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Issue #187: July 26, 1998
fastfax is available by fax in the 215 and 610 area codes at no cost, or by mail anywhere for $20.00 per year, by calling 215-545-6868, and by E-mail by contacting and type the message SUBSCRIBE in the message section. Sources for some articles in this issue include Philadelphia Inquirer, United Press International, Washington Blade.AIDS clinic moves forward amidst Allegheny collapse
Activists renew push for Medicaid HIV coverage
Protesters occupy office of "AIDS Czar"
Court upholds Philadelphia school condom program
Rite Aid in PR blitz on eve of demonstration
AIDS clinic moves forward amidst Allegheny collapse
As the nine Philadelphia hospitals in the Allegheny health system face bankruptcy and sale to a for-profit hospital chain, its popular AIDS clinic -- once called "Partnership for the People" and now the "Partnership Comprehensive Care Practice" -- moved up into spacious new facilities at 1427 Vine Street near Allegheny's Hahnemann Division.Marla Gold, M.D., who started the Partnership several years ago to provide care to low-income and uninsured people living with HIV/AIDS, told fastfax that she anticipates that the AIDS program at Allegheny will remain "intact regardless of the overall outcome" of the chain's financial troubles.
Earlier this week, Allegheny filed for Chapter 11 bankruptcy protection for all of its Philadelphia hospitals, including St. Christopher's, Graduate, Hahnemann and City Avenue Osteopathic Hospital. The four hospitals have traditionally been major providers of health care to people living with HIV/AIDS, with St. Christopher's the primary care site for children with HIV infection.
Allegheny's board of directors also approved the eventual sale of the Philadelphia hospitals to Vanguard, a Tennessee-based for-profit hospital chain. If the Vanguard purchase passes numerous legal and political hurdles, it will be the first time that a for-profit chain has built a major presence in Philadelphia -- a source of great concern for public health advocates, who say that for-profit hospitals are much less likely to emphasize quality care for low-income people and people with expensive, chronic diseases such as AIDS.
The Partnership Comprehensive Care Practice (PCCP) is one of the only hospital-based AIDS clinics that welcomes people without health insurance in Philadelphia. With Philadelphia FIGHT's Lax Center, it is also the only source of quality medical services from experienced HIV physicians for Philadelphia's uninsured PWAs.
Several city-run health centers and neighborhood clinics associated with the Health Federation of Philadelphia also provided care to thousands of people with HIV disease, although many AIDS advocates have complained that the number of HIV/AIDS specialists available through those clinics is too low.
In the midst of the headline-grabbing troubles of Allegheny as a whole, "our staff reached a dream last Friday and moved into a new space on the third floor of 1427 Vine Street -- an Allegheny property that we spruced up," Gold said. "It is beautiful and quite an improvement from the tiny space at 245 North Broad where we have been for years, saving for this day. With the move comes a full service facility with great providers and we are as focused as ever with 24 hour care."
Gold said it was important that PCCP's patients and others in the AIDS community recognize that she and her staff intend to continue to provide quality AIDS care whatever happens with the parent corporation. "We have been so busy assuring service delivery and reviewing options depending on the outcome, that I didn't even get a press release out yet!"
PCCP offers HIV primary care, nutrition services, case management, and dental services in collaboration with Dr. Michael Glick at the University of Pennsylvania. PCCP also has a pharmacist on staff who, in addition to prescribing medications, helps patients with understanding drug interactions and adherence issues.
Gold said that PCCP also employs a research coordinator for clinical trials and remains part of the federal community-based clinical trials network, CPCRA.
Gold remains concerned about the impact of the Allegheny bankruptcy and sale on the clinic's operations, however. "Despite all that is going on, local administration have been very supportive of our move. I just wish -- we all do -- that I could reliably predict how future owners will support us. The staff remain focused on providing services to people with HIV/AIDS. It is not clear how a Chapter 11 ruling would impact the funds we receive that allow us to provide services to anyone, regardless of ability to pay, but thus far, various funders have been encouraging." The clinic receives funding under Title I of the Ryan White CARE Act from the city's AIDS Activities Coordinating Office, under Title II from The Philadelphia AIDS Consortium, and directly from the federal government through Title III. Gold said that maintaining stability in that funding will be critical to the clinic's ability to continue offering care to uninsured people with HIV/AIDS.
TPAC executive director Larry Hochendoner told fastfax that TPAC has temporarily withheld payments to PCCP until it can be sure who will be legally responsible for its contracts once the Allegheny financial situation is clarified. No immediate impact on service delivery is expected from TPAC's action at this point, Hochendoner said.
"The Partnership program is committed to non-profit work and I will be exploring our relationships between the hospitals and University" as the situation develops, Gold said. "Many providers throughout the health system have grant support and a commitment to provide care for under- and uninsured persons. Our commitment is unchanged in this regard. It is too early to know exactly what the configuration will be or can be -- but throughout this period of time, the clinical practice remains fully accessible, open and prepared to provide the full range of services. The inpatient service is also providing the same level of care, staffed by Partnership providers."
"We are thankful for an outpouring of community support thus far," Gold concluded.
PCCP holds a monthly meeting of consumers, which will be held this month on Friday, July 24 at 1pm in the conference room on the 16th floor of the New College Building (entrance on
15th and Vine). More information may be available at this meeting and patients can provide input to PCCP staff on their concerns about the Allegheny situation and it's impact on the clinic.
The clinic, which closed for a day to accomplish the move, opened formally for business on July 13th. The telephone number is 215-762-2530.
Meanwhile, Pennsylvania Attorney General Mike Fisher has announced that he will try to keep Allegheny's "charitable" assets from being caught up in the institution's bankruptcy case and distributed to other creditors, according to a report in the Philadelphia Inquirer. But some consumer advocates have complained that Allegheny is seeking bankruptcy protection in order to get around a state regulatory process that would guarantee the protection of those assets.
The group is concerned that despite Fisher's promise, they are concerned that Allegheny's "community assets" -- such as individuals' donations and benefits from the hospitals' tax-exempt status that have accrued over decades while the hospitals operated as non-profits, might be lost as the institution tries to erase what is claims is over a billion dollars in debt.
Usually, when a nonprofit organization is sold to a for-profit company, the full value of the nonprofit as determined by the attorney general is put into a charitable foundation so the organization's social mission can be maintained.
However, some believe that by filing for bankruptcy first, Allegheny may be able to sidestep that regulation. Allegheny says that it is selling the hospitals to Vanguard for $502 million but has $1.3 billion in debt, which it says makes it impossible to set up a charitable foundation to protect the funds.
The proposed sale "takes the revenues and assets and charitable inheritance of this community," said Robert Brand of Solutions for Progress, a consulting firm. Brand said he does not believe that Allegheny's financial problems are as severe as it is representing, but that the company is trying to dramatize the situation in order to get out of the hospital business in Philadelphia as soon as possible.
"We feel that the people of Pennsylvania are being hoodwinked by Allegheny and its partner Vanguard," said Lauren Townsend of Citizens for Consumer Justice, which also opposes Allegheny's sale.
"The attorney general is obviously concerned that these charitable assets currently held by [Allegheny] are protected," Fisher spokesman Sean Connolly told the Inquirer. "He plans to ask the Bankruptcy Court to segregate the charitable assets to ensure that they are not used to pay the debts owed to creditors."
One financial executive quoted by the Inquirer said that over the last five years, the system lost close to $900 million in addition to the $605 million of long-term bond debt owed by the nine Philadelphia-area Allegheny hospitals.
Activists renew push for Medicaid HIV coverage
The national AIDS policy group AIDS Action and Sen. Robert Torricelli (D-NJ) are lobbying public health officials to expand Medicaid to provide low-income HIV patients with access to life-saving drug therapies. Their lobbying effort comes, in part, as a result of the Supreme Court's recent decision that HIV-positive individuals are eligible for protection under the Americans With Disabilities Act.Most state Medicaid programs limit eligibility to those formally diagnosed with AIDS or with highly symptomatic HIV disease.
The Washington Blade reports that Torricelli sent a letter to Health and Human Services Secretary Donna Shalala that said providing AIDS drugs to HIV-positive patients is "not only good health policy from a human standpoint, it is also good policy from a fiscal viewpoint." The cost of combination drug therapies, though expensive, can "offset money that would have to be spent ... once AIDS is full-blown," the Blade reports.
AIDS Action Executive Director Daniel Zingale wrote a similar letter to Health Care Financing Administration head Nancy-Ann Min DeParle in which he described the federal government's current Medicaid policy as "a recipe for disaster."
"In essence, the federal government is telling low-income, HIV-positive Americans that they can't receive AIDS-preventing drugs until they develop AIDS," Zingale said.
HCFA spokesperson Chris Peacock responded by saying that Medicaid pays for more than half of all AIDS health care in the nation. An unnamed White House official, present at a meeting between HCFA and White House Director of AIDS Policy Sandra Thurman, said, "The only thing we can do without a legislative solution, has to be revenue-neutral, but when they look at the cost of providing drugs versus hospitalizing someone with AIDS, it just doesn't work."
The meeting was called to "draw in senior members of the administration who operate agencies that need to get moving on this issue." The Clinton administration has indicated interest in expanding Medicaid coverage, but estimated that it would cost $3 billion to $9 billion over five years to cover HIV-positive patients under Medicaid.
Activists have been frustrated at the pace of the reforms since Vice President Gore pledged to come up with a solution to the problem "within 30 days" at an AIDS Action event in April 1997. "Well over a year later, that solution still eludes us," Zingale said. He points out that "the policy change ... could be accomplished state by state." Several states, including Maine and Massachusetts, have applied to HCFA for waivers, but sources said that neither Pennsylvania nor New Jersey has any plans to consider a waiver until they see how the states which have already applied fare.
Protesters occupy office of "AIDS Czar"
Nearly a dozen AIDS activists angered by President Clinton's refusal to support needle exchange programs staged a brief sit-in protest in the office of Clinton's AIDS policy director Sandra Thurman.The protesters shouted, "Clean needles save lives -- Lift the ban now," as police cut heavy chains to remove them from Thurman's office, which is located in a row of office buildings across the street from the White House.
Protest organizers said those who participated included needle exchange program organizers from New York, Ohio and New Hampshire, and a public school teacher from New York City.
The protesters, including members of the National Coalition to Save Lives Now! and ACT UP, demanded that President Clinton oppose and promise to veto Senate Bill 1959, now pending, which would permanently prohibit federal funds for needle exchange, and wipe out other vital AIDS services. An identical bill (HR 1737) has already passed the House. Sandra Thurman recently told community advocates that Clinton would sign the bill into law, if it passes both Houses.
The activists also called for Clinton to dismiss drug czar Barry McCaffrey, who has opposed needle exchange, the activists said, by misrepresenting scientific evidence.
Experts say that 33 Americans are infected with HIV due to sharing dirty needles. While local funding allows 120 needle exchange programs nationwide to operate, they reach only a fraction of the people at risk. Despite numerous studies affirming that needle exchange lowers HIV transmission while not increasing drug use -- officially recognized by Health Secretary Donna Shalala -- the ban was maintained in an April 20 decision by President Clinton. The Chair of the Presidential AIDS Advisory Council called the decision "immoral."
"President Clinton's April 20 act of cowardice spells death for tens of thousands of American men, women and children," said Chris Lanier, Coordinator of the National Coalition to Save Lives Now! "We've taken drastic action today to insist that human lives not be sacrificed to political expediency!"
Uniformed Secret Service officers bundled the group of 11 protesters into a van and took them away. All 11 were released without facing charges after they agreed to pay $50 fees, said one of the demonstrators, Ken Vail, director of Xchange Point of Cleveland.
Thurman, herself a former AIDS policy protester who had urged Clinton unsuccessfully to fund needle exchange programs, said she spoke with the protesters, some of whom chained themselves to her desk, and understood their frustration.
Thurman told United Press International following the protest that "to be on this side is incredibly awkward for me," but she expressed confidence that Clinton "really cares" about the AIDS epidemic and she promised the debate over needle exchanges will continue.
Although Clinton cited the advice of his chief anti-drug strategist, Barry McCaffrey, in his decision to oppose needle-exchange funding, Thurman shifted the blame to the Republican-led Congress, accusing it of being "incredibly reactionary" on the matter.
Court upholds Philadelphia school condom program
The U.S. Third Circuit Court of Appeals has upheld a Philadelphia policy that allows for the distribution of condoms in high schools, rejecting arguments that the policy "supplants parental authority."The program, launched in 1991 and currently applied in nine of the city's 40 secondary schools, includes a form that allows parents to opt their children out of the program if they object. Still, Parents United for Better Schools, a Germantown-based advocacy group, had challenged the legality of the program shortly after its inception.
For five years, the group litigated in local and state courts against the school district, which had the backing of the American Civil Liberties Union's Reproductive Freedom Project, among others. The parents wanted to strengthen the opt-out provision, asking that the policy be changed so that parent approval would be necessary before their child could obtain condoms or counseling.
Parents United argued that the program went against the "fundamental 14th Amendment right to freedom from unnecessary governmental intrusion in the raising of their children." In September, U.S. District Judge Robert Gawthrop ruled in favor of the school district, holding that "it is sadly self-evident that students' education is hindered when they drop out of school because they are pregnant, sick with venereal disease, or dying of AIDS."
Judge Anthony Scirica, writing for a unanimous Appeals Court, upheld Gawthrop's ruling. He wrote: "We recognize the strong parental interest in deciding what is proper for the preservation of their children's health. But we do not believe the board's policy intrudes on this right. Participation in the program is voluntary. The program specifically reserves to parents the option of refusing their child's participation."
Dennis Abrams, attorney for Parents United, said, "Now, [theschool district is] free to extend it all over the place. My clients are going to be very disappointed." He said he was unsure if the parents would appeal to the U.S. Supreme Court, as it has already refused to hear similar cases.
Philadelphia was among the first major cities in the nation to offer condom availability in schools, and also was among the first to offer condoms in male-only prisons.
Rite Aid in PR blitz on eve of demonstration
Just three days prior to a planned ACT UP demonstration protesting the inability of many Rite Aid pharmacies to provide HIV medications in a timely fashion to customers with HIV/AIDS, the company issued a national press release congratulating itself on "expanding" access to the drugs.According to a Rite Aid press release, over 400 Philadelphia-area Rite Aid pharmacists participated in a "newly enhanced continuing education program" designed to address the "special needs of HIV/AIDS customers."
"Rite Aid is committed to making sure that all of its pharmacists are informed about the rapidly changing therapies and medications that affect HIV and AIDS patients. We regularly receive and solicit feedback from our pharmacists so that our continuing education programs address the pharmaceutical and counseling needs of our customers," said Deborah Faucette, R.Ph., Director, College and Professional Recruitment for Rite Aid.
The course entitled, "Current Management of Human Immunodeficiency Virus Infection" is part of a series of continuing education seminars that Rite Aid says are "designed to increase the knowledge base of the company's pharmacists on HIV/AIDS and other diseases."
"Access to the most up-to-date information provided by leading experts in the field ensures that Rite Aid pharmacists can provide the highest quality pharmaceutical services," added Faucette.
The four-hour session was developed for Rite Aid by Steven P. Gelone, Pharm.D., Associate, Professor of Pharmacy and Medicine, Temple University School of Pharmacy and noted clinical specialist in infectious diseases. "It's most important for practicing pharmacists to understand the rapidly changing therapeutic options available to HIV/AIDS patients. This continuing education program presents state-of-the-art therapies to Rite Aid pharmacists so they can best deal with issues in this population for optimum patient care," said Gelone.
Also featured in the four-hour session was an overview of the pathogenesis of human immunodeficiency virus infection by Jay R. Kostman, M.D., Associate Professor Medicine, Section of Infectious Disease at Temple University Hospital and School of Medicine. He also is currently Medical Director of Philadelphia FIGHT.
Rite Aid says that other steps Rite Aid has taken to ensure proper dispensing and processing of HIV/AIDS medications include instructing all pharmacy personnel on the billing complexities related to the implementation of the Pennsylvania Department of Welfare's HealthChoices, Access and Special Pharmaceuticals Benefits (SPBP) programs.
Rite Aid said it had modified its pharmacy computer system to help its pharmacists to ensure eligibility for HIV/AIDS prescriptions. A team of pharmacists has been designated to assist other pharmacists in handling special questions or concerns in the filling and processing of these prescriptions.
While many people with HIV/AIDS have complained that they often have to wait for days for Rite Aid pharmacies to fill their prescriptions, Ed Hughen, Philadelphia market manager for Rite Aid, said that "All Philadelphia pharmacies are monitored to make sure that all medications needed by HIV/AIDS customers are in stock and in sufficient quantities.
"Moreover, discussions with members of local HIV/AIDS advocacy organizations led us to clarify procedures of providing a 72-hour emergency supply of protease inhibitors and other medications if eligibility questions arise," Hushen added.
Hushen was referring to discussions with the Working Group on HealthChoices and HIV, which negotiated with Rite Aid to obtain most of the concessions announced in the press release.
Rite Aid Corporation, based Pennsylvania, is one of the nation's largest drugstore chains with approximately 4,000 stores in 30 states and the District of Columbia with annual revenues of $11.4 billion.
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