Norfolk, Va., HIV Treatment Network Doctors Reject City Proposal To Restore Ryan White Funds
Eastern Virginia Medical School AIDS clinic doctors this week rejected a proposal from Norfolk city officials to restore Ryan White CARE Act Title I funding to the clinics, the Virginian-Pilot reports (Szabo, Virginian-Pilot, 4/24). A contract dispute between Norfolk officials and clinic doctors regarding billing practices resulted in the revocation of the clinics' Ryan White funds on April 11. EVMS clinics use a billing method in which doctors receive a set fee for each patient, a practice that is reportedly not allowed under federal government regulations. As a result, the clinics, which are the primary source of HIV/AIDS care for 1,200 of the area's uninsured and underinsured patients, lost their Ryan White money and had to cease operations (Kaiser Daily HIV/AIDS Report, 4/15). The city offered EVMS $750,000 to resume services and would have allowed the clinics to start seeing patients before a contract was signed, according to the Virginian-Pilot. City Manager Regina Williams said that she thought the negotiations were "headed in a pretty good direction," but Dr. Edward Oldfield, director of infectious disease at EVMS and founder of the system of satellite clinics, called the city's latest offer "unworkable," according to the Virginian-Pilot. Oldfield said that the plan would "dismantle" the medical school's system of 11 clinics, eliminating patients' ability to receive medical care and social services in one visit, according to the Virginian-Pilot. Several other reasons Oldfield stated for rejecting the city's plan included:
- The plan did not contain contingencies to provide outpatient services in James City, Williamsburg and York County.
- City officials have not yet found a replacement for an experienced nutritionist whose Ryan White funding was recently eliminated.
- Ryan White patients would be limited to filling prescriptions at only one particular pharmacy, which is closed nights and weekends.
- Doctors would no longer be permitted to treat HIV/AIDS patients for sexually transmitted diseases or give Pap smears.
Oldfield said, "I've treated AIDS patients for 21 years, and I've suffered through many deaths, but I've never suffered through the death of a comprehensive system of care," adding, "It's hard enough to fight AIDS in a community as a team, but when you have another group of people trying to sabotage your work, it's impossible." Williams said that disagreements between Oldfield and city staff lie in differing interpretations of the intent of the Ryan White program, according to the Virginian-Pilot. Williams said that she believes the grants should go to emergency care rather than serving as a lasting source of health care. "We need to find the funding for a comprehensive medical system, but I don't think that Title I is it," Williams said (Virginian-Pilot, 4/24).
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