Two important medical advisory committees voted Wednesday to oppose the creation of a 22-bed AIDS treatment unit at Cedars-Sinai Medical Center, citing concerns over bed space, staffing and funding for the proposed $2.5-million facility.
The action, by groups representing surgeons and the hospital’s Department of Obstetrics and Gynecology, puts the future of the project in jeopardy. But advocates of the unit, which is designed to improve both treatment and counseling services for AIDS patients, expressed hope that it still will win support from the hospital Board of Directors, who have the final say over the plan.
The board is expected to consider the proposal in April.
“I don’t think it’s a roadblock,” Thomas Priselac, the executive vice president of the medical center, said of Wednesday’s votes. “The fact that the (committees) voted against it is a real concern. But I personally believe we will have such a facility at the medical center.”
Prior to Wednesday’s votes, the proposal for Cedars-Sinai won support from the hospital’s departments of Medicine, Nursing, Pediatrics and Psychiatry. Supporters say specialized AIDS units, which already exist at several Los Angeles-area hospitals, are the way of the future in the treatment of AIDS.
The unit, a source of escalating debate at the hospital in recent weeks, is considered significant because Cedars-Sinai serves West Hollywood and surrounding areas, which account for many of the reported AIDS cases in Los Angeles County.
The unit would be funded largely through a private, $2.5-million grant that was offered to Cedars-Sinai late last year. It would offer psychiatric care, social service counselors, family meeting rooms, a library of AIDS-related literature and a 24-hour outpatient clinic. Cedars-Sinai now houses 15 to 20 AIDS patients at a time, but those patients are scattered throughout the hospital in wards considered most appropriate for their symptoms.
On Wednesday, hospital surgeons questioned the proposal’s impact on other programs at the medical center and overwhelmingly voted to reject it--at least for the near future.
Dr. Kenneth Elconin, who spoke against the proposal during a lengthy, private discussion among about 35 surgeons and administrators, said later that too many questions remained unanswered. He wondered how the unit would deal with AIDS patients that required long-term hospitalization--will they remain at Cedars or be transferred elsewhere? Will the five-year gift, for $500,000 a year, pay for necessary remodeling and still offset the cost of eight additional staff members within the unit? Will the hospital be able to recruit enough nurses to handle AIDS patients?
Although hospital administrators tried to assuage the surgeons’ concerns, many surgeons seemed torn between the advantages of the unit, which impressed them, and the possible problems in running it, Elconin said.
Even though Cedars-Sinai is regarded as one of California’s wealthiest hospitals, units within the medical center are expected to support themselves financially, Elconin said. In addition, surgeons are keenly aware that the hospital has launched three other ambitious programs within the last year to handle heart, lung and liver transplants, he said. Those programs are just beginning to gear up.
“The impact has yet to hit the hospital . . . as far as patient (capacity) and the utilization of rooms,” Elconin said. “There’s a lot of apprehension that the hospital might be going too fast into new programs. There are worries that the hospital is really overextending itself.”
Fear of More AIDS Patients
In the days before the meeting, sources within the medical center charged that surgeons were planning to oppose the unit for fear of increasing the number of AIDS patients at the hospital. The sources, who asked to remain anonymous for fear of reprisals, claimed that surgeons are wary of operating on AIDS patients because they risk contracting the virus if they are cut by a scalpel, for example.
Elconin, who acknowledged the existence of that fear, denied that it played any role in the surgeons’ position on the unit. To his surprise, he said, that issue was not raised during Wednesday’s discussion.