published by We The People Living with AIDS/HIV of the Delaware Valley, Inc.
NuCore patient confirms poor quality care; city tax agency probes group
NuCore blames "unprofessionalism" for firing
IL2 therapy doubles T-cell counts
PWAs critical of COMHAR at federal meeting
State seeks money from Ride organizers
City tax agency investigates group
NuCore patient confirms poor quality care
A former patient and the staff of the personal care boarding facility where he resides have confirmed reports of sub-standard care and treatment of patients at Neumann Medical Center's AIDS program, operated by NuCore Health Management, Inc.
NuCore fired its medical director and AIDS program director several weeks ago after they complained about the quality of care.
George Anderson, NuCore's president, said in a letter to fastfax that Daryl Jackson, M.D., and Robert Capone were fired because their "unprofessional conduct" in confronting hospital officials on their patient care complaints "was clearly inappropriate, unwarranted and disrespectful." (See related story.)
Dennis Johnson, age 43, a former patient of the Nuemann program, confirmed to fastfax that he agreed with the allegations made by Jackson and Capone regarding the nursing care he received at the hospital.
"The nurses treated me like dirt," Johnson said in an interview. "I was having severe abdominal pain and would ring for the nurses assistance but they would not come to my room. I had to go to the nurses station for help."
Johnson said that the nurses made him feel that "it always seemed like I was getting on their nerves." Capone, he said, "was the only one who seemed concerned. When he found out that I was only on Medicare and had no prescription coverage he helped me fill out an application for the Special Pharmaceutical Benefits program. When he found out that I couldn't be admitted to Calcutta House he got me in Partners-N-Care." PNC is a local personal care boarding home.
Johnson also told fastfax that during his first admission he was under the care of Dr. Raymond Silk, who has been the subject of previous controversies over the quality of his AIDS care. NuCore president George Anderson had previously denied to We The People that Silk had ever provided care for his project at Neumann.
Johnson said that during his first hospitalization, while under the care of Silk, it was discovered that he had active tuberculosis. He said that "Dr. Silk discharged me without any medication or a prescription to get any."
"They (Neumann) didn't even return the medications that I had with me when I was admitted," Johnson said.
Jo Friday, Director of Partners-N-Care, a personal care boarding facility in the Germantown area, also confirmed that when Mr. Johnson was released from Neumann into her care he had no medications and no prescriptions. Friday said that the hospital also provided no nursing care plan, which, she said, is standard practice for such admissions.
"When Dennis arrived and I looked at the paperwork from Neumann, I noticed there was a list of medications but no prescriptions. When I called Dr. Silk about it he seemed resistant to ordering the medications, so I paged Rob. Rob was really upset and very apologetic about the situation when I told him what happened. He said he would take care of it. Later I got a call from Dr. Silk. He asked me where the closest pharmacy was. It was about 8:30 that evening when Rob dropped off the medications."
Friday was critical of NuCore's failure to take steps to treat Johnson's TB infection.
"Dr. Silk and Neumann Medical Center put both Dennis and our entire facility at risk, due to the fact that he was required to be on the TB medications daily. This happened on a Friday, and if he had gone without the medications for the entire weekend he may have developed resistance to them and he may have infected everyone at our facility."
In a related matter fastfax has learned that NuCore is currently under investigation by the City of Philadelphia's Revenue Department. A city source said that none of the three names being used by the company (NuCore, NuVision, and NuLife) are registered with appropriate city licensing agencies. A manager of the city's tax investigation unit confirmed that the city is conducting an active investigation of NuCore.
NuCore blames "unprofessionalism" for firing
George W. Anderson, president and chief executive officer of NuCore Health Management, Inc., has charged that recent fastfax articles on the quality of AIDS care provided at the organization's Neumann Medical Center AIDS unit contained "numerous inaccuracies and distortions," according to a letter sent to We The People executive director Joe Cronauer.
The letter will be printed in full in the At-Issue section of December's Alive & Kicking!
Anderson said that the articles also misrepresented "the actual reasons for the dismissals of Mr. Capone and Dr. Jackson."
Anderson said that Capone, a We The People board member and member of the city's HIV Commission, was hired "because in him we saw someone who was both intimately involved in the HIV/AIDS community and who shared our company's vision."
"Mr. Capone's greatest asset was his passion," Anderson said. "However, his passion is also his greatest shortcoming. It is Mr. Capone's passion that makes him an effective advocate and it is his passion that causes him to appear to be myopic and inflexible. There is no doubt that Mr. Capone believes he acted and is acting on behalf of quality patient care. However, he should not have been surprised by the actions taken. Mr. Capone and Dr. Jackson's UNPROFESSIONAL conduct was clearly INAPPROPRIATE, UNWARRANTED and DISRESPECTFUL." [Emphasis included in original letter.]
Anderson, who had been asked by Cronauer to provide a response to the charges made by Capone and Jackson, said his letter was not intended "to address the many inaccuracies point by point. I must stress the fact that Mr. Capone and Dr. Daryl Jackson were dismissed because they alienated the administration and staff of Neumann Medical Center through conduct which we deemed to be clearly inappropriate and unprofessional."
Anderson said that "during a meeting, called to resolve alleged concerns, Mr. Capone and Dr. Jackson were adamant in their desire to indict and defame the experienced and dedicated health care professionals employed by Neumann Medical Center. Working men and women, who were in fact part of the team, not the enemy. During said meeting, Mr. Capone and Dr. Jackson refused to accept Mr. Hares' offer to address any concerns that had arisen regarding the program. They CURSED Mr. Hare and called him a LIAR without provocation. This conduct is unacceptable in any civilized forum, regardless of the cause." [Emphasis included in original letter.]
"It is not our intent to fight with Mr. Capone and Dr. Jackson," Anderson continued. "It is our intent to fight for what is right and what is truth! This is not a patient care issue. It is an issue of professionalism. Mr. Capone and Dr. Jackson were dismissed because of irreconcilable differences about professionalism."
NuCore is "resolved to have an HIV/AIDS program," Anderson said. The reason for our resolve is simple...there is an overwhelming need. We invite the input and scrutiny of people of reason.
Anderson said that NuCore has spent more than a year developing its AIDS program, "unlike any in the area," to specifically target "the homeless, uninsured, underinsured as well as those struggling with Drug and Alcohol problems." He said that NuCore chose Neumann Medical Center for its program "because they were able to share our vision ... the best possible quality in patient care was, currently is, and always will be our highest priority."
Responding to Capone's charges that NuCore was more concerned about "making money" than in quality care, Anderson said that "there is little doubt that if the quality of care goal was met, there would be financial benefits. The financial benefit is important! It gives a community-based hospital additional means of staying competitive in this age of giant health care systems and shrinking medical assistance reimbursements."
While stating that We The People "is not the enemy and the press is not the battle ground," Anderson said that "we will not stand by and permit you to divert attention fro the serious health care issues to be resolved, or to destroy all the good work that has been done. We rise above such conduct and will channel our energies to fight the true war. We hope you will do the same."
Capone, provided a copy of Anderson's letter by fastfax, noted that Anderson was silent on his and Jackson's charges that the incidents which led to his termination involved Neumann nurses refusing to clean a patient after he had defecated on himself, refused to give a blanket to the patient when he complained of the cold, and that the hospital was too quick to discharge patients and used inappropriate precautions in caring for AIDS patients.
"Well, I have no fear of addressing this fiasco point by point," Capone told fastfax, "because as my father always said 'no matter how many times you tell the truth, it always comes out the same way.'"
Capone agreed that during his brief tenure as AIDS coordinator for NuCore, his attitude was seen by Anderson and Neumann administrator Joseph Hare as "myopic and inflexible."
"To this I say; when it comes to the lack of providing people with HIV/AIDS the basic human dignity and respect that they deserve, absolutely. When it comes to providing at least the basic standards of care, yes and if this is a fault so be it. I shall proudly live with it."
Capone denied using foul language in his and Jackson's meeting with Anderson and Hare, but said it was an angry encounter. He noted that Anderson had first told him he was not fired, but then did so the next day with a promise of severance pay, possible employment with other NuCore programs, and other benefits. These were later withdrawn when Capone told his story to fastfax.
"I think they realized that they were not going to get away with anything with me around so I had to go."
Capone said he was concerned at Anderson's assertion that his company is "resolved to have an HIV/AIDS program."
"This assertion fills me with feelings of dread," he said. "I truly fear that the lives of those who end up in their care will be in grave danger, because in my mind they are complicit in the mistreatment of two AIDS patients already, and I believe that people will prematurely die if they are allowed to continue." Capone also criticized NuCore for what he said was its failure to develop other aspects of its program called for in its contract with Neumann, including psychological support services, case management, housing counseling and skilled nursing services.
IL2 therapy doubles T-cell counts
In a one-year study of HIV-infected people, infusions of the immune system protein interleukin-2 (IL-2) have resulted in dramatic and sustained increases in the primary immune system cells depleted during HIV infection, according to investigators at the National
Institutes of Health (NIH).
In the study, patients randomly assigned to receive IL-2 plus standard antiretroviral therapy had mean CD4+ T cell counts that increased from 428 cells per cubic millimeter of blood (mm3) at baseline to 916 cells/mm3 at month 12. Among patients randomly assigned to receive standard antiretroviral therapy alone, mean CD4+ T cell counts decreased from 406 cells/mm3 to 349 cells/mm3. CD4+ T cells are the main targets of HIV; the progressive loss of these cells leads to the symptoms of AIDS.
Researchers reported there findings in The New England Journal of Medicine.
"This work highlights the potential role of immune-based therapies in the treatment of HIV-infected people," says Anthony S. Fauci, M.D., NIAID director.
Significantly, the amount of HIV in the blood of study patients receiving IL-2 therapy remained stable over time. Previous studies had shown that IL-2 treatment can result in transient bursts of virus production in some patients, but the current data clearly indicate that these bursts do not lead to sustained increases in viral load.
In addition, the side effects of IL-2 infusions in the current study were much less severe than those seen in previous studies using higher doses of intravenous IL-2.
"Our study has clearly demonstrated that IL-2 therapy can have a substantial positive impact on the major immunologic abnormality associated with HIV infection, the loss of CD4+ T cells, without leading to an overall increase in the level of HIV in the bloodstream or to unmanageable toxicities," says Dr. J. A. Kovacs, who headed the study.
Despite flu-like symptoms and other side effects during IL-2 infusions, patients in the study reported feeling as well overall as patients not receiving IL-2, according to a quality of life analysis presented at the XI International Conference on AIDS in Vancouver last summer.
"We are encouraged that the increases in CD4+ T cells observed in this study did not come at the expense of a patient's overall quality of life," says Dr. Kovacs. "Additional work by our group has shown that other dosing regimens, especially subcutaneous administration of lower IL-2 doses, can further reduce toxicity."
All immunologic studies performed thus far suggest that the CD4+ cells that proliferate during IL-2 therapy are functional, Dr. Lane notes. As further evidence of this, "the current study has provided the first clinical data that IL-2 therapy may be able to prevent new AIDS-related conditions or death," he says. "Among individuals randomized to standard antiretroviral therapy, five people developed AIDS-related symptoms or died, as compared to two in the group randomized to IL-2 in addition to standard antiretroviral therapy. In each instance, these events occurred in patients with low CD4+ T cell levels. Phase III studies are needed to accurately determine the clinical benefits of IL-2 therapy."
PWAs critical of COMHAR at federal meeting
People living with HIV/AIDS attended -- uninvited -- a meeting of federal evaluators of COMHAR's Community Living Room project this week to press their concern that the management of COMHAR is insensitive to the needs and input of people with HIV/AIDS.
COMHAR operates several programs providing mental health services to people living with HIV disease.
The meeting was held by city health department officials and several evaluators working for the federal Center for Mental Health Services, which funds the CLR program as a demonstration project.
The advocates complained that COMHAR has "refused to develop a partnership with people with AIDS."
"Each of your agencies have expressed a firm public commitment to consumer involvement and empowerment. Despite our consistent, peaceful efforts to participate in an advisory and helpful capacity to COMHAR, this commitment has been violated by [COMHAR director Matthew Elavumkal and [Robert] Meale and requires your immediate action to redress."
The group noted that despite a requirement that there be a consumer advisory board associated with the CLR program, none had been created in the two-year history of the effort.
COMHAR has "made significant decisions regarding program design and implementation strategies without the input of consumers of services or people living with HIV/AIDS," the group said. They also complained that city officials who claim they are soliciting members for an advisory board have sought to limit the role of consumers.
The group called on city officials to meet with We The People to develop an advisory board that includes "trained and supported" consumers.
The CLR management was also criticized for failing to coordinate its services with We The People and other AIDS agencies, although such partnerships were specifically included in the city's application for federal funds for the project.
The group also told the evaluators that COMHAR's refusal to act on its commitment to pay disability benefits to the CLR's former education director, Ted Kirk, indicated "that insensitivity to people living with HIV/AIDS has been enshrined as a basic core value of COMHAR's approach to the people living with HIV and AIDS in its care."
"COMHAR's continued insults to people living with HIV/AIDS and its willingness to ignore its own public commitments and the requirements of its funders with regard to consumer involvement and empowerment have greatly eroded the credibility of its programs and violated the trust of people living with HIV/AIDS," the group said.
We The People, ACT UP and other AIDS advocates have encouraged city and federal agencies to shift their funding for COMHAR's AIDS programs to other organizations unless the Kirk dispute is resolved.
The evaluators responded that they would include the group's concerns in their reports to CMHS.
State seeks money from Ride organizers
Mary Beth O'Hara Osborne, of the Pennsylvania Attorney General's Office, told the Philadelphia Gay News last week that local AIDS Ride organizers will owe "some restitution to the state, because the organizers solicited without the benefit of registration [and] there was a period of time when they were not in good standing."
Osborne said that the attorney general is seeking financial and business information on the Ride's promoter, Pallotta and Associates, and the three main sponsoring organizations, ActionAIDS, the AIDS Information Network, and Philadelphia Community Health Alternatives.
Osborne said that the state investigation is expected to continue for several months,, and could result in fines of up to $1,000 for each civil violation and $10,000 if the state believes there has been "fraud or deceit."
She said that Ride proceeds should not be delayed by the investigation. "That money shouldn't be going to us," she said. "How they decide to pay us back is their affair, as long as they pay it back."
An audit released by ActionAIDS last week confirmed that only about 19% of the Ride's proceeds will actually go to the organizations benefiting from the event, held this summer. Expenses, including fees to promoter Dan Pallotta, reached over $1.5 million, according to the report, leaving only $324,000 for distribution to the three agencies and the Greater Philadelphia Urban Affairs Coalition, which has pledged to distribute its share to minority AIDS organizations originally excluded from Ride sponsorship.
PGN also reported that ActionAIDS is still responsible for the rental of the Ride office in center city until next September, at an annual cost of at least $24,000.
ActionAIDS attorney Paul Madden criticized the state attorney general for its inquiry. "Any financial data on the Ride is going to be available," PGN quotes Madden as saying. "But she [Osborne] is also looking at the AIDS agencies and doing more than looking at the Ride."
Jones will be the first African American to serve in a senior management position at ActionAIDS since its founding in 1986. His AIDS experience includes work at the Whitman-Walker Health Clinic in Washington, D.C., and with the now-defunct National AIDS Network.
The agency has been severely criticized by people of color living with HIV/AIDS for resisting the hiring of people of color in management positions, even though the majority of its clientele is African American or Latino. Littrell, during her term at ActionAIDS, was a leading critic of the expenditure of public funds on minority-based community AIDS initiatives.