Two of Washington's largest teaching hospitals are considering setting up what would be the area's first inpatient units specializing in care for AIDS patients, hospital officials have disclosed.
Officials at George Washington University Medical Center and at Washington Hospital Center said the proposals to centralize activities dealing with acquired immune deficiency syndrome could improve treatment of patients and raise the quality of medical student education. The Washington area ranks fifth in the nation in reported AIDS cases, according to federal statistics.
The two hospitals, the area's largest providers of AIDS care, now treat AIDS patients in rooms scattered throughout the institutions. Under the proposals, centralized AIDS units would be established with specially trained teams of nurses and health care workers.
However, Michael M. Barch, administrator of the 501-bed GWU facility, and Dunlop Ecker, president of the 851-bed Washington Hospital Center, indicated that final decisions on the proposed AIDS units will not be made for several months, and said the hospitals may eventually reject the idea.
The issue has set off intense debate at the hospitals. Several factors weigh against the concept, administrators and physicians said, including the difficulty of adequately staffing any AIDS unit and the potential for health care workers to "burn out" from the high stress involved in caring for patients with the fatal disease.
In addition, sources said, hospital administrators fear that the two institutions might become stigmatized as "AIDS hospitals" -- a label that could drive away patients and staff members.
"Most people in my field think it is a good idea," said Dr. John G. Bartlett, an infectious-disease specialist who directs an AIDS unit at Johns Hopkins Hospital in Baltimore. "The people who think this is a bad idea are people in hospital administrations who don't want the publicity of AIDS associated with the institution."
Bartlett said that by establishing AIDS units, hospitals invite possible lawsuits, anxiety among other patients and potential adverse publicity. "A lot of them feel that it is better to keep a low profile," he said.
Dr. Gary Simon, assistant chairman of GWU's department of medicine, said he favors establishing an AIDS unit, but said, "One of the downsides is being identified as the place all patients go -- we can't have that."
"That would be detrimental to the primary goal of this hospital," Simon said. "This is a teaching hospital" -- one where, he said, students must learn about caring for a wide range of diseases, not just AIDS.
AIDS units in other cities have had mixed results. San Francisco General Hospital has a national reputation for compassionate, quality AIDS care at its inpatient unit. Several New York hospitals have highly regarded AIDS units.
But in Houston, a widely publicized AIDS hospital was forced to stop accepting new patients last year after it was overwhelmed by patients who had no insurance to cover their medical bills.
With an AIDS unit, doctors say, health care workers are likely to recognize illnesses associated with the disease earlier, and head off potential complications that require lengthy hospitalization.
"When you specialize, you're going to have a greater concentration of knowledge and experience," Barch said. "The assumption . . . is that the outcome is a higher quality of patient care."
Simon said that grouping patients in one part of the hospital should make it easier for researchers to carry out clinical tests of potential AIDS drugs.
Another benefit would be the creation of teams of health care workers who are eager, rather than reluctant, to work with AIDS patients, doctors said. "There's a lot of nurses who don't want to work with AIDS," said Dr. Peter Hawley, medical director of the Whitman-Walker Clinic, a D.C. facility that provides testing and outpatient services for AIDS patients.
At the end of 1987, GWU had recorded 290 admissions of AIDS patients from the District, and Washington Hospital Center had reported 174, according to Dr. Martin E. Levy, head of the city's Preventive Health Services Administration. On any day, there are usually about 20 AIDS patients at each facility.
A total of 1,057 AIDS cases have been reported in Washington, and roughly 700 have been reported in the Virginia and Maryland suburbs, Levy said. D.C. General Hospital, the area's third-largest provider of AIDS care, has recorded 70 admissions of AIDS patients from the District.
Hospital administrators express concern about possible difficulties in staffing any AIDS unit at a time of severe personnel shortages in health care, especially among nurses. Officials also said they would have to develop counseling programs and take other measures to make sure that workers in an AIDS unit would not become emotionally drained.
"There's no doubt that nurses burn out on oncology units if certain things aren't done," said Dr. Jeffrey S. Akman, a GWU psychiatrist who specializes in educating health care workers about AIDS. "Clearly the possibility of burnout exists" in an AIDS unit, he said.
But, Akman said, health care workers in AIDS units may be more motivated than regular staff members. "They will want to work there," he said. "You will not be dealing with health care workers who are anxious, resentful or homophobic."