Cedars-Sinai Cuts HIV/AIDS Services

Cedars-Sinai Medical Center will reduce its HIV/AIDS treatment and research programs and no longer employ an HIV specialist as of July 1, according to the director of the Infectious Diseases Division, whose comments are disputed by hospital officials who insist little will change.

While hospital officials confirmed some cutbacks to the Infectious Diseases Division, the director, Dr. David Hardy, says the academic aspects (research, teaching and indigent patient care) are being reduced significantly, leaving West Hollywood residents who get HIV/AIDS care at the non-profit hospital on San Vicente Boulevard scrambling to find treatment.

“This is a tremendous loss,” said Hardy. “A program that’s been in existence since 1990 will no longer be here anymore in terms of HIV research and specialized care.”

Hospital-wide cutbacks were announced internally in December. Mark Gavens, the hospital’s chief operating officer, did not return requests for comment.

HIV/AIDS patients can still be seen at Cedars, Hardy said, but they will no longer have the expertise of full-time, credentialed “HIV specialists.” To be considered an HIV specialist, the American Academy of HIV Medicine requires a doctor to meet three criteria that include special experience, education and external credential validation.

Hospital officials confirmed that cutbacks to the infectious diseases division will include Hardy and Dr. Paula Gaut, who are both HIV specialists.

Dr. Yoko Miyasak, an infectious disease researcher and HIV specialist, also will lose her position unless she receives grant funding, according to Dr. Zab Mosenifar, the executive vice chairman of Cedars-Sinai’s Department of Medicine, which houses the infectious diseases division.

Both Mosenifar and Sally Stewart, the hospital’s media relations manager, said Hardy “has been giving out erroneous information.”

“I can’t address that other than to tell you the truth about how HIV care and HIV research will be affected at Cedars Sinai Medical Center,” said Hardy.

Hardy and Mosenifar differ in their public statements about the number of positions that will be eliminated, which might be accounted for by different ways of calculating part-time and fulltime positions.

According to Mosenifar, Hardy’s division will lose one and a half of its four and a half employees. “The department is not closing,” he said.

Hardy, on the other hand, said eight of 10 total paid staff positions will be eliminated, including two nurses who do work on HIV and Hepatitis C (one full-time), a laboratory research manager, who does HIV research and two administrative assistants.

Mosenifar said the division will keep more than 30 “volunteer physicians.” Hardy said Mosenifar was referring to the more than 30 private practice doctors specializing in infectious diseases who are able to admit their patients to the hospital, although they are not employed by it.

“It doesn’t mean that if a patient gets sick, they can’t come to Cedars, it just means that the expertise will no longer be there,” Hardy said. “Yes, there are going to be doctors who have treated HIV before, but they will no longer be a part of a coordinated HIV care and research program. ”

Cedars also will no longer be conducting AIDS-related research, according to Hardy. In the past 20 years, Cedars has conducted more than a hundred clinical trials of HIV medications. In the early 1990s, Cedars-Sinai researcher David Ho conducted investigations into HIV viral load, a measure now considered an important barometer of patient’s health. In the late 1990s, researcher Eric Daar studied the first stage of HIV infection, known as “acute HIV infection,” which led to recommendations to begin treatment soon after infection.

Hardy, who as yet has been unable to find a new position, began notifying patients in mid-April of the cutbacks, but has not made any recommendations for where patients should go for their ongoing care. AIDS/HIV patients typically see a doctor for a check-up every three months.

Hardy estimates that of the approximately 350 patients the infectious diseases clinic sees, 95 percent have HIV/AIDS. According the Los Angeles County Department of Public Health’s 2012 annual HIV Surveillance Report, 2,328 people in West Hollywood are living with HIV/AIDS, representing approximately seven percent of city’s 34,000 residents. That report also shows that 57 West Hollywood residents were newly diagnosed with HIV in 2012.

“I’m telling my patients because I want them to be prepared,” said Hardy, who joined the division in 2002. “I’m encouraging them to request their medical records.”

Hardy is a member of the American Academy of HIV Medicine, where he serves as on the national board of directors, and chairman of the California/Hawaii chapter. Since 1988, he has been president of the Los Angeles Physicians AIDS Forum, which he co-founded. He has been the principal investigator on a number of HIV clinical trials.

Gaut’s half-time position will also be cut. Gaut splits her time between Cedars-Sinai, where she is the associate medical director of the AIDS and Immune Disorders Center, and UCLA’s David Geffen School of Medicine, where she is an associate clinical professor of medicine.

Gaut’s research focus is on HIV therapeutics and novel anti-microbials for drug-resistant infections. She has written a number of articles on AIDS and has been published in the American Journal of Medicine and Archives of Internal Medicine.

Two full-time doctors, Dr. Jonathan D. Grein and Dr. A. Rekha Murthy, will remain on the infectious diseases staff, according to Mosenifar. Both are focused on epidemiology and neither deal with patients.

Mosenifar points out that the division’s fellowship training program will remain intact, with long-time private practitioner and volunteer teacher, Dr. Phillip Zakowski taking over Hardy’s responsibilities as part-time coordinator of the fellowship program. Zakowski has been on the staff since 1984.

A year ago, Cedars shuttered its psychiatric division, another victim of budget cuts. That decision left many West Hollywood residents scrambling to find care and taxed the remaining mental health providers. With its immediate proximity to West Hollywood and a higher rate of addiction in the LGBT community, many residents used Cedars’ mental health services.

West Hollywood Human Services Commissioner Jimmy Palmieri is worried the same thing will happen again with AIDS/HIV providers.

“My concern is the patients, the constituents that use the immunological clinic,” said Palmieri. “Once the clinic is not available, where is the windfall going to go? If you have HIV, you’re not looking for a GP, you’re looking for an immunologist. I’d be a little afraid if it were me.”

West Hollywood doesn’t contract for services with Cedars. As a result, Cedars was not required to notify the city of the changes to its HIV/AIDS staffing. However, West Hollywood — currently preparing its annual budget — does have contracts for various services with AIDS Project Los Angeles, Being Alive, Aid for AIDS, the Saban Free Clinic and others, many of whom may see an influx of people seeking help.

As a non-profit, Cedars is required to offer a “community benefit program.” Under California law (SB 697, passed in 1994), in exchange for a non-profit hospital to receive tax-exempt status, the hospital must “assume a social obligation to provide community benefits in the public interest.”

According to the Cedars website, one of the community benefits it offers is “need.” With West Hollywood being highly impacted by HIV/AIDS, Hardy contends that curtailing HIV/AIDS services is disingenuous.