Cedars-Sinai Medical Center is studying plans for a $2.5-million AIDS treatment unit designed to house 22 beds and a 24-hour outpatient center, but the proposal is being challenged by some surgeons who question whether the hospital should commit space and manpower for such a facility.
The unit, patterned after facilities in several other Los Angeles-area hospitals, would bring a variety of services for AIDS patients to one location, possibly by July. It would provide psychiatric care and psychological and social counseling. The all-night outpatient clinic would enable AIDS patients to go in after work, if necessary, for blood transfusions or other care.
The proposal--the result of a $2.5-million private donation offered to the medical center late last year--is considered particularly significant because of Cedars-Sinai’s location at the edge of West Hollywood, a city that has accounted for a sizable share of the AIDS cases in Los Angeles County. The 1,015-bed hospital is active in AIDS research and houses 15 to 20 AIDS patients at a time in various wards, spokesman Ron Weiss said.
Supporters say the proposal reflects a trend toward consolidating services for AIDS patients who are thought to benefit from easily available counseling and medical help.
But sources within the medical center said a small faction of influential surgeons seem intent on torpedoing the plan, in part because of their own fears of operating on AIDS patients. A surgeons subcommittee is expected to review the proposal today prior to a vote at a future date by the board of directors.
According to these sources, the surgeons couched their opposition in the fact that the unit might take away beds and nurses that are needed in other parts of the hospital, the sources said.
“They don’t like AIDS patients,” one doctor said of the surgeons, asking to remain anonymous for fear of reprisals. “They’re trying to kill the whole program because they don’t want AIDS patients in this hospital and certainly do not want to have any more (AIDS patients) in the hospital. . . .
“They’re saying, ‘We certainly don’t want to turn Cedars into a hospital for gay patients, AIDS patients or for (intravenous) drug abusers.’ ”
The sources said several high-ranking surgeons are fearful that the unit might draw additional AIDS patients to the hospital, thus increasing the risks for doctors. The human immunodeficiency virus that causes AIDS is carried in the blood and could be contracted by doctors who nick themselves on a scalpel, the sources said.
Hospital officials, including former Chief of Staff Dr. Kenneth Elconin, acknowledged that the fear of exposure has been a matter of recent discussion. But the same officials denied that the concern is playing any part in the decision on whether to establish the unit. Concerns over the unit focus entirely on the question of how hospital resources should be allocated, Elconin said.
“It’s a great fear,” Elconin said of possible exposure to the virus. “When we have patients with AIDS, special precautions are taken. We’re using double gloves and double masks on just about everybody now. (But) we’re obligated to treat the patients whether they’re on a segregated floor or not.”
Although sources identified him as one of the doctors who had raised the concerns, Elconin said surgeons at Cedars-Sinai currently operate on AIDS patients when necessary and will continue to do so. He expressed doubt that the unit would add to the number of AIDS patients at the hospital and suggested that the new unit might actually help to protect the surgeons by making it clear to them which patients have the disease. Surgeons would then know when to take added precautions, he said.
Elconin said he raised his concerns, instead, over a shortage of beds and nursing staff. At one point in January when the unit was being discussed, Cedars-Sinai was at capacity and not admitting new patients, Elconin said.
“Beds were just not available,” he said. “I had one patient who was very sick and my patient was No. 139 on the list” for admission.
The idea of setting aside 22 beds for AIDS patients--whether or not those beds are filled--seemed an apparent threat to other hospital services, Elconin said. In addition, he said, he and other doctors still question whether AIDS patients should be segregated rather than housed within appropriate wards--in a pulmonary ward, for example, for a patient with lung-related symptoms.
A segregated unit strikes some doctors as almost “a leper colony,” Elconin said. “Some patients who are admitted to a hospital do not want people to know they have AIDS. They may not want to be transferred there . . . and then you have a problem.”
In recent years, however, a number of Los Angeles-area hospitals have opted to create specialized units for AIDS patients, notably Sherman Oaks Hospital, Century City Hospital and Midway Hospital in Los Angeles.
Called Thin Excuse
One source who favors the unit at Cedars-Sinai called arguments against it “a thinly veiled” excuse that surgeons have used to postpone approval of the unit. The proposal had been cleared by several groups, including a new programs committee, and was nearing final approval when several surgeons--including Elconin--raised concerns, sources within the hospital said.
Several of these doctors declined to be interviewed.
Because of the concerns, administrators scheduled additional hearings before subcommittees representing the departments of surgery, pediatrics, and obstetrics and gynecology, said Dr. James R. Klinenberg, senior vice president for medical affairs. Until the issues were raised, those departments were not considered relevant to the question of whether to establish an AIDS unit, he said.
Klinenberg acknowledged that he talked with hospital personnel about the alleged fears of exposure to AIDS. But he downplayed the concern over exposure, calling it a non-issue in the debate.
“There are always going to be some doctors who believe a hospital shouldn’t have any AIDS patients. We have to live with that,” Klinenberg said. “That (issue) has come up ever since AIDS was identified. . . . It’s an issue in general. It’s also true of policemen and firemen.
"(But) I don’t think anything is going to be scuttled. We see this (unit) as a better way of handling the AIDS patients we already have. We just want to make sure the resources are available. The major concerns we’ve heard have really been a question of resources.”
Almost a third of the 6,336 cases of AIDS reported so far in Los Angeles County have originated from the Hollywood/Mid-Wilshire area that includes Cedars-Sinai.
Societal Benefit Foreseen
Dr. Neil Schram, a member of the Los Angeles County Medical Assn. Aids Committee, said a top-quality AIDS treatment center as proposed by Cedars-Sinai “would be a tremendous service to the community at large,” particularly since so many hospitals have been reluctant to devote themselves to providing AIDS care.
Schram said the risk to surgeons and other health-care providers is real. Twenty or 25 health-care workers worldwide are known to have been infected with the virus through accidental exposure, Schram said. Studies of perhaps 2,000 to 3,000 cases of accidental needle punctures have shown that about one in 250 leads to infection with the virus, he added.
“The risk is minuscule, but it is real,” he said.
Klinenberg predicted, however, that surgeons and other professional staff members at Cedars-Sinai will approve the AIDS unit as soon as they understand its benefits. Hospital administrators have identified space for the unit and could quickly make necessary renovations. The unit, which would accept insured and uninsured patients, could be functional by July, he said.
“It’s a very exciting program. It really is,” Klinenberg said. “I don’t see it running into any problems. Of course, you can never really predict until it’s done.”
Times staff writer Marlene Cimons contributed to this story.