A mental 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 mental hospital and then refused readmission to a private hospital in Anaheim.
The 37-year-old man, who has been declared a ward of Orange County, reappeared at his guardian's office in Santa Ana on Oct. 26 and is now hospitalized at UC Irvine Medical Center in Orange.
Orange County health officials who related the story said it 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 and in need of medical care. 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.
Lack of Facilities
Orange County Public Health Director Dr. L. Rex Ehling said the confusion in this case exemplifies the lack of treatment facilities in the county and throughout the state for AIDS carriers who also have serious medical or mental 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 . . . 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 Orange County Mental Health Director Timothy P. Mullins: "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."
'Much Larger Problem'
Dr. Alexander Kelter, a deputy director in the California Department of Health Services, said he did not know if any policy changes were necessary. "To me this is a microcosm of a much larger problem that doesn't have anything to do with" the AIDS virus, he said, "but with (psychiatric patients) who are medically acute or sub-acute and nobody wants them."
But Orange County officials said they believed that the man's AIDS infection was an important factor.
Hospital and health officials declined to name the patient because, as a ward of the county, his privacy is protected by law. But they agreed to provide details of the case because of the dilemma it posed and the ethical issues involved.
Their problems began July 7 when police picked up a psychotic transient and brought him to Western Medical Center-Anaheim, 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 Medical 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 Medical.
Although the man has not developed a full case of the deadly acquired immune deficiency syndrome, he could infect others if his blood came in contact with theirs, health officials said. And because of his psychosis, Gerdes said, the patient for 20 years has scratched himself until his arms and legs bled. Then, three weeks ago, 750-bed Metropolitan State Hospital in Norwalk agreed to accept him when its next bed became available, Gerdes said.
On Friday, Oct. 23, the bed came open. At about noon that day, Western Medical officials said, they discharged the patient and put him in an ambulance for Norwalk.
But during the ambulance ride, the patient became agitated, scratching his arms and legs until they were raw and bleeding, Orange County AIDS coordinator Penny Weismuller said.
When he arrived at Metropolitan at 1:50 p.m., admissions staff immediately noticed the "weeping sores" on his legs, Metropolitan Executive Director Dr. Bill Silva said. Greeted by a bleeding, AIDS-positive patient who appeared both "medically unstable" and infectious, Metropolitan could not admit him, Silva said.