass hysteria among the parents of his young patients. Within a week, the patient load dropped from 100 to fewer than 40 a week.

“It was like a death,” he said. “I thought of them as my children. I know it’s different, but it’s on the order that I felt about them.

“The main depression was that I lost my practice. I started crying, and I couldn’t stop for a while. I was incapacitated. I couldn’t get anything done.”

The $100,000 the physician had earned annually from his practice ceased. His partner terminated their agreement to share office expenses and cover for each other. The potential buyer of his 12-year, once-thriving practice withdrew the offer, saying that few patients would be left. Huse spent a couple of weeks transferring records to other area pediatricians’ offices, then went home.

The test results were made public after Huse filed a lawsuit against a former roommate who allegedly had threatened to tell patients, professional organizations and the media that the physician had acquired immune deficiency syndrome. The suit was filed Sept. 11; the story hit the papers the next day.

Three weeks later, Huse’s practice was closed. The dream he had held since high school appeared shattered.

Fellow physicians called with suggestions, one advising him to take a fellowship in infectious diseases so he could work with AIDS patients. He had thought often about practicing in California, but for weeks he had trouble just thinking, much less studying for the exam that would make this possible.

“I knew this would happen” if the HIV antibody test results were made public, he said. “Still, it all seemed overwhelming.”

The stress didn’t end with the closing of his office. His lymphocyte count had dropped from 400 to slightly more than 200. He was living off his savings, awaiting approval of disability payments. There were house payments, living expenses and the $600-a-month cost of treatment with zidovudine.

The parents of one child Huse had treated threatened suit against the physician for endangering their child. The suit was later dropped. Another parent considered suit, requesting the necessary records, but was dissuaded from filing. Yet another parent, armed with 400 signatures, went before a committee of the Texas Medical Assn. (TMA) demanding that physicians who test positive for exposure to the AIDS virus be required to tell their patients. The TMA Reference Committee on Public Health and Scientific Affairs stood firm. Physicians should not be forced to tell patients of positive HIV tests, the committee said, but should not engage in activity that creates a risk of infection to others.

“I felt that was part of my defense,” Huse said. “If it had gone the other way, I would have had a mass of lawsuits.”

Huse attended a support group, then started studying for the examination that he took in December.

But even after taking the test he questioned whether he had passed and whether he would ever treat another patient.

As the weeks dragged on, he worried about constantly working with sick people and the possible effects on his own health. “Maybe I will get into landscaping, managing a nursery, something else,” Huse said in January. “I don’t want a lot of stress.”

It was in high school that Huse decided he wanted to become a physician. But he grew up in a lower-middle-income home, and his mother said there wasn’t enough money for medical school. The Minnesota youth pursued his dreams, however, attending college, then taking out federal guaranteed loans to attend the University of Minnesota Medical School.

He was drawn to pediatrics because of his love for children, he said, and went on to take a pediatric residency at Children’s Memorial Hospital in Oklahoma City. He first set up practice in Dodge City, Kan., but grew tired of the isolation of the area.

Twelve years ago he moved his practice to Mesquite, where he was the first pediatrician. His practice started growing, and other Dallas doctors felt comfortable in referring patients to him. Then in July, 1985, he anonymously went to the public health department for an HIV antibody test, fairly confident the test would be negative. It was positive. He went to a physician treating AIDS patients.

“I felt I was healthy,” Huse said. “I didn’t think I would come down with an infection. I was told I wasn’t a danger to my patients. I knew what precautions to take. I didn’t do things where there might be a danger. At that time, I didn’t have any problem with it at all.”

He confided his HIV status to his roommate, he said, in an effort to encourage him to undergo testing. But in the spring of 1987, Huse asked the roommate to move out. Allegedly his roommate threatened that, if he was forced to move, he would tell patients and professional organizations that Huse had AIDS. Finally, in August, Huse said, the roommate moved out, but harassing phone calls were left on the answering machines in his office and at home.

“It was hard to deal with,” Huse said. He sought the advice of an attorney, who recommended that they seek a restraining order against the former roommate and file suit against him. (In documents filed in the court case, the roommate has denied Huse’s charges.) The attorney, Bill Nelson, requested the records of the legal action be sealed.

Nelson told State District Court Judge John McClellan Marshall that Huse was not a danger to his patients and that public disclosure of his HIV status would destroy his practice.

The judge refused to seal the records. Rejecting the request, he said government records should be open to the public, particularly when a public health hazard is involved.

Huse’s plea for confidentiality may have been affected by events that occurred shortly before he filed his lawsuit: A reporter with the Dallas Morning News found a large increase in the number of sealed court records during the previous seven years. According to the News, 202 civil cases had been sealed from public view since 1980. Only 80 cases had been sealed in the history of Dallas county before 1980.

After reviewing the then-unpublished findings, Marshall, Dallas county’s chief administrative judge, issued new guidelines for the sealing of court records. He also ordered dozens of records unsealed. This occurred three days before Huse filed his lawsuit.

However, Marshall says the newspaper reports had no effect on his decision. “The court’s decision in the Huse case was consistent in other cases relating to prior restraint of the media. It was also consistent to this court’s position in relation to keeping things secret. He came to the court as a plaintiff. He didn’t come involuntarily.”

Although state law protects HIV test results, Marshall said, Huse waived his right to privacy by telling his roommate and filing suit.

There was also a public health risk involved, Marshall said. While the chance of a physician spreading the disease to a patient is small, it is real, he contended. “So far the vast body of medical opinion has not been successful in saying it can’t happen. They say there hasn’t been a recorded case. But that isn’t acceptable for a court, and not where children are concerned. That fact that it hasn’t happened doesn’t mean it can’t. There still is a finite possibility,” he said.

“You can’t take the risk on behalf of the people,” Marshall said.

Attorney Nelson disagreed. “No one has the right to know when the chance of transmission is so minuscule--every medical expert concedes to that,” he said.

Huse said he never realized that his test results would be public information. Although he filed suit, he thought the case would be settled without going to trial. “The impression I got was that it would be public only if it went to court,” he said.

Huse said the judge’s decision discourages people from undergoing HIV testing and then telling sexual partners if they test positive. “You get the test done, and you feel morally obligated to tell those you have had sexual relations with,” he said. “Then one acts like this, and you are in bad shape. Once you tell someone, then legally it’s an open book.

“It involved a patient’s records. What about a patient’s right to privacy?”

The decision on whether to seal court records should be made on the basis of whether the person is a proven danger to the community, Huse said. “If they are a danger to the community, then the records shouldn’t be sealed. The judge should have shown some compassion. I didn’t see any of that.”

When the story broke, Huse attempted to allay the fears of his patients’ families by writing a letter. The physician said he had chosen not to tell patients of his positive test because he considered it a private matter and he was no health threat to them. Public health officials agreed that he presented no threat and vainly tried to calm the parents.

The physician said he holds no bitter feelings toward the parents but remains angry with the legal system and the media for not recognizing his right to privacy.

Huse picked up a book on how to sell a home and switched the topic of discussion from the past to the future.

He will put his home on the market, but with the Dallas economy depressed, he expects to lose money. At least he will be relieved of the monthly payments.

He would like to work with AIDS patients and has been volunteering twice a week with a local group. There is hope that he might be employed at a new AIDS clinic that might be established in Dallas. But funding for the proposed clinic remains in limbo. If not hired there, he is still considering establishing a practice in California. Yet he worries about the financial risks of starting a new practice. He is keeping his goals short-term.

“I have to have goals,” Huse said. “My goals aren’t long-term. I think in terms of the next three years. That is about as far as I can think about. It took until this year to face the fact that (AIDS) could result in my death. But you can’t constantly worry about it.

“You can’t live your life that way.”