Contract Dispute Between Norfolk, Va., City Officials and Local Doctors Puts HIV Treatment Network in ‘Immediate Jeopardy’
A contract dispute between city officials in Norfolk, Va., and doctors from the Eastern Virginia Medical School's AIDS clinic network regarding billing practices has resulted in the revocation of federal Ryan White CARE Act funds, a move that public health officials say has put the region's HIV treatment network in "immediate jeopardy," the Virginian-Pilot reports. Shirley Tyree, a city employee in charge of the disbursement of Ryan White funds, said that EVMS clinics use a billing method in which doctors receive a set fee for each patient, a practice that is 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, have lost their Ryan White funds and on Monday notified patients that care may no longer be available. Dr. Edward Oldfield, director of infectious disease at EVMS and founder of the system of satellite clinics, said that the billing practice has been in place for three years and does not violate federal regulations. Iris Jessie, an assistant city manager in Norfolk, said that the funds had been cut because federal officials thought the region's overall medical care costs were too high. Oldfield said that not only are the clinics' costs average, but the region over the past two years has failed to spend more than $1 million in federal funds.
Other Sources of Care
Norfolk officials offered to allow EVMS to retain its clinic in South Hampton Roads, closing the three other locations in Williamsburg, Hampton and Newport News. Patients from those areas would have to be treated at the more "cost effective" Peninsula Institute for Community Health, city officials said. Oldfield has refused to offer services only in South Hampton Roads, saying that it is unethical to provide a standard of care for some patients while depriving others of that same standard of care. He added that the Peninsula Institute is not equipped to deal with the AIDS patients because it has no infectious disease specialists on staff. Without the assistance of the EVMS clinics, AIDS patients will have to seek care from the Chesapeake Health Department, Tyree said, but Dr. Nancy Welch, director of the health department, said that the center has "never been set up to handle this," adding, "We can't provide AIDS care if it's not in conjunction with EVMS ... [which has] the hospital care and infectious disease expertise" (Szabo/Kruse, Virginian-Pilot, 4/3). The Greater Hampton Roads HIV Health Services Planning Council met last night to discuss the changes. About 24 clinic patients attended the meeting to voice their concerns about possible disruptions in access to and quality of AIDS care. Norfolk officials said that that they are still trying to negotiate with EVMS and are waiting for a response to a letter sent Wednesday (Kruse, Virginian-Pilot, 4/4).