Leaders of the Los Angeles County AIDS Commission have agreed to meet with directors of the Barlow Hospital to consider ways in which the hospital can help with the human immunodeficiency virus (HIV) pandemic. It is yet another indication of the constructive leadership that both the hospital and the commission have provided.
The meeting grows out of some misunderstandings, some prejudices and some unfortunate accusations that have clouded efforts to work out a plan that is consonant both with Barlow’s mission as a unique respiratory-illness tertiary-care facility and with the growing needs of the community for expanding and diverse facilities to serve the HIV-infected population.
Even as these consultations take place, work is being completed on a 25-bed AIDS hospice in a remodeled nurses’ dormitory on the Barlow camus. It is the work of the AIDS Hospice Foundation, led by Michael Weinstein. When it opens in November it will be one of the most ambitious facilities of its type in the nation. Both the foundaion, which has raised the funds independently, and Barlow, which is renting the building at $1 a year, deserve credit for this imaginative, important project.
Beyond the hospice, there had also been the hope that other facilities at Barlow could be used to create a comprehensive AIDS treatment center. Initially it was thought that the center might include residential, skilled-nursing, acute and outpatient care, all close to the hospice. It is on the prospects for those other services that the leaders of the County AIDS Commission and the Barlow board of directors will be meeting.
As Barlow has explored the possibilities for using its facilities, two issues of great concern to the entire community have emerged:
--Barlow has found, as have other agencies, that funding, public and private, for AIDS programs is inadequate.
--Hospital officials also have encountered evidence that a major comprehensive AIDS program could deleteriously affect referrals to its acute-pulmonary-care hospital, such are the lingering prejudices that haunt this deadly disease, even among health-care providers.
Clearly, then, two things need to be resolved at the outset of the dialogue: adequate financing, and assurances from the community that the new venture will in no way affect the willingness of other hospitals to continue referring pulmonary cases to Barlow.
There is a further problem. At this stage in the AIDS pandemic there is no way to know precisely what future needs will be.
The current availability of $300,000 in federal funds to allow Barlow to prepare cottages in order to provide housing for 24 AIDS patients opens a promising opportunity for the expansion of services in home care, the most humane and efficient treatment setting. There is, however, no clear indication as to the utility or need of a skilled-nursing facility for AIDS patients. And, while outpatient services at County-USC Medical Center are overwhelmed, it is not clear that a solution would come in the opening of new outpatient facilities at Barlow, which is near Dodger Stadium in Elysian Park. There are doubts also that Barlow’s specialized acute-care facilities for respiratory cases would fit well with AIDS cases except those where the opportunistic infection is respiratory-related.
The challenge now is to be sure that the comunity and this important hospital do not miss an opportunity to serve the HIV-infected population--a population that, unfortunately, will only increase in the years immediately ahead.