|
 |
|
|
|
Issue #188: August 2, 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 Chicago Tribune, DVHC/HAP Update, and the Philadelphia Gay News.Norvir patients forced to shift to liquid form
House makes major cut in HOPWA
State settles HealthChoices lawsuit
Legislator says Keystone violates state regs
TPAC challenged on cost of Geneva "junket"
Positive Health to broadcast Jackson tribute
Norvir patients forced to shift to liquid form
Abbott Laboratories has stopped production of the capsule form of its protease inhibitor Norvir because of unexplained manufacturing problems.The company cautioned in a press release posted on PR Newswire that the manufacturing difficulties with the capsules will cause shortages and an interruption in supply of the capsules. The company said that capsules currently in distribution are not affected by the issue and the product is safe and effective.
Abbott said it will run out of the capsule before the end of next month.
"It did not become clear until just recently that we would not be able to fix it in time to prevent a capsule shortage," said Dr. Eugene Sun, head of Abbott's anti-viral venture group. Company officials said they are unsure when the problem, which is preventing the pills from dissolving properly, will be fixed.
"Although maximum efforts are underway, to date we do not have a solution to the capsule problem," said Abbott Senior Vice President Arthur Higgins. The Norvir capsules already on the market are "safe and effective," Abbott officials say.
Abbott will continue to produce Norvir in liquid form, which doctors say is a problem because of its "awful" taste. Some PWAs may be more likely to skip or abandon the treatment because of the unpleasantness of the liquid formulation.
Additionally, the liquid must be stored unrefrigerated at temperatures of 68-77 degrees Fahrenheit, which may pose difficulties given the long heat wave being experienced in most of the country.
The dosing of the liquid formulation is as follows: 600 mg. = 1 1/2 teaspoons; 400 mg. = 1 teaspoon.
"I think it would be an interim nuisance, but most patients ought to do just fine," said Dr. Renslow Sherer, head of the AIDS unit at Chicago's Cook County Hospital. "It's a problem, but it certainly would have been worse had there not been a liquid to substitute." Physicians routinely recommend that patients take the liquid form of Norvir with chocolate products or protein drinks to disguise the bad taste. Sun said the company is upping production of the liquid form of the drug to ensure that it will cover the market.
Abbott said it has notified the Food and Drug Administration and AIDS service organizations of the problem, and that it will send a mailing to patients, physicians and government agencies, notifying them of the problem. The company has established a toll-free number (800/637-2400) and a web site (www.norvir.com) to answer patient and provider questions.
House makes major cut in HOPWA
The U.S. House of Representatives has reduced federal funding for the Housing Opportunities for People with AIDS (HOPWA) program by over ten percent, shifting $21 million from the only AIDS housing program on the federal level to support new housing programs for veterans.The measure, which was sponsored by Rep. Van Hilleary (R-TN), was passed 231-200 as part of a larger bill that would finance veterans affairs and housing matters for fiscal year 1999, which starts October 1st. It would affect funding available for rental assistance subsidies and emergency financial assistance for people living with HIV/AIDS starting with the new city fiscal year in July, 1999.
The House measure could still be defeated if it is not supported by the Senate, which has, in the past, restored HOPWA funding cuts initiated by the more conservative House. Since the Senate has not passed corresponding legislation, the measure could be dropped when the House and Senate negotiate the final spending bill they send to President Clinton, who is likely to oppose the action.
There are potentially 11 new communities that will become eligible for HOPWA funding in fiscal year 1999. The Clinton Administration had added the $21 million to assure that the new communities would receive funding without reducing allocations for other cities and regions. Without the allocation, those new communities would probably be unable to receive funding unless significant cuts were made in regions where funding is already distributed.
Over the past two years, the number of communities qualifying for HOPWA funding has increased by 20% while the amount of funding has only increased by 15%. Conversely, the Veterans program has seen a 70% increase in funding during this period. Additionally, while new AIDS cases have declined by 6%, the number of people living with AIDS has increased 13% - adding even more of a burden to a program that is inadequately funded.
In other action, the House also passed an amendment that would deny all federal housing funds to any city which requires local employers to adopt domestic partners provisions. This measure, if finally enacted into law, would not apply to Philadelphia, which only guarantees domestic partnership benefits to a small number of gay city employees.
The amendment, introduced by Congressman Frank Riggs (R-CA) would eliminate any funding for housing programs to localities that have ordinances that require businesses contracting with the local government to provide domestic partner benefits for their employees. This includes all housing monies including HOPWA and Section 8 grants.
State settles HealthChoices lawsuit
A class-action lawsuit -- filed last June against the state Department of Public Welfare and involving HealthChoices -- has been settled. The suit alleged that special needs HealthChoices beneficiaries, including people living with HIV disease, did not get proper notice when denied medical services and that some services were wrongfully denied. The case, Metts v. Houstoun, raised several challenges to the implementation of the HealthChoices program for physical health services. Key terms in the settlement include:HealthChoices beneficiaries have the right to receive written and timely notices that adequately explain reasons for denial of service. Also, information is to be provided specifically for any additional information needed.
Covered benefits may not be denied, reduced or terminated for any of the following reasons, unless the benefit will not meet any of the broad bases for medical necessity identified in the state's request for proposal: (1) the member's condition is chronic, developmental, long-term, will no longer improve, or is stable; or (2) because the member has or does not have any particular diagnosis or condition.
Members under 21 should receive case management if it is medically necessary. Moreover, the plan may not provide case management through any individual employed by an HMO or through a subcontractor of an HMO if the individual's responsibilities include outpatient utilization review or reviews of requests for authorization of outpatient benefits.
The plans must use the written criteria in the fee-for-service system to assess whether motorized wheelchairs, scooters, or other motorized equipment are medically necessary. The plans may not expect a family member to push the patient in a chair.
Incontinence products shall be provided if medically necessary.
Nutritional supplements should be provided to members under age 21 if medically necessary.
HMOs are to inform beneficiaries of the information they need to support such a request.
Legislator says Keystone violates state regs
Pennsylvania state representative Lawrence Curry of Montgomery County has charged that Keystone Mercy Health Plan, the largest Medicaid HMO in the Philadelphia area, has violated state regulations by hiring a new medical director who is not licensed to practice medicine in Pennsylvania.In a letter to state welfare secretary Feather Houstoun, who is responsible for the Medicaid program, Curry was severely critical of the Keystone action and of the Department of Public Welfare for not enforcing the HMO Program Standards, which regulate HealthChoices, the Medicaid managed care program in southeastern Pennsylvania.
"Would you please explain how this is possible?" Curry wrote, in correspondence obtained by fastfax. "Does the Department [of Public Welfare] monitor its own standards? Or are the standards merely words for public consumption and practices are something else?"
Curry questioned whether DPW bothers to review procedures for the hiring of pivotal personnel in the HMO program. "Could it be that because this HMO serves poor people, the Department is less scrupulous in its oversight activity?"
A staff member in Curry's office said he was out of town and would not be available to comment on his letter before fastfax press time. A spokesperson for Keystone refused comment to fastfax, and also refused to provide the name of the new medical director.
Over 50 percent of all Medicaid recipients are enrolled in Keystone Mercy Health Plan. The other HMOs participating in HealthChoices -- Health Partners, HMA and Oxford -- cover 22.2 percent, 14.5 percent and 13.3 percent, respectively.
Keystone is not the only Medicaid HMO facing difficulties.
Oxford Health Plans has recently agreed to voluntarily suspend marketing and enrollment of most new members in its Medicare managed care in Pennsylvania and in the other four states it serves. The decision came after the Health Care Financing Administration's (HCFA) discovery of contract violations with the managed care organization.
Specifically, HCFA found deficiency's in Oxford's claim payment turnaround times and interest payments; enrollment and disenrollment procedures; and documentation and member appeal procedures. Oxford has developed a corrective action plan, in which it will need to demonstrate progress to HCFA in order to resume marketing and enrollment, and be granted new Medicare+Choice contracts for 1999. Failure to comply would force Oxford out of the federal program, which last year constituted 22 percent of the organization's total premium revenue.
Oxford's local operation recently laid off 40 to 45 employees. The restructuring comes as the managed care organization continues its re-evaluate its performance in the Delaware Valley. While Oxford maintains that there is no difference in the people who are working with the network providers, area hospitals report that there have been changes in their provider representatives. Moreover, area providers have also noted a significant turnover among Oxford's utilization management professionals, as the people they normally speak to about issues are changing rapidly.
Meanwhile, the Delaware Valley Healthcare Council has reported that he number of Medicaid beneficiaries in the Delaware Valley dropped by 1.6 percent since January, and by 5.3 percent in the last year. Elsewhere in Pennsylvania, the number of beneficiaries declined by 3.6 percent in the last year. Although there has been a drop in the overall number of beneficiaries, the number in managed care plans in this region has remained stable at just under 94 percent.
TPAC challenged on cost of Geneva "junket"
Controversy has again engulfed The Philadelphia AIDS Consortium (TPAC), this time for spending as much as $14,000 on sending a group of staff and volunteers to the 12th International AIDS Conference in Geneva last month.Mick Maurer, a TPAC board member and co-chair of the Philadelphia HIV Commission, called the trip a "junket" and said that the money could have been better used to provide direct services to people living with HIV/AIDS.
TPAC sent six representatives to the conference, and served as a fiscal agent for a committee of people living with HIV/AIDS that was attempting to raise funds on its own to send eight others.
"A junket is a junket, whether it involves a congressman or a consumer," Maurer told the Philadelphia Gay News. "The money spent by TPAC on this conference could have been used for direct services that are much more pressing. The information from the conference could have been gathered freely from other sources."
Larry Hochendoner, TPAC's executive director, told the PGN that TPAC joined with the PWA committee partly to receive a discount-travel rate to Switzerland.
PGN also incorrectly reported that the PWA committee was associated with We The People, which Rob Capone, interim executive director of the agency, said was not true.
"Members of We The People did participate in the committee, but it had no affiliation, formal or otherwise, with our organization. It was a totally independent group and did not even have meetings at We The People," he said. He has asked PGN to printed a clarification on the issue.
Capone said he agreed with Maurer that too much money was spent on sending people to the Geneva conference. "From what I've heard, this conference is simply too big for anybody but a scientist or researcher to actually get much from it," he said. "Any important advances or information presented at the conference is always available through the media, the Internet, and PWA newsletters. If you add up all the public money that has been spent over the years to buy off consumers and staff of AIDS service organizations by giving them free vacations in exotic places, you probably have enough to help a lot of PWAs who desperately need help."
Capone noted that the amount of money TPAC allegedly spent on the Geneva trip is about half as much as the total funding it provides We The People for its meals program.
The practice of sending large groups of representatives to national and international AIDS meetings began in 1988, when the city's AIDS Activities Coordinating Office (AACO) sent a group of 15 people to the first national gay and lesbian health conference in San Francisco. At the time, the gay health conference was a major source of new information on AIDS treatments and prevention models, and the AACO staff were among the few paid AIDS service providers in the region.
AACO decided this year that since information from the Conference would be generally available from other sources, it would not send any representatives to Geneva.
Since then, several other international trips have generated controversy. Carmen Bolden, then-director of Congreso de Latinos Unidos, once sent a group of staff and their families to an international AIDS conference in Amsterdam at a cost of over $10,000, all of which was charged to Congreso's city contracts for AIDS services. Bolden was later arrested twice on fraud charges and is currently serving time in prison. Charges have also been made that Fran Stoffa, another former agency director later convicted of fraud, would routinely use public funds awarded to Philadelphia Community Health Alternatives to attend conferences with personal friends and favored clients of the agency.
A similar charge has been leveled in the most recent controversy. The PGN article notes that Hochendoner used TPAC funds to pay expenses for the Geneva conference for Yoshiaki Yamasaki, a close personal friend, who no longer works in the AIDS system but at one time was a board member of TPAC. Yamasaki was fired as director of Congreso's AIDS programs several years ago, and briefly worked at the Philadelphia HIV Commission when he left Congreso. He continues to volunteer at TPAC and as a member of the Commission's Latino Caucus, and told PGN that his attendance at Geneva would help him in that work.
With most national and international trips, participants claim they will make reports to the community on their return. This has rarely happened, however, except for reports from Kiyoshi Kuromiya, an internationally-known AIDS treatment activist based in Philadelphia, who routinely has provided reports on conferences he attends at public forums and through his web page and appearances on programs such as We The People's Positive Health TV broadcast.
Hochendoner said TPAC representatives would report on their experiences at the Sept. 8 TPAC board meeting. He said he knows of no immediate plans for a community forum.
Maurer told PGN that it was wrong for TPAC to send six representatives to the conference.
"I really think two people would have been sufficient for the group," he said. "It was a conference that dealt primarily with medical issues, and TPAC is not a medical-treatment provider."
Maurer said TPAC contributed about $14,000 for conference attendance, according to documents discussed at a July 14 closed board meeting. Hochendoner disputed that estimate to PGN, but would not offer an alternate figure, according to the newspaper.
In a faxed statement to PGN, Dennis Murphy, TPAC's treasurer and director of the Delaware County AIDS Network, estimated the organization contributed about $11,000 for conference attendance.
Maurer said he wants a comprehensive TPAC report, detailing the staff time and tax dollars spent in connection with the nine-day excursion. Hochendoner said that report would be delivered at TPAC's Sept. 8 board meeting.
PGN also reported that two members of the fund-raising committee, Roy Hayes and Grayling Hall, received a $900 grant from the HIV Commission to assist with conference-related expenses. Maurer said the commission may seek to recover some or all of that money because of reports that Hayes and Hall left the conference early to visit other parts of Europe.
Hayes said that he did leave the conference to visit his wife in England, but that he did so at his own expense.
The PGN article also reported that WTP's Life Center Director, Warren Hunt, had gone to the conference but had left to join his mother on a European vacation.
Hunt said that all of his expenses were covered by a scholarship from the AIDS Conference itself and his own money, and that he did not receive support from TPAC or the fundraising committee. As a delegate, Hunt said, his conference-related expenses were paid by conference organizers. In return, Hunt said, he was required to spend at least 20 hours at the conference.
Maurer was not the only TPAC board member who questioned TPAC's conference expenditure, according to PGN.
"No, I don't think we needed to send six people to Switzerland," said Rob Shover, a TPAC board member. "I'm not against enhancing the learning experiences of board members. But there must be other, less expensive ways to do that, rather than taking money from our budget." Shover said a policy is being formulated to prevent similar occurrences without TPAC board approval.
Officials at the state Department of Health, which contracts with TPAC to distribute state and federal AIDS dollars throughout the region, had no complaints with TPAC's conference expenditures, according to PGN.
"If TPAC feels it was an appropriate use of funds, we have no problem," said Bonnie Jo Brautigam, a state health official and TPAC's project officer. "We encourage staff development, organizational development, and consumer empowerment at TPAC. If TPAC's relationship with the conference did all three of those things, that's fine with the state."
Meanwhile, Maurer has also filed complaints with various state officials about the recent allocation of funding awards by TPAC using state and Ryan White CARE Act Title II funds.
Maurer, who represents Bucks County on the TPAC board, told fastfax that he has "written to all our county reps, state senators, Congressmen Jim Greenwood, Lt. Gov Mark Schweiker and our county commissioners about the TPAC allocation process. My complaint is over the process and not who was or was not funded."
Maurer said that TPAC established three people of color caucuses, then allowed board members to determine how funding in a category called "Other" would be allocated.
"The 'Other' [category] was not community consumer driven as were the three caucuses," Maurer said. "That is my complaint, that the Board is making decisions and not empowering consumers who did not fit into the three caucuses to determine how the 'other' monies were to be prioritized. To me that smacks of the old TPAC."
TPAC has not publicly responded to Maurer's complaints on the funding process. Several other organizations and individuals have also complained about the mechanisms used by TPAC to determine funding priorities, which resulted in the de-funding of most historically minority organizations providing AIDS services in the region. One group, Congreso, is working on a federal discrimination lawsuit over the process, based on what they say was a TPAC prohibition against funding organizations targeting Latino PWAs with case management and primary care services. The suit, which has been in preparation for several months, is expected to be announced soon.
Positive Health to broadcast Jackson tribute
Positive Health, We The People's weekly television broadcast focusing on "health care in the age of AIDS," will present a tribute to the program's co-founder, Arnold Jackson, in a special program on Tuesday, August 11th at 8:00 p.m.The program will be broadcast on WYBE Channel 35.
Jackson was the original host of the program when it was started as Epidemic! HIV in 1992, and later joined co-host Carol Rogers in broadening the scope of the program to cover other health issues under the name Positive Health. He left the program in 1997 as his health deteriorated. Jackson died on May 3rd of this year.
The program features interviews with friends of Jackson, including Yolanda Lollis, managing attorney at the AIDS Law Project of Pennsylvania, and Michael Hinson, executive director of The Colours Organization. Clips of interviews and commentaries by Jackson are also included.
David Fair, Jackson's roommate for eleven years, has also produced a website featuring various commentaries and fictional pieces written by Jackson. The website can be found at http://www.critpath.org/wtp/_private/arnold.htm.
To obtain a weekly email version of fastfax, contact with the message: "subscribe" or fill in the box on the fastfax index page.