! NAT. COW, Panel Criticizes Doctors Who Won't Treat AIDS e Health: U.S. report says a ‘shocking’ number avoid the disease. It terms that attitude unacceptable. By MARLENE CIMONS - TIMES STAFF WRITER WASHINGTON—The National AIDS Commission said Tuesday that a “shocking’’ number of phy- sicians and other health care pro- fessionals across the naticn are atili refusing to care for AIDS patients. “It can no longer be acceptable for a physician or a dentist to offer ag an excuse: ‘IT don't have expertise in relation to this particular dia- ease,’ the panel declared, noting that an estimated 1 million Ameri- cans are infected with the human ‘immunodefietency. virus. “They simply must ¢ cquire the expertise.” In issuing its third interim report to President Bush, the commission said ‘it is clear... that effective AIDS education programs are needed for all health care work- ers,” ineluding programs for those already in practice as well as those still in training, “We must support and ‘[rein- force] those who have chosen to provide the care and services needed over the iast decade to people living with HIV infection and AIDS,” the panel said. “Caring for people with HIV infection and AIDS will cnallenge health care providers to overcome their fears, ignorance and prejudic- es," the commission added. "For many, this will not be easy.” © Immediate action is néeded, the panel said. to enhance “all pro- grams designed to educate ... practicing health care profession- alg and to create incentives for providers to care for people in underserved areas,” The commission is an independ- ent body established by Congress ta advise lawmakers and the Presi- dent on how to develop “a national consensus on policy” for the AIDS epidemic. In two earlier reports, it assessed the response of the health care aystem to the growing AIDS caseload and the need to target additional funds to cities and states hardest hit by the epidemic. In its latest report, the commis- sion ertticized the federal AIDS: research effort, saying that tco few women, ¢hildrén and minority members have been included in clinical trials of experimental AIDS therapies. In addition, the panel said there has been too little research direct- ed at the opportunistic infections that afflict many patients with weakened immune systems, “even though they are usually the cause of death for people with AIDS.” The National Institutes of Health recently announced that it will increase its cppertunistic-infec- Please see AIDS, Ald Continued from Al tions work and make a greater effort to expand studies to include previously under-represented RPOUDS. The commission said also that many areas of rural America are Still ill-equipped to cope with the AIDS epidemic. and it proposed expanding education and outreach services in thase communities be- fore they are "blindsided.” D: June Osborn. commission chairman, said that the reluc- tance of some health care workers to treat AIDS patiants is based on the fear of infection as well as “what paopie presume has put one . in the path of HIV." meaning sexual orientation and intravenous drug use. . "The mix of phobias is what's doing it,” she said. So far, 37 health care workers are known to have been infected. through occupational exposure, ac- cording to the federal Centers for - Disease Control. CDC officials, however, have said the true figure is probably higher. Dr. M. Roy Schwarz, senior vice president for medical education and science for the American Med- ical Assn., said the AMA has taken the position that doctors. ethically may not refuse to care for AIDS patients. , Schwarz added. however, that he believes physicians are entitled to know in advance if their patients are infected. “I think the ethics are clear,” he said, “Dottors are supposed to treat. They're supposed to educate themselves so they can treat. And they live with the fears. But they are entitled to some pretections, one of the protections heing full knowledge of what they're dealing with,” . AMA policy further states that is in the “best interest” of the patient for the doctor to “focus on treat- ment of the disease, rather than on making value judgments about how the diséase was contracted.” - Nevertheless, Gordon Nary, ex- ecutive director of the Physicians Aasn. for AIDS Care, whose 600 members have cared for about £4.000 people with AIDS or AIDS- related complex, said “judgmental- iem'’ ig the reason many health professionals are unwilling to care for AIDS patients. ‘ “Ws got a call last week from a woman whose brother's physician told her, ‘Your brother was out partying and deserves what he got, and there's nothing more we can do for him.’” Nary said. “" .,. Patients nave been blamed by their physicians.” However. Nary said ne consid- ered it wrong Lo ‘insist that every physician take care af a new pa- tient he does not want to take care of.” ‘It deesn't help the patient to force a physician to take care of him, not if judgmentalism on the part of the physician 18 causing unnecessary pain and suffering and inappropriate care.” he said. Osborn, on the other hand, said that “the trouble right now is that, quite often, the alternative is no care, | agree that bad care (3 to he shunned. But no care is a oretty tough option.”