A psychiatric patient, infected with the AIDS virus and bleeding from his arms and legs, spent last weekend wandering through central Orange County after he was turned away from a state psychiatric hospital and then refused readmission to a private hospital in Anaheim.
The 37-year-old psychotic man, who has been declared a ward of Orange County, reappeared at his guardian's office in Santa Ana on Monday and is now hospitalized at UC-Irvine Medical Center in Orange.
Orange County health officials said the saga began Oct. 23, when Western Medical Center-Anaheim tried to transfer the patient to Metropolitan State Hospital in Norwalk for long-term psychiatric care, and Metropolitan declined to accept him because he was infectious. Returned to Western Medical, where doctors said he no longer met their standards for admission, the patient walked out a back door when a social worker assigned to watch him went to the bathroom, hospital officials said.
Dr. L. Rex Ehling, county public health director, said the confusion in this case exemplifies the lack of treatment facilities in the county and around the state for AIDS carriers who also have serious medical or psychiatric problems.
Orange County health officials also expressed concern that the state appears to have no coordinated policy for how county, state and private hospitals should care for a psychotic and infectious AIDS carrier with acute medical problems.
"We have gotten very little help. They've given us AZT monies (money to buy an experimental drug for AIDS patients) but we have gotten little or no policy direction from the state Department of Health," said Ehling, who, as president of the California Conference of Local Health Officers, lodged a protest with state health officials last week.
Added Timothy P. Mullins, Orange County mental health director, "The problem . . . is there are no places, or at least only a few places, in the entire United States that are equipped to handle the medical and psychiatric needs of the severely mentally ill person who has AIDS or AIDS Related Complex. . . . Programs for those are not currently in place."
Thelma Frazeiar, chief of the state's Office of AIDS, said Friday that a state task force would investigate the case. "I think there are some gaps in the system," she said.
Her boss, Dr. Alexander Kelter, a deputy director in the California Department of Health Services, said he did not know if any policy changes were necessary but added: "To me this is a microcosm of a much larger problem that doesn't have anything to do with (the AIDS virus) but with (psychiatric patients) who are medically acute or sub-acute and nobody wants them."
But Orange County officials said they believed the man's AIDS infection was an important factor. From time to time, as in the case a year ago of an Orange County prostitute with AIDS--no hospital will take an AIDS carrier with serious medical or psychiatric problems, they said.
"This is another big catastrophe," said Pearl Jemison-Smith, infection control nurse-epidemiologist at UCI Medical Center and chairwoman of a county advisory group on AIDS called ACTION.
State, county and private agencies must resolve the problem soon, she warned, because until they do, "we'll be seeing more people like this" on city streets.
Though hospital and health officials provided details of the latest case, they declined to name the patient. As a ward of the county, his privacy is protected by strong confidentiality laws.
Officials agreed to discuss the situation, however, because of the dilemma it posed--and because of the ethical issues involved when both the state psychiatric hospital and the private hospital in Anaheim refused to admit the patient.
Their problems began July 7 when police picked up a psychotic transient and brought him to Western Medical, officials at the 248-bed nonprofit hospital said. For 17 days, he was acutely psychotic, hospital officials said.
After that, the man still was mentally ill but was no longer acute, they said, and because his diagnosis had changed, Medicare no longer automatically covered his $552-a-day costs for psychiatric nursing in an isolation room. So the private hospital began looking for another placement.
For three months--and with increasing desperation--Western Med officials and the patient's county conservator looked for a long-term locked psychiatric bed among the overloaded mental health institutions in Los Angeles, Riverside and Orange counties.
But because of his psychosis and because he carried the AIDS virus, no one would take him, said Sharon Gerdes, who is in charge of discharging patients at Western Med.