Parkland Hospital administrators say il was Just a “communications lag” that led the director of the hospital’s AIDS clinic. Dr. Daniel Barbaro, to submit his resignation last November. Barbaro wanted to quit, he says, because he was tired, overworked, and frustrated with the hospital’s lack of response to his overcrowded and understaffed clinic. He told Internal Medicine Department Chair* man Dr. Donald Seldin that in order to run the clinic properly he’d have to have, among other things, another full-time physician, a second full-time nurse, and two physician’s assistants. But by late December, Barbaro had withdrawn his resignation. Seldin and Dr. David Bilheim-er, associate dean for clinical affairs, expressed regrets for not keeping the young doctor better informed. The staff and equipment he needed were already on the way.
Barbaro, who became the year-old clinic’s first full-time physician last July, says he has been far busier than he expected to be ever since his first day at Parkland. Until January he was the sole doctor following AIDS victims at Parkland. In December he was working with between sixty-five and seventy AIDS patients and following 300 other men and women diagnosed with AIDS-related complex. Each week he completed detailed, individual paperwork on thirty patients taking the experimental anti-viral drug Azidothymidine (AZT). Barbaro, who is thirty-three and straight out of residency at Baylor, followed by a two-year fellowship at UTHSCD, says he’s already turned down offers to go into private practice for as much as three times his current salary in order to stay at the Parkland clinic.
His proposed resignation generated quite a bit of anxiety in and out of the hospital and brought some of Parkland’s administrators sharp criticism for not acting more quickly to get the AIDS clinic in efficient working order.
The clinic currently treats about one-third of those diagnosed with AIDS in Dallas County, but that share of the burden is likely to grow dramatically over the next months and years due to a number of factors. Increased awareness has provided for earlier diagnosis of the disease for many victims and thai makes for longer treatment periods and greater potential of loss of employment and insurance coverage. Although the drug AZT works to enhance the immune system and thereby lengthen an AIDS victim’s life, it actually increases the cost of dying from AIDS. With that added time comes the necessity of more labor-intensive nursing, prolonged hospitalization, and, of course, compounded related costs of treatment. Private hospitals see AIDS as an especially unprofitable disease. A survey of California hospitals reported losses that averaged more than $5,000 over other uncollectible cases.
All the grim signs that signal the likelihood of financial straits for AIDS patients, coupled with the fact that the number of AIDS victims here tripled in 1986 and is expected to double in ’87, mean the patient load ai Parkland’s clinic is going to boom. And if that’s the case, community political and medical leaders had better act quickly to bring the clinic up to par.
Dr. F. Kevin Murphy, an internist in private practice who treats several AIDS patients, says that locally and nationally, people need to wake up. “We’re talking about a disease that could destroy our entire healthcare system without careful planning. By 1990 more men and women will have died from AIDS than did in the Vietnam War.” The slowness to adequately prepare at Parkland is not surprising, says Murphy, ’”given that this is a disease about which so many naive moral judgments are made,”
“Emotionally,” Barbaro says of the twelve-hour days and mounds of paperwork, “it’s difficult. But I’ve found it very fulfilling from the point of view of working with the patients and as a career decision. These patients really want you to be here for them,” Along with a heavy patient load and a lack of help, Barbaro has been dealing with the problems that result from ignorance and fear of the disease. He recalls a Parkland nurse who refused to allow an AIDS patient to leave his room and walk through a hospital corridor. “You have AIDS.” the patient says the nurse screamed at him.
“You stay in your room.” Barbaro says he also believes more of the lab tests that he requests be done on his patients are lost than from other departments. The specimens or blood samples he collects from patients are sent to lab technicians with a special label alerting them to take special precautions in handling. The implication is that nervous lab techs “lose” some samples rather than taking the risk of handling them.
Parkland administrators say they have long been well aware of Barbara’s problems in the clinic and they approached his list with a “consider it done” attitude. Bilheimer says Barbaro was having trouble gelling his needs across to administrators because he didn’t make his requests through the proper channels. “The decision was made months and months ago to hire another physician.” Bilheimer says additional equipment Barbaro needs has been purchased and that he is “developing a plan to immediately provide for a psychiatrist.”
Bilheimer says that Parkland has had a seven-member AIDS task force at work for more than a year with representatives from a wide variety of departments. To hear hospital spokesperson Catherine Ellis describe the committee’s work, it seems Barbaro was about the only person in the hospital who didn’t know all that was being done to shapo up the clinic. But Barbaro, either because he was loo busy to find out or because the task force members neglected to fill him in on their plans, says he submitted his resignation without knowing that another physician would be joining him after the first of the year.
Barbaro never seemed anxious to leave Parkland. “I feel a special commitment to continue monitoring the patients receiving AZT, and I feel we’re making strides in educating people about AIDS. I feel good about what 1 do. All the money in the world can’t replace that feeling. But I can’t do it on my own.”