Keep AIDS Tests Voluntary, State Health Chief Argues

The state’s health department director said Sunday that he has not heard “any convincing argument” for mandatory AIDS testing, but believes that private physicians “need to substantially expand voluntary testing” among their patients.

Dr. Kenneth Kizer, director of the state Department of Health Services, made the comments in Anaheim after a wide-ranging speech on AIDS and the Medi-Cal budget deficit delivered to the California Medical Assn. The association, meeting at the Disneyland Hotel, is expected to vote Tuesday on several policies involving mandatory AIDS testing.

During a question-and-answer period after his speech, two physicians queried Kizer about problematic situations where AIDS testing could be needed.

One doctor, a pulmonary specialist, asked the health director what a doctor can do when a patient shows symptoms of an AID-associated illness, but refuses to take the test. A second doctor asked how a physician can sign a premarital health certificate, a document needed before marriage that states the patient is free of contagious diseases, if a test for AIDS antibodies has not been administered.

Kizer sidestepped both questions, citing the California state law that requires the test to detect exposure to the AIDS virus to be voluntary and confidential.

“It’s a subject that was discussed last year and no doubt will be debated this year” by people who believe there should be some “loosening” of the law, he told the doctors.

But in a brief interview after the presentation, Kizer said he personally does not favor such loosening. He has heard no convincing arguments to make testing mandatory, even under limited situations, such as premarital health certification, he said. “I just don’t see a role for mandatory testing,” he said.

In the case of premarital testing, he told the assembly of physicians, “there’s clearly not a reason from a cost-benefit standpoint to do across-the-board testing.” And regarding a symptomatic patient who refuses the test, he said, “under existing state law, if he refuses, that is the law.” But Kizer said he is “unaware of any cases” in which symptomatic patients refused the test. “That’s not to say it has not occurred, but there is no indication that it is a substantial problem,” he told the medical association.

Acquired immune deficiency syndrome is an affliction that attacks the body’s immune system, leaving it vulnerable to fatal diseases and infections. AIDS is caused by a virus carried in bodily fluids and transmitted primarily through intimate sexual contact or the sharing of hypodermic needles. A blood test can determine whether a person has antibodies to the virus, which means that the person has been exposed and can transmit the virus, even if he or she is not suffering from the disease.

Mandatory Testing

The state medical association’s policy-making House of Delegates will vote Tuesday on a number of proposals calling for mandatory AIDS testing. Among them are proposals that would require AIDS testing before marriage and allow an AIDS antibody test to be given without a patient’s consent so that results could be made known to physicians, nurses and other health-care professionals caring for the patient. A third proposal would allow physicians to report to an “endangered third party” that their sexual partner has tested positive and therefore is infected and contagious.

In his prepared comments to the medical association, Kizer, 35, said state officials are looking for a solution to the $274-million Medi-Cal deficit.

Medi-Cal now represents 10% of the state’s entire budget, with medical expenditures having increased by $1.1 billion in the past three years, he said. Medi-Cal now spends $10,000 a minute around the clock, he said.

“We have to ask ourselves if Californians are getting the most for their money,” Kizer said.

And the future is not promising, he said. The new federal immigration law is expected to make more people eligible for Medi-Cal, and while the financial impact has not yet been calculated, “it’s likely to be substantial,” perhaps $200 million a year, he said.

Mounting Medi-Cal Costs

In addition, AIDS is likely to make Medi-Cal expenditures mount, he said. The number of AIDS patients in the state is expected to reach 50,000 within the next five years, he said. Further, as researchers discover new and better ways to treat the disease, those patients are expected to live--and require costly medical care--longer, he said.

In the past few years, the number of AIDS patients dependent on Medi-Cal for financial assistance has risen from 12% to 20%, which is still a lower percentage than in many other states, he said.

Urged to Stay Knowledgeable

Kizer called on all doctors to stay knowledgeable about the ever-advancing research and facts about AIDS because “AIDS patients will present themselves to all practitioners,” he said. He encouraged the physicians to educate their patients about the disease, through personal discussions and by stocking their waiting rooms with brochures.

Kizer also told physicians they can encourage their patients to opt for voluntary AIDS testing “in many settings where it should be routinely offered,” such as during counseling about contraception and sexually transmitted diseases, and during prenatal care.

The health department director said state officials are considering many “short-term, limited options” to cut the Medi-Cal deficit. They include reducing services, modifying rates paid to doctors, hospitals and other health-care providers, and requiring patients to increase their share of the medical bill. “But none of these ideas should be viewed as a specific proposal that’s being pursued,” he said.

Gov. George Deukmejian recently proposed a 10% cut in Medi-Cal fees to physicians and other health-care providers. The California Medical Assn. last week won a preliminary injunction in federal court to block the cuts, arguing that the state now pays doctors only about 43 cents for every $1 they could receive from private patients or insurance companies.

Dr. Gladden Elliott, outgoing president of the medical association, said during the presentation that, despite the Medi-Cal deficit, California ranks 47th among the 50 states in per-capita health care expenditures. But Kizer said that statistic must be questioned because it involved figures from before California’s 1982 Medi-Cal changes. In addition, he said, the variety of services varies from state to state.