Health commissioner near completion on Albany proposal on testing consent, treatment
Draft legislation by Dr. Thomas R. Frieden, the city’s health commissioner, that would end written consent for HIV testing and allow the health department to monitor the treatment of New Yorkers with AIDS and HIV could be in front of legislators in Albany as soon as the end of March.
“I think Dr. Frieden hopes to have a bill to submit some time in the next couple of weeks,” said Assemblyman Richard N. Gottfried, a Democrat who represents the Upper West Side and chairs the Assembly health committee. “I know the city health department has been working on bill drafts for a long time.”
Gottfried saw an early draft “two or three months ago.”
When the health department was asked in a March 13 e-mail if it would have a bill finished in the next one to two weeks, its press office responded, “That’s a fair statement.”
Frieden wants to change state law to allow healthcare providers to do HIV testing after a patient gives verbal consent and to allow his department to use data that it already collects, such as viral load and T cell count tests, to assist in the treatment of people with AIDS. To date, there has been little discussion of the proposals in Albany.
“It’s not really a big story up here now,” said state Senator Thomas K. Duane, an openly gay Democrat who represents portions of Manhattan, including Chelsea. “Tom Frieden came up here, although he didn’t have a bill so it seemed more like a meet and greet.”
Frieden met with members of the Legislature’s Black and Latino caucus in late February. He started pushing for the legislation last year in an editorial in the New England Journal of Medicine. He has since met with AIDS and community groups, newspapers, and others to drum up support. The health department has announced six town meetings, at least one in each borough, that will further showcase the proposals.
Assemblywoman Deborah Glick, an out lesbian who represents the West Village, said there has been no talk of the proposals in the Assembly.
“I haven’t seen anything in writing which is worrisome because they can say anything,” she said. “Until you see something on paper it’s very hard to judge.”
The immediate future of any legislation will be set by the fate of the state budget. With the next state fiscal year beginning on April 1, the budget should be finished by March 31. Albany, however, has been very late with budgets in the past two decades and, typically, no other legislation moves until the budget is done, or at best as part of resolution of the budget.
“Nothing will happen until after the budget gets done,” Duane said. After that, the Frieden proposals could come up or they could be eclipsed by other issues.
“The thing about Albany is you never know,” Duane said. “You never know what is going to pop up.”
Glick said that currently legislators were particularly concerned with the effectiveness of child protective services, enacting a law that would allow civil commitment of sex offenders after they complete a prison term, and with the death penalty.
“The governor is trying to ramp up the death penalty again in the aftermath of the shooting of a couple of police officers upstate,” she said. “There are a lot of other issues that might take precedence and that people have been paying a lot of attention to.”
Then the Frieden legislation will have to pass muster with members of the Assembly and the state Senate. Duane was an early skeptic on the proposals.
One issue is that increasing the number of people who access these records could raise the likelihood that the confidentiality of patient data would be breached, Duane said.
A second issue is that while Frieden’s goals are laudable and the problems he hopes to solve are serious, his solutions may not be the right ones. Duane said that the state might better focus on educating doctors to provide better care and on eliminating barriers that keep people with AIDS out of care.
“I am absolutely not willing to consider his solutions if he is not willing to consider the solutions on the other end,” Duane said. “I hope he’s hearing that.”
Some legislators will want to hear from AIDS groups that, to date, have expressed qualified support to outright opposition to changes in state law.
“Unless the HIV community is comfortable with this legislation, you would expect quite a few members of the Legislature to be opposed,” Gottfried said. “If that’s the case, changing people’s minds could take a long time or perhaps never.”
Gottfried said that while he supported increasing HIV testing and moving more people with HIV into care, he opposed ending written consent.
“I do not support the idea of eliminating written consent,” he said. “I think there is too much potential in some settings for oral consent to end up being no consent and records being made of consent that are not honest.”
Health Department forums scheduled to date are: in the Bronx, Mar. 22, 6-8 p.m., Hostos Community College’s Repertory Theatre, 450 Grand Concourse; in Manhattan, Mar. 27, 6-8 p.m., Harlem Hospital, 506 Lenox Ave. at W. 138th St., 2nd fl. auditorium, and Apr. 4, 6:30-8:30 p.m., FIT, Haft Auditorium, Building C, 2nd fl., north side of 27th St. at Seventh Ave.; in Brooklyn, March 29, 6-8 p.m., Medgar Evers College, Founders’ Auditorium, 1650 Bedford Ave. btwn. Crown and Montgomery Sts. Meetings in Queens and Staten Island have not yet been scheduled.