Hospitals Doing Secret AIDS Tests, Study Says

Many hospitals in the nation are testing admitted patients for AIDS without their knowledge or consent, in some cases in violation of hospital policies or state laws, according to preliminary results from new research released Thursday.

The majority of 500 hospitals studied maintained that they always informed patients before testing, said Dr. Charles E. Lewis, professor of medicine at UCLA and an author of the study. But he said extensive interviews with physicians and other hospital personnel suggested that this was not the case.

“We believe that a significant proportion of hospitals in the United States . . . have testing policies that violate patients’ rights,” Lewis said.

The tests are often conducted by physicians or surgeons who come in contact with large quantities of blood and are worried about exposure to HIV (human immunodeficiency virus), which causes AIDS, Lewis and other researchers said. Their work is believed to be the first comprehensive national study of hospital practices regarding testing for AIDS infection.

The researchers would not disclose how many of the 500 hospitals studied conducted AIDS testing without informing patients, and the geographic locations were not disclosed. Lewis said he could not release specific details because the study was currently under review by a medical journal.

But, although he would not give exact numbers, Lewis said that many physicians and surgeons acknowledged that they routinely order tests on patients who do not have symptoms or signs of AIDS, and that the tests are often administered without informed consent by the patient and without counseling. Further, he said, many patients are not informed of the test results.

Informed consent for AIDS testing, counseling and telling patients their test results are accepted principles of good medical practice.

“The purpose of the testing has nothing to do with patients, but is done for the benefit of the staff,” Lewis said.

Some hospitals “change their treatment plan” based on a positive test result, and a small number of facilities transfer patients who test positive, he said.

Lewis and his colleagues discussed their findings at an AIDS workshop here sponsored by the Robert Wood Johnson Foundation, which funded the research. The foundation, the nation’s largest health care philanthropy, is based in Princeton, N. J.

Civil rights groups and AIDS activists have long opposed routine or mandatory testing because many AIDS patients and those who test positive for the virus have experienced discrimination in employment, housing and insurance.

Several major reports, including one issued by the presidential AIDS commission established by former President Ronald Reagan, have recommended that federal laws be enacted to protect the confidentiality of test results and prohibit discrimination based on AIDS infection.

California, like several other states, forbids testing for AIDS infection without the explicit permission of the individual, except in some criminal cases. Also, California law protects the confidentiality of tests results. Although there is no statewide anti-discrimination law regarding AIDS patients, some cities, including Los Angeles, have enacted such laws.

But Lewis said some testing was done in violation of both state laws and hospital policies.

He said that a “distressing proportion of institutions do not have in place policies that prohibit these violations of patients’ rights.”

“Policies or not, there is a whole lot of testing going on,” he said.

“These are not ‘good’ hospitals or ‘bad’ hospitals,” Lewis said in an interview. “These are a lot of very concerned people who don’t want to become infected. The fear is so prevalent. I think everyone’s concerned about being exposed.”

The researchers said that they interviewed key executives and health care professionals--including administrators, surgeons and other physicians--at more than 500 general hospitals in various size communities, excluding Veterans Administration hospitals.

“We believe that the nature of the sample and the high response rate would allow us to project these findings to the entire United States,” Lewis said. There are more than 5,000 general hospitals in this country, he said.

Hospital officials and medical personnel were guaranteed “total anonymity,” Lewis said. Researchers have since “destroyed the linkage,” so that facilities and individuals cannot be identified, he said.

“If I were about to be admitted to a hospital, I’d ask my doctor what he intends to do with my blood,” Lewis said. “I would ask if an HIV test will be taken, and then I would ask how that information will be used.”

Jim Brown, a spokesman for the Public Health Service, said that the federal government supports voluntary testing and so-called “blinded” testing for research purposes, where there “are no names attached.” But, he said, “testing for any other purposes should not be done without the consent of the individual.”