COLUMN ONE : A Doctor’s Struggle With AIDS : When and what to tell patients and medical partners was an agonizing decision for an Orange County physician, reflecting the national debate over the obligations of health care workers.

The letter that showed up in homes across Orange County early in March of 1988 was jarring for what it said and puzzling for what it left out.

“It is with very heavy heart that I announce that effective immediately I must leave my medical practice,” wrote Dr. Don G. Hagan. “I have personally chosen to notify certain patients of my situation. It will not be possible to notify everyone.

“Please share this information with any fellow patient who may not receive it.”

But only a few learned why Hagan was quitting medicine at age 42. “Sorry to cop out on you,” he told one longtime patient in a handwritten postscript. “I’ve been diagnosed with AIDS-related complex. We’re hopeful less stress and less exposure to illness will be good for me. Hope we will remain friends--I’ll miss being your doctor. . . . Love, Don.”

Some were not totally surprised by the news. He was always something more than just another Republican doctor in Irvine. Hagan had been a prominent gay activist in Orange County throughout the 1980s, battling discrimination against homosexuals, writing letters to newspapers and leading gay-rights groups.

His quitting medicine came 19 months after he tested positive for the virus that causes AIDS, a period in which he continued to practice, hoped for a medical miracle, and debated how to break the news to his medical partners and patients.

Hagan’s dilemma over what to say--and when--is being echoed now in debates in medical associations, Congress and patients’ groups. Under what circumstances should doctors with AIDS be allowed to practice? What procedures should they be allowed to perform? How much should they disclose?

Hagan stresses that as a general practitioner he never posed a risk of infecting his patients, and other doctors agree, noting that no patient has been shown to have contracted AIDS through a physician. Proposed regulations by the federal Centers for Disease Control would not require Hagan to do anything differently.

“I struggled with the issue when I was still working,” Hagan said. “It was tough because I felt a real bond with so many people (and) I couldn’t be honest” with them.

Former patients who know of Hagan’s condition have been supportive, he says, but even today, many do not know. Leaning back on a leather chair in his home, Hagan sounds frustrated by it all. “I had to buy into a . . . process I’m critical of, with regards to hiding this disease process.”

A gay doctor with a large number of gay patients, Hagan was no stranger to AIDS. A patient had died of the disease in 1981, when it was barely known to doctors. When word of AIDS began to filter from the laboratories into the gay community, Hagan said he “couldn’t imagine not having been exposed” to the virus because he had “lived through a tumultuous time in the sexual revolution of the late ‘70s and early ‘80s.”

Still, it was only after an internist friend could not find a reason for the headaches that had plagued Hagan for months that he decided in 1986 to be tested for the human immunodeficiency virus that causes AIDS. Even then, he waited until “my spouse,” Drew Barras, was out of town on a business trip. Hagan said he had a “fantasy” that the test “would be negative.”

So he “sneaked off “ to a gay and lesbian center in Long Beach to be tested anonymously. Ten days later, he went back for the results.

“I was called into this little room and sat down” at a plain wooden table. “When the person walked in the door, I interpreted in the face that . . . the test was positive.” It was.

“It was a devastating moment, because it confirmed my worst fears,” Hagan said. “In the matter of a few seconds, all of the possible scenarios went flashing through my mind. What happens to my job? What happens to my income? What happens to Drew? How am I going to tell Drew this? We’re 1 1/2 years into a wonderful relationship, and what if he’s positive? What if I’ve infected him? All of those things.

“I have told lots of people that they have cancer, they have leukemia. I’ve told people they had AIDS. But for it to be personalized was very different.

“I got home and I cried. I cried.”

Days after getting the test results, Hagan flew to New Orleans to meet Barras for a vacation. After struggling over what and how to tell his lover, he blurted out the news before the two got out of the airport.

“We cried together that night,” Hagan said. “We basically felt bad for a couple of months.” Then they “went on about our lives.”

For nearly two years, Hagan juggled work and illness, driving to Tijuana for medicine not available in the United States and then switching to a new drug when it went on the market here. Every day, he would gulp a dozen or more aspirin to battle headaches caused by HIV aseptic meningitis, a rare form of AIDS-related illness.

Finally, he found he was losing sympathy for patients he knew were less ill than he was.

So just before a scheduled vacation, Hagan marched into the corporate offices of his 30-doctor group and told three top officials he was quitting, and why.

The group administrator, Patrick Kapsner, who keeps in touch with Hagan, said the three felt “shock.”

“It was like having your brother say: ‘Gee, I’m HIV positive.’ It was a terrible feeling.”

Hagan said the letter to his patients was the subject of negotiations with his colleagues in the medical partnership. He said that while his first concern as a doctor was the health of his patients, when disease struck, he also was forced to consider the financial impact on his fellow doctors and himself.

Even healthy gay men “live in fear people might take our jobs away, or we might lose our insurance” because they are at risk for AIDS, he said. Those stricken with the disease face big bills for drugs and medical care. Unlike Hagan, they often have little or no disability insurance.

He said that after testing positive for HIV, it was partly financial worries that stopped him from telling his colleagues, let alone his patients, until his health forced him to quit. He said he was afraid that his medical partners would throw him out before he could make sure his financial affairs were in order.

When the doctors discussed his leaving, they wanted “to try to figure out how to protect the image of the group,” he said. While that made him unhappy, his “business sense” told him they were right.

Hagan told his partners he would inform his patients with AIDS--and a few others--why he was leaving. Other patients who called the office would be told he was on leave to write a book and might or might not be back. He agreed not to talk to the press for six months, but said he warned his colleagues that if someone asked him directly about his health, he would not lie.

“I would have liked for everyone to have known why I left,” Hagan said. “Because until people know that they know someone affected by this disease, they don’t have to buy into what we’ve got to do to deal with it.

“But in all fairness I recognize the stupidity that is associated with many people’s emotions over the disease, and I had no reason to want to hurt the medical group financially or hurt its image. Because I knew someone would have its name on the front page of the paper with a lawsuit in a moment.”

Hagan said he is “aware of 9 or 10” Orange County doctors who have died from AIDS, though the public announcements always have listed another cause of death. He believes his death will be the first of a doctor in the county to be publicly labeled AIDS-related.

“I’m likely to die within the next year,” he said calmly. “The reason I’m willing to tell you anything about me is it’s hard to do anything to me. . . . It makes a great difference to be at a point in your life where you’re free.”

In recent months, Hagan’s strength has ebbed. He spends much of his time in the home he has shared since 1987 with Barras, a veterinarian whom he met at Mardi Gras in New Orleans two years earlier.

The modernistic, three-level home overlooks a canyon where deer sometimes graze. Out past the leafy trees lies the Pacific Ocean. When he has the strength, Hagan speaks to doctors’ groups and others about his attempt to cope with AIDS. Those speeches are increasingly coming against a backdrop that worries him: the ever-louder debate over the nature of the obligation physicians with AIDS have to their patients.

The Centers for Disease Control in Atlanta says that only one health care professional, Florida dentist Dr. David J. Acer, has been identified as having infected patients before he died. Whether his blood mingled with patients’ blood directly or was passed from dental instruments used on AIDS-infected patients is unclear.

But the letter written to Florida health officials by one of the five patients infected by Acer, 23-year-old Kimberly Bergalis, was very clear. “I blame Dr. Acer and every single one of you bastards,” she wrote. “Anyone that knew Dr. Acer was infected and had full-blown AIDS and stood by not doing a damn thing about it. You are all just as guilty as he was. You’ve ruined my life and my family’s.”

The CDC said that as of June 30, it has received reports of 6,782 health care workers with AIDS, including 728 physicians, 46 surgeons, 171 dental workers and 1,441 nurses.

On July 15, the CDC issued non-mandatory guidelines recommending that health care workers who perform “invasive” procedures that require entry into the body’s tissues or organs be voluntarily tested for the viruses that cause AIDS and hepatitis B. The directives will mostly affect surgeons and dentists doing root canals. If they test positive, they should not perform the invasive procedures without permission from a panel of experts and informing the patients.

Three days later, the U.S. Senate voted to jail health care workers if they perform invasive procedures without telling patients they have the AIDS virus. That the measure has a long way to go before it becomes law.

Hagan, who is not a surgeon, said he consulted with medical experts in the county and was assured that he posed no danger to patients in his practice, although it did involve some minor surgery in his office. The doctors he consulted confirm that.

But there is the collateral issue of patients’ wishes and rights to know a doctor’s condition. A Newsweek poll found that 94% of those questioned believe that all physicians and dentists should be required to tell patients if they are infected with the virus; 65% said they would no longer want treatment by an infected doctor, dentist or other health care worker.

Dr. Sanford F. Kuvin, vice chairman of the National Foundation for Infectious Diseases, said health care workers and patients should be forced to undergo testing for AIDS and hepatitis B, but that the results must be kept confidential. “Each has the right to know what harm each has for the other,” the Miami doctor said.

“It’s the first time in the history of public health that a lethal, communicable disease is being treated as a secret disease,” said Kuvin. That is “outrageous from a moral, ethical and public health point of view.”

Hagan rejects calls for mandatory testing, contending that they are fueled by “public hysteria” and are “not based on any scientific evidence whatsoever.”

Rose Marie Harvey, a 77-year-old Irvine widow who says she considers Hagan nearly a son, said she would have “absolutely no problem” in seeing him professionally if he were still practicing. She also said that his not telling her about his condition until he stopped practicing did not bother her.

Iris Hayles, who was Hagan’s nurse for seven years, said not a single former patient expressed concern at having been treated by an HIV-positive doctor. “Their concern is that he gets better, that a miracle happens,” she said.

Hayles, a grandmother of 10 who grew up in the Mississippi Delta, said that Hagan “taught me a lot” about medicine, homosexuality and the AIDS virus. She said the knowledge has “helped me make other people feel better” when they fall ill, especially if they are AIDS patients.

Still, Hayles admits that if her doctor had AIDS, she would like to know. It would not make her change doctors, but it would be nice to know.

Hagan said it is impossible for a doctor to tell patients he has the virus that causes AIDS “and stay in business.”

“A handful of people will come to you no matter what,” but most patients pick a doctor “either because you’re convenient or because of their insurance or because of some other reason. And if there’s a doctor down the street that’s HIV negative, the reality is they’re going to go where their fears send them. And their fears will send them somewhere else.”

Patrick Kapsner, chief executive officer of Bristol Park Medical Group, said Hagan’s fellow doctors support him. But he said that when Hagan is mentioned in a newspaper story, “There’s always a patient who is upset.” After one recent newspaper reference to Hagan’s continued practice after he was found to have the virus, “We probably received calls from 18 to 20 patients, with one concern or another,” Kapsner said.

Most patients are reassured over the phone, Kapsner added; those who are “seriously concerned” are invited to the office. He said he has not heard of any patients whose worries have not been calmed.

Hagan said that before he hung up his stethoscope he made sure his patients who had AIDS knew why he was leaving and he did what he could to help them find another doctor. “In the major metropolitan areas of America, most of the gay patients are being cared for by gay physicians,” Hagan said. As those doctors develop AIDS, it creates a “tremendous void” of understanding physicians with specialized knowledge of the disease.

One of Hagan’s toughest moments came when he told his parents about his medical condition.

“My family was probably one of the most traditional conservative families in America,” said Hagan, the son of a Southern Baptist minister and who grew up near Lake Charles, La. In high school he thought he would never be able to join the “special breed of people” known as doctors--because he was gay.

But by college, “I saw people in premed that I didn’t think were as smart as I was,” so he pursued his dream and went to medical school in New Orleans. He was in his 30s by the time he told his parents he was gay, a disclosure that brought some temporary “rough spots” in his relationship with them.

After medical school, he practiced and taught in Louisiana and Texas and then went to USC as director of the program for medical residents specializing in family practice. In 1981, he returned to private practice and opened the Irvine office of the Bristol Park Medical Group.

In the fall of 1987, more than a year after Hagan’s AIDS diagnosis, his parents came to visit. “I took them out on the deck, sat them in chairs and said, ‘I have something to tell you,’ ” Hagan said. “You know we have a test for the AIDS virus. I took the test and I have bad news.”

His parents took the news relatively well, Hagan said, and it was “like an enormous burden was lifted.”

Since quitting his practice, Hagan has tried writing a book and has lectured on AIDS and his battle with the disease.

“It has kept me in touch with the fact that I am a medical doctor. It has helped me keep my identity.”

Hagan said he has “a special talent” for dealing with death after watching his clergyman father counsel the grief-stricken and spending years himself breaking the news of terminal illnesses to patients and families. “You turn some of that in on yourself, and I think it’s been very beneficial to me,” he said.

Hagan said he helps himself by “preparing well” for death. “I know I have lived a very rich and full life; there aren’t many things that I wanted to do that I haven’t done, and that is very comforting.”

Another source of support is Barras, who works only part time so that he can be with Hagan more often. After learning about Hagan’s positive test, Barras took the HIV test and it was positive. Both men say they were infected long before they met each other and have practiced safe sex. Barras said he is healthier than Hagan, but must take care to conserve his energy.

Hagan, who stands just under 6 feet, 4 inches, has seen his weight drop from over 200 pounds to around 180 in the last year. He is been forced to add the drug DDC to AZT to fight the disease, yet he finds his stamina waning.

In addition to battling his disease, he has had to cope with the death of his father and putting his mother in a nursing home.

“Lately, some days I don’t do very much, I don’t feel up to it,” Hagan said. “But most of the time I’m able to do household chores.

“It’s real humbling to be aware of the changes that take place” in other people with AIDS, “and then to see them begin to occur to you individually.” Recently, he has started suffering from night sweats, a “typical deteriorating process” for people with AIDS. He wonders if the sweats and fevers will pass or “if this is a sign that things are going to get worse.”