AIDS Panel Endorses Stiffer Anti-Bias Laws : Final Report Approves Almost 600 Proposals Seeking to Provide Strategy to Combat Epidemic

The presidential AIDS commission sent a strong and far-reaching mandate to the Reagan White House Friday, calling for the expansion of federal anti-discrimination laws to protect the ill and infected and urging sweeping reforms in health care.

Wrapping up its nearly year-long assignment, the 13-member panel approved almost 600 recommendations that its members hope will serve as a comprehensive blueprint for a national strategy to combat the deadly epidemic. The report will be formally presented to the White House by the end of next week. Panel members estimated that the package of proposals would cost $3.1 billion a year, divided among federal, state and local governments, with the federal government picking up two-thirds of the bill.

Late Compromise

The commission’s relatively smooth approval of the bulk of the major recommendations Friday was expected because its chairman, Adm. James D. Watkins, said he had the consensus of the panel before he drafted the final document.

However, panel members parted company with the chairman in one area--how to change the federal system for responding to a national health emergency--but were able to reach a compromise late Friday night.

Watkins had proposed giving the surgeon general enhanced powers to act during a national health crisis, such as AIDS. However, other commissioners objected to the concept of an AIDS “czar” and Watkins dropped it.

The panel, agreeing that some structural change was needed to allow for a more effective response than occurred during the AIDS crisis, recommended that “some special management oversight entity” be created to ensure that an AIDS action plan was carried out and suggested that the White House consider a series of options to deal with AIDS and other future health-care emergencies.

These options include establishing an independent department of health, separating it from welfare and other social services; expanding the public health emergencies provision of the Public Health Service Act “to allow streamlined action when a public health emergency is declared” and appointing a “crisis” deputy secretary to take charge in such emergencies. The AIDS commission’s far-ranging proposals have come as a surprise to many who had been skeptical of a panel beset with controversy since its creation last summer. Watkins, retired chief of naval operations, assumed leadership last fall after its two top members resigned, unhappy about personality conflicts and ideological differences about how to approach critical AIDS issues.

The document has been widely hailed by AIDS experts and others for its ambitious public health policy initiatives and has been characterized as compassionate and sensitive.

The panel approved virtually all of the major proposals released two weeks ago by Watkins, with only minor changes.

However, the vote was much closer than anticipated on the key anti-discrimination measure, with five of the commission’s most conservative members voting against it. The commission recommended that laws currently barring discrimination against the handicapped, which the courts have extended to those suffering from infectious diseases, be expanded to cover the entire private sector. The current law applies only to institutions or to contractors receiving federal funds.

Some of the commissioners said they were concerned it would extend special privileges to those suffering from AIDS or AIDS infection. Also, the proposal’s chief opponent, Dr. William B. Walsh, said he feared precipitous action by Congress in that area. “It scares the hell out of me what Congress might do, it being an election year,” he said.

But Polly Gault, the commission’s executive director, insisted that the proposal “is not an affirmative action statute” for people with AIDS. “It simply says they cannot be fired from their jobs.”

In the report, the commission declared: “Each act of discrimination . . . diminishes our society’s adherence to the principles of justice and equality. Our leaders at all levels--national, state and local--should speak out against ignorance and injustice and make clear to the American people that discrimination against persons with (AIDS) infection will not be tolerated.”

Other major recommendations included tougher safeguards for ensuring confidentiality of AIDS test results, extensive AIDS education in schools and criminal penalties for those who “knowingly” engage in behavior likely to transmit the virus.

Thus far, there has been no response from the White House on the proposals, and it is unclear how President Reagan will respond to such a comprehensive plan of action with less than seven months remaining in his term.

The Reagan Administration is on record as opposing federal action to ban discrimination against those with AIDS, preferring to leave such action to the states.

One of the proposals approved by the commission calls on Reagan to issue an immediate executive order banning discrimination against AIDS-afflicted individuals in the executive branch.

OKs 10-Year Program

Earlier this year, commission members approved recommendations for a dramatic 10-year program, with an annual minimum increase of $2.2 billion in federal, state and local funds, to expand drug abuse programs to establish a nationwide system of “treatment on demand” for intravenous drug abusers. The $2.2 billion includes $1.7 billion for drug abuse programs, with the rest for health care and education programs.

The commission’s far-ranging proposals have come as a surprise to many who had been skeptical of a panel beset with controversy since its creation last summer. Watkins, retired chief of naval operations, assumed leadership last fall after its two top members resigned, unhappy about personality conflicts and ideological differences about how to approach critical AIDS issues.

However, Watkins and other members won credibility for the effort and the commission conducted 10 months of site visits and hearings, with testimony from nearly 800 witnesses, including many with AIDS.

In its final report, the panel proposed new laws on confidentiality, with strong sanctions to protect the identity of those who test positive for infection with the AIDS virus. It called for legislation prohibiting the disclosure of such information without the written consent of the infected individual, except under certain specific circumstances.

Those exceptions would include disclosure to limited members of the individual’s health care team; to health care workers accidentally exposed to contaminated blood; for statistical reports, if done anonymously; to blood, organ, semen or breast milk banks; to a spouse or sexual partner, when the individual will not inform them, and to the victim of a sexual assault.

The panel supported comprehensive AIDS education from kindergarten through the 12th grade to be in place by the year 2000. The panel, however, said the content of the education should be the province of local communities.

Focus on Infection

Also, the panel called for the nation to shift its emphasis on AIDS away from the onset of symptoms to the entire range of AIDS conditions, beginning with infection. Federal health officials believe that up to 1.5 million Americans are currently infected with the AIDS virus.

Recognizing the strain on the health care delivery system, the commission proposed that municipal hospital systems in cities with a high prevalence of AIDS assess their current and five-year anticipated demand for AIDS-related services, and forward these figures to the Departments of Health and Human Services and Housing and Urban Development “for incorporation into a plan for increased funding for patient care in community and long-term care settings.”

Also, the panel recommended that HHS and the states provide funds for a broader range of home health care services for persons with AIDS, “incorporating nursing, respiratory, infectious disease and other consults in home health settings as appropriate.”

Stresses Self-Worth

The panel called on the health care community to treat patients with AIDS “with professionalism” and said that “every effort should be made to maintain an individual’s autonomy, sense of self-worth and personal dignity.”

AIDS, or acquired immune deficiency syndrome, is caused by a virus that destroys the body’s immune system, leaving it powerless against certain cancers and otherwise rare infections. It can also invade the central nervous system, causing severe neurological disorders. It is transmitted through sexual intercourse, through the sharing of unsterilized hypodermic needles and by woman to fetus during pregnancy.

In this country, AIDS has primarily afflicted homosexual and bisexual men, intravenous drug users and their sexual partners. As of Monday, a total of 64,898 Americans had contracted AIDS, of whom 36,480 had died.

Federal health officials have predicted an estimated total of 450,000 cases of AIDS in this country by 1993.