PRESIDENTIAL COMMISSION ON THE
HUMAN IMMUNODEFICIENCY VIRUS EPIDEMIC

HEARING ON AIDS IN THE WORKPLACE
The Hearing was held at the
Indiana University Executive Conference Center
850 West Michigan Street

Indianapolis, Indiana

Tuesday, May 10, 1988

COMMISSION MEMBER PRESENT:
ADMIRAL JAMES D. WATKINS (RET.), CHAIRMAN
COLLEEN CONWAY-WELCH, Ph.D.
KRISTINE M. GEBBIE, R.N., M.N.
BURTON JAMES LEE, III, M.D.
FRANK LILLY, Ph.D.
CORY SerVAAS, M.D.
JOHN J. CREEDON
THERESA L. CRENSHAW, M.D.
RICHARD M. DevVOS
BENY J. PRIMM, M.D.
PENNY PULLEN
POLLY L. GAULT, Executive Director
COMMISSION MEMBERS NOT PRESENT:
JOHN CARDINAL O’ CONNOR

WILLIAM B. WALSH, M.D.
I-N-D-E-X

PAGE
WELCOME
Admiral Watkins, Chairman 162
Richard DeVos, Hearing Chairman 162
PANEL ONE
OVERVIEW OF THE PRIVATE SECTOR
B.J. Stiles, President 163
National Leadership Coalition on AIDS
Washington, D.C.
\
Edward L. Morgan, Jr., Assistant Vice President 166
Corporate Relations
Allstate Insurance Company
James A. Klein, Manager 169
Pension and Health Care Policy
U.S. Chamber of Commerce :
PANEL TWO
WORKPLACE POLICIES: DEVELOPMENT AND
IMPLEMENTATION
Peter W. Bertschmann, Vice President 195
Human Resources; New England Telephone
Anthony A. Herrmann, M.D., Vice President 199
Employee Health, Safety and Environmental Affairs
Johnson & Johnson
Dwight W. Sawyer, Vice President 202
Human Resources
Amway Corporation
Sigrid G. Deeds, DR. P.H., Senior Advisor 206
AIDS Program, American Red Cross,
National Headquarters
Henry C. Ryder, Partner, 209

Barnes and Thornburg

PANEL THREE
HEALTH ISSUES AND WORKPLACE ENVIRONMENT
Yvonne Ellison-Sandler, L.C.S.W., Manager 226
Employee Assistance Program
Levi Strauss & Company

Justine C. McArthur, M.B., B.S., Assistant 231
Professor of Neurology
The Johns Hopkins Medical Institutions
I-N-D-E-X (continued)

PANEL THREE (continued)

Frank Scorgie Rhame, M.D., Assistant Professor 235
Infections Diseases Section, Department of Medicine,

and Director, HIV Clinic,

University of Minnesota Hospital

Martin Schneiderman, Partner 245
Steptoe and Johnson

PANEL FOUR
SCONOMIC IMPACT
The Honorable Frank S. Swain, Chief Counsel for 263
Advocacy, U.S. Small Business Administration

David E. Bloom, Ph.D., Professor Economics 267
Columbia University

Patricia A. Wiley, Managing Consultant 270
A. Foster Higgins & Company, Inc.

PANEL FIVE
PUBLIC SECTOR ISSUES
The Honorable William Hudnut, III, Mayor 298
City of Indianapolis, Indianapolis

Jordan A. Barab, Occupational Safety & Health 286
Coordinator

American Federation of State, County

and Municipal Employees, AFL-CIO

Richard M. Duffy, Director 289
Department of Occupational Health and Safety,
International Association of Fire Fighters

Dewey R. Stokes, President 295
Fraternal Order of Police
P-R-0-C-E-E-D-I-N-G-S
9:00 a.m.

MS. GAULT: Good morning. Ladies and gentlemen,
distinguished guests, members of the President Commission, my
name is Polly Gault. I am the designated federal official here
today and in that capacity it’s my privilege to declare this
meeting open. Mr. Chairman?

CHAIRMAN WATKINS: Good morning. We’1ll start the next
set of hearings today on the subject of AIDS in the workplace.
And I’m very pleased to be able to turn the chair over this
morning to Mr. Richard DeVos, CEO, Chairman and founder of Amway
Corporation, who is in the middle of these issues in the
workplace himself and his own corporation has done a superb job
and I think Rich is extremely well qualified to take over and run
this set of hearings. So without further ado, I’1l turn it over
to Mr. Richard DeVos.

MR. DeVOS: Good morning, everybody. Today the
Commission on HIV epidemic will address the issue of AIDS in the
workplace. We want to welcome you here and especially thank our
witnesses who have taken time from their busy schedules to
discuss this very important issue with us.

I hope you relax and realize it’s just a matter of
trying to get information. This is not a court. Sometimes it
must seem like that. All we’re trying to do is get differing
viewpoints so we can come to some conclusions.

Today’s hearing will focus on the impact of AIDS on
American business, industry and on the state and local government
work force. Issues involving the federal sector will be
discussed at the Commission’s May 16th hearings in Washington,
D.C.

AIDS has become a critical issue for U.S. business as
the epidemic continues to spread to every geographic region of
the country. The impact on business will be felt in two ways;
either directly through employees or their dependents becoming
infected and with the attended cost that comes from that in the
corporate health programs, to say nothing of the loss of the
personnel and their efficiency, or indirectly through higher
taxes to cover the costs of those receiving public assistance for
treatment of the disease.

During today’s hearings we will be addressing the needs
and concerns of both management and employees. We will hear
about successful workplace polices and we’1ll be asking our
witnesses to identify specific ways to best address the human,
economic and medical aspects of this disease within the workplace
setting.

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We’ll be hearing testimony from a number of the
distinguished figures in the country who have been closely
involved in AIDS and workplace concerns. Our first panel will
present an overview of the impact of AIDS on business and
industry. Witnesses include: Mr. B.J. Stiles, President of the
National Leadership Coalition on AIDS; Mr. Edward L. Morgan,
Assistant Vice President for Corporate Relations at Allstate
Insurance Company, and; Mr. Jim Klein, Manager of Pension and
Employee Benefits for the U.S. Chamber of Commerce.

Before we begin I want to submit for the record
testimony from the Citizens Commission on AIDS for New York City
and Northern New Jersey and policy statements on AIDS adopted by
the AFL-CIO.

MR. DevOS: I would like to remind the witnesses that
in the interests of time we’re asking you to limit your oral
presentation to five minutes. After each of you have given your
presentation, we’ll proceed with questions from the Commissioners
and we’ll try to limit them, too. Try.

Gentlemen, if you would begin. And, Mr. Stiles, we’ll
begin with you this morning on your prepared comments and then
we’ll begin the dialogue after we go through all three of you.

MR. STILES: Thank you very much, Mr. DeVos.
Admiral Watkins, Ms. Gault and Commissioners, thank you very much
for the work you have been doing. You followed --

MR. DeVOS: Would you get your microphone a little bit
closer so those in the back can hear you. Thank you.

MR. STILES: I didn’t want to bark at you.

MR. DeVOS: That’s all right. I’ve been barked at
before.

MR. STILES: And probably will be again before the work
is finished. Thank you very much for this invitation. My name
is B. J. Stiles. I am President of the National Leadership
Coalition on AIDS. We will be one year old only a few weeks
before you will be one year old. Probably we may last a little
bit longer, than you at least in terms of statutory
responsibility. Fortunately, you have a mandated expiration
time, and a final report you have to complete and then you can
continue to do the work that each of you were doing long before
you came on this Commission.

Our organization began to form approximately two and a
half years ago when representatives of the private sector, having
attended numerous public and private meetings discussing the HIV

163
 

 

epidemic, felt that though there was growing expertise -- medical
and scientific and fiscal -- beginning to be attentive to the
epidemic, one thing that seemed to be lacking then, and I regret
to report I think is still lacking unfortunately is a sense of
clarity and public commitment to the discussion and resolution
of the challenges posed by this epidemic. And therefore, about
two years ago representatives of a number of industry
associations, several corporate executives from insurance and
other companies, started discussing what the role of the private
sector might be trying to provide a visible and more coordinated
effort in response to this epidemic.

Our initial planning meeting attracted about 60 people
representative of 40 national organizations, but most agreed that
the subject was too narrow. That is, we were convened around the
subject of whether there could or should be a private sector
clearinghouse in response to the epidemic. Most of the
participants in that meeting said there are already several
clearinghouses, and there will be more. What is missing in this
epidemic is leadership.

That group of people and their successors met three
times to consider what representatives of the private sector
might do. We formed a national organization a year ago in May.

My written testimony summarizes some of our activities
and several of my colleagues today will report on specific
projects that we have been involved in. I am the 26th
representative before this Commission of organizations that, in
fact, are members of the National Leadership Coalition and I
think that number alone will suggest that we have tried to be
aggressive and responsive and collaborative.

In our’ one year’s experience I’d like to highlight two
or three things that I think we have learned and that we consider
to be critical about this epidemic. As my colleagues will report
throughout the rest of the morning, when a corporation or
business begins to deal with this epidemic one does better when
you plan ahead of time. If you wait until there is an incident
or a fear of an incident or have a particular reason why you are
concerned about the presumption of someone in your work force who
may be HIV positive, your response may be helpful, it may be
constructive, it may be balanced, it may even be effective, but
it will not be nearly as effective and balanced as if you
planned that response well in advance of a particular incident,
much less a confrontation.

We and our members, and I think virtually every
business leader in the country, are discovering that the sooner
one plans, the wiser one plans. Not only the wiser one plans,
but the more effective, the more balanced and the more focused
will be the response of that business or that corporation.

164

 

 
 

 

Secondly, I think we’re all learning that the better
response is one that is comprehensive. This epidemic requires a
planning process which represents of virtually every segment of
the work force and as much of the working community as possible.

As Andrew Smith, the President of the Pacific
Northwest Bell Telephone, emphasizes how their company in
Seattle, Washington -- a region not yet dominantly associated
with this epidemic -- responded. They did so by working with
representatives of the employee work force, which included an
organized group of employees of Pacific Northwest Bell who are
gay and lesbian employees. Mr. Smith and his corporate
colleagues, in turning to employees, deliberately sought the
advice of those persons presumed to already be knowledgeable
about health matters within the homosexual community and
particularly those persons on the forefront of responding to the
HIV epidemic in Seattle.

To plan wisely in response to the epidemic does
require, obviously, the combined resources of human resources,
legal, communications and every other segment of the work force.
It also requires that we have employees present and those who
represent the fears and the anxieties of the workers themselves.

Plan soon, plan broadly, obviously plan legally.....
though in many communities that raises questions because some
employers often are unsure of all the laws that pertain when
trying to sort out how to deal with confidentiality on one side
and the rights of the public to be protected on the other.

It seems to a number of us that we have a long way to
go yet before we have a simple, clear and full understanding of
the full, legal context in which we operate when we approach AIDS
in the workplace. However, the real issue that confronts every
business person, as I suspect it has confronted each of you as
Commissioners, is the question of timing. When is the right
time? When is it too late, when is it too soon for each of us to
become clear and balanced and committed in order to make a
positive contribution?

My colleagues on this panel and others throughout this
morning will provide evidence of how leaders have bitten the
bullet, how people have reacted wisely and how people have
created programs and policies that are constructive. However,
these individuals are not the tip of an iceberg; unfortunately
they barely represent the smattering of community leaders across
this country who have yet taken action. And, tragically we’re
still on the threshold of the epidemic; unfortunately we will
move through the hallways and into the main rooms far faster
than most of us expect.

165

 

 
In the eighth year of the epidemic we have just passed
over 60,000 diagnosed cases reported. If the projections of the
Centers for the Disease Control and others stay on target, as
tragically they have been very close to target in the last few
years, within the next 24 months we will have dealt with 270,000
cases of diagnosed AIDS. That’s a large number of men and women
in our neighborhoods, our communities, our churches and our
business offices and our workplaces to begin to deal with.
Again, if we want to deal with them wisely, cost effectively and
compassionately, that will require resources that are yet barely
visible.

I am extraordinarily pleased to be a part of an
organization that tries to represent the diversity of American
life; corporate leaders, business leaders, health and social
welfare leaders, academic leaders, religious leaders, gay leaders
and a number of other persons who have acted positively in
response to the epidemic. But I think they are acting, as I
hope that respondents to this Commission will react, because we
are convinced that the epidemic is serious, it is urgent, it is
costly and, most importantly, because it is widespread and it is
on our doorsteps.

This is not an epidemic that shall be restrained to any
single segment of the American population or to any geography,
although there are populations and geographies that are
disproportionately and seriously affected. It is an epidemic
about which we need to be literate, about which we hope we can
act rationally and about which we must begin our work
immediately.

Thank you for what you have done to help make the
factors of the epidemic clear. Thank you for your rationality
and your candor, and your commitment to present a report to this
country that will say that this is an issue of extraordinary
importance and urgency. Thank you.

MR. DevVOS: Thank you, Mr. Stiles.
MR. DeVOS: We go to Mr. Morgan.

MR. MORGAN: Thank you. Admiral Watkins, Ms. Gault and
Commission members, Allstate is honored with the opportunity to
provide testimony at this public hearing on AIDS on the
workplace. I’m not here as representing an employer with a
great deal of expertise in the issue, but rather as a concerned
employer that has been involved with looking at and addressing
the AIDS in the workplace issue.

The Allstate Forum on Public Issues was established in
1987 to provide a platform where leaders of diverse parts of
American society could be invited to address pressing and

166
critical issues. Its intent is to respond to the need for
business to take a leadership role and to recognize that
government alone cannot solve all of society’s problems. The
Forum’s goal is to forward the action toward solutions and
resolutions of major problems as they exist in contemporary
American life. Last summer, in response to a call for action
from the Surgeon General, Allstate chose AIDS in the workplace as
the first issue to be dealt with by the Allstate Forum. It was
the first national discussion and workshop dealing specifically
with the issue of AIDS in the workplace.

As a first step, Allstate askedFortune magazine to
conduct a survey of the nation’s business community to determine
their opinions and policies on AIDS. I think the Commission has
received a copy of this report.

One of the findings of the survey showed that only one
in five U.S. corporations had or were developing policies dealing
with AIDS in the workplace. Because AIDS has such a major human
and fiscal impact on American business, it became apparent to us
that companies large and small must deal with the issue as soon
as possible, preferably before an AIDS case actually arises
within the workplace.

More than 250 executives representing 150 major
corporations and organizations met in Chicago last October to
listen to experts on the issue at the first Allstate Forum
entitled "AIDS: Corporate America Responds." Incidentally, Mr.
B.J. Stiles played a key role in helping us put together both the
program and the panel.

As a result of the first meeting, task forces were
established in the areas of human resources; medical/corporate
health services; government/legislative relations; legal;
corporate communications and corporate philanthropy. Task force
representatives of 78 corporations and organizations met during a
three month period to gather data and develop AIDS in the
workplace guidelines for employers.

Some of the questions these task forces dealt with
were:

1: How should a company go about developing such a
policy?

2: What should it include?
3: What form should it take?
4: What else should companies do in dealing with the

AIDS issue?

167
Their recommendations were compiled in what we believe
is the first comprehensive national report dealing with the issue
of AIDS in the workplace written by and for the business
community.

I’d now like to take a few minutes to cover a few of
the guidelines that were developed by the Forum’s task force.
Bear in mind, these are not Allstate’s recommendations, but
rather recommendations that come from businesses that had
expertise and had experience on the AIDS in the workplace issue.
They’re contained in this report entitled "AIDS: Corporate
American Responds. A Report of Corporate Involvement," a copy of
which I believe you also received.

One of the major recommendations in the report notes
that AIDS polices must have the active support of senior
management. They should also be the product of a task force
approach which includes representatives from such areas as
corporate communications, medical, employee relations and human
resources, legal, safety, affirmative action and corporate
philanthropy. Where applicable, a company task force should
include members from management and labor unions. Outside
medical and legal experts should also be called upon for
guidance. The task force should analyze workplace risk with
respect to the nature of their individual business.

Consulting with other employees and community groups
can provide additional perspectives. The ultimate goal should
be to develop a policy that provides safety and fairness for the
workplace and, compassion for persons with AIDS. Overall, the
report points out an AIDS policy should include the following.

Number one. It should develop a communications program
for employees designed to minimize fears and help prevent the
spread of AIDS by explaining the facts of AIDS and AIDS
transmission. Such a program should also help explain the
company’s AIDS policies.

Number two. It should treat employees with AIDS in the
same manner as any other employees with life threatening
ilinesses.

Number three. It should allow affected employees to
continue working as long as possible, provide reasonable
accommodations and job modification, where appropriate, and
maintain eligibility for all company benefits.

Four. It should discourage testing for the HIV virus
within the employee population.

Five. It should guarantee confidentiality of all
medical information relating to AIDS.

168
Six. It should provide for referral of affected
employees to appropriate company and community resources and
experts for consultation and treatment.

Seven. It should encourage creative corporate
philanthropy with respect to AIDS, especially in the areas of
research, education, care and treatment, and technical
assistance.

And finally, the AIDS policy should be consistent and
tailored to the needs of individual companies.

These recommendations and many others were developed as
a result of the task force process and we believe they can be of
great vaiue to both large and small corporations and
organigations.

We have responded to requests for more than 25,000
copies of the report and the requests continue to flow in at a
rate of more than a 100 a week.

Allstate printed the report and we have been providing
single copies to companies and organizations at no cost. There
is a charge which covers the printing and handling of the report
for multiple copies. And we have received many requests for
large of quantities for different seminars.

But we believe the reports deserve an even wider
distribution. We believe the federal government could help by
reprinting the report and making copies available through its
publications catalog. The Labor Department might consider
distributing it through its regional offices. Other government
departments, such as the Department of Health and Human Services
end the Department of Education, could also assist in the
dissemination of the report. We believe the information in this
report is valuable, it doesn’t need to be redone. Essentially,
our name can be removed and the report can be reprinted by the
government and sent out. And we think that it’s very, very
important that this information gets out to organizations as
quickly as possible. Allstate is pleased to have had the
opportunity to play a part in helping to address the AIDS issue
in the workplace and we appreciate the opportunity to testify
before you this morning.

MR. DeVOS: Thank you. And we appreciate the work of
Allstate in moving forward on that project.

MR. DeVOS: Mr. Klein?

MR. KLEIN: Thank you. Mr. Chairman, Admiral Watkins,
members of the Commission and Ms. Gault, my name is James Klein.
I’m Manager of Pension and Health Care Policy for the U.S.

169
Chamber of Commerce. I am pleased to be here today to testify on
this most important issue which the Commission has been charged
to investigate. Because the full text of my statement will be
filed for the record, I’ll simply try to highlight and, in the
interest of time, touch on the most important issues.

It’s a particular privilege for me to serve on the same
panel with B. J. Stiles and Ed Morgan because, certainly the
National Leadership Coalition on AIDS and Allstate have been two
leaders within the business community that have made tremendous
strides in helping employers understand the many issues that
they need to understand about AIDS. And they’ve been both a
tremendous help to me personally.

A complete description of who the Chamber’s membership
is, is shown on the inside front cover, of my statement, and I’1l
refer you to that in order to understand it in greater detail.
But I only draw attention to it in order to make the point,
since it is not always known, that although most of the large
companies in America are members of the U.S. Chamber of Commerce,
in terms of sheer numbers we are predominantely a small business
organization. And I believe that’s particularly relevant to the
questions at hand because small firms, perhaps even more greatly
than larger companies, have a tremendous need for advice and
guidance on how to deal with workplace issues including, of
course, AIDS.

The personal human dimensions of the suffering caused
by AIDS cannot even begin to be calculated. Employers, like all
individuals, have an obvious concern for preventing and
ameliorating that suffering. But concern about halting an
epidemic such as AIDS also takes on additional dimensions for
employers. Among those considerations involve legal questions,
financial concerns, the employee benefits concerns, employee
relations matters and, of course, public relations issues, as
well, especially for those companies that have a good deal of
interaction with the public.

For many of us who deal with AIDS issues regularly, it
may be difficult to appreciate that in many communities there
still is very little known about AIDS. The infrastructure of
those communities, the health system, the education system, local
government agencies, businesses and the media simply have not yet
had to gear up to deal with AIDS. In most communities
individuals and businesses have not yet been confronted with the
reality of AIDS among friends, coworkers and employees.
Regrettably, it appears that that experience will soon change as
more and more cases of AIDS occur outside of those few
metropolitan urban areas that have seen the greatest number of
AIDS cases thus far.

170
This underscores the need to engage quickly in
education efforts to overcome misunderstandings or lack of
information that will hinder the ability of individuals and
businesses to respond appropriately to the great number of AIDS
cases that we will see in the near future.

Where businesses are beginning to ask questions, I’ve
found that most of the questions they’ve put to the U.S. Chamber
have fallen into one of three categories: legal issues, employee
benefits issues and employee education efforts. A sampling list
of the most frequently asked questions appears in my written
statement and, of course, those questions are by no means an
exhaustive list. But just to highlight them quickly, among the
legal questions we most frequently hear: Is an AIDS infected
individual considered to be handicapped under federal, state or
local law? If so, what are the reasonable accommodations that
employers must make for handicapped employees? There are also
lots of questions about confidentiality, also what legal
remedies are available to management if employees refuse to work
alongside a person with AIDS? And then, of course, employers
just want to know what the relative advantages and disadvantages
are of promulgating written polices or guidelines to deal with
AIDS or other catastrophic illnesses.

Some commonly asked employee benefits questions
include: Should AIDS be treated the same or differently than
other catastrophic illnesses? Should there be limitations or
exclusions in benefits plans and, if so, what type? Do company
health plans cover prescription drugs, mental health benefits,
experimental treatments, nursing home and hospice care and the
like? Also the relative merits of self insuring or purchasing
insurance.

Questions that we increasingly find employers asking
themselves, and in turn us, regarding their proper role in
education programs are no less probing. These include: If AIDS
cannot be transmitted in normal workplace settings, is it even
appropriate for a company to address the issue of AIDS with their
employees? If the company wants to do so, what is the most
appropriate way to do so and what is the most suitable format
and what are the best materials to use and speakers to have?

Not all of these questions can be easily answered, but
the Chamber is determined to help our constituents -- businesses
-- address these questions as best as possible. Accordingly, the
Chamber has taken several steps toward this end.

The U.S. Chamber’s Board of Directors adopted
unanimously a policy statement on AIDS which appears in Appendix
A of my testimony, which urges our members to engage in
educational efforts on AIDS and to consider the adoption of
policies on catastrophic illnesses.

171
We have also devoted considerable attention in our
broadcast and print media to this issue. The Chamber’s morning
news program, Nation’s Business Today, which is carried on the
nation’s largest cable network, has run several segments
including a special four part series on AIDS. The Chamber’s
magazine, Nation’s Business which is the largest monthly
business publication in the country, has run numerous stories on
this issue, some of which are found in Appendix B to my
statement.

Reflecting the composition of our membership, the
Chamber’s communications efforts have focused extensively on the
concerns of small and medium sized businesses.

The Chamber’s educational activity has now entered an
even more in-depth phase. The Chamber will be publishing shortly
a book,AIDS: Am Employer’s Guidebook, which I have written,
that focuses particularly on giving small businesses, local and
state chambers of commerce, and other trade and professional
associations necessary information and materials on AIDS.

Additionally, the Chamber will be offering seminars on
AIDS on the workplace starting next month at our Institutes for
Organization Management, which is a continuing education program
for local and state chamber of commerce and trade association
executives.

I would like to turn in, conclusion, to the
Commission’s request for specific recommendations. And I suppose
we have, in general terms, three.

First, the Chamber urges the Commission to use its
position to convince private and public sector leaders to devote
resources to educate the public about AIDS. Myths and
misunderstandings can only be overcome by a strong commitment to
give the public the information it needs to understand the facts.

At the same time, the Chamber strongly urges the
Commission to resist any effort that would require employers to
sponsor education programs or to adopt specific corporate
policies. We note with great concern that in California
legislation has been introduced that would mandate employers to
provide AIDS education to employees and to promulgate written
AIDS guidelines containing specific provisions. The Chamber
certainly hopes that such legislation does not pass at the
federal, state or local level.

As much as we support these education efforts, and I
hope one thing that has come through loud and clear in my remarks
is that the U.S. Chamber is doing a number of things to encourage
employers to undertake such efforts, we believe that it would be
a mistake to mandate something that really should be strongly

172
promoted on a voluntary basis. A mandate fails to recognize the
varied degree of employers’ abilities to impart educational
information to their employees and this is especially true when
dealing with an issue as complex and evolving as the AIDS
epidemic.

A second important function that the Commission could
fulfil is to encourage that in every way practicable AIDS in the
workplace should be handled like any other catastrophic illness.

Whether it is a question of modification of employee benefits
plans or permitting access to medical records to allow a better
management of AIDS cases, AIDS should be handled to a no greater
nor lesser standards than other illnesses. This, we believe,
will help foster an environment in which employees, employers and
the public at large understands the seriousness of the epidemic
without overreacting to it.

Finally, recognizing that the scientific facts about
AIDS are rapidly evolving, we believe it would be wise to avoid
the hasty adoption of rules or policies that are inflexible and
might be ill suited to dealing with this epidemic as it changes
in the future.

The battle to defeat AIDS and the myths that accompany
it will require vigilant efforts by both the public and private
sectors. The Chamber stands ready to contribute its effort to
help corporate America respond to this important challenge.

Thank you very much.
MR. DeVOS: Thank you, Mr. Klein.

MR. DeVOS: Thanks all of you for your prepared
statements. We will now go to a period of discussion with the
panel members here. And we’ll just dialogue together. You
should each feel free to respond if it’s in your area, and
dialogue between yourselves if you wish. And we’re going to
start this morning with Frank Lilly down on my left and we’ll let
Frank take the ball and run with it.

DR. LILLY: Mr. Klein, I’m interested in the very last
part of your comments where you’re proposing that we -- I’d like
a little fuller explanation because it went by me very fast and I
didn’t entirely seize all the nuisances where you were
suggesting that there are a lot of things we need to wait on
because we don’t know enough. I’m not entirely sure exactly what
you’re referring to there.

MR. KLEIN: Just in general terms, the fact that since
there still seems to be so much unknown or developing in terms of
our medical and scientific knowledge, for example, questions
about AIDS dementia or the risk to an individual with AIDS in

173
terms of their own being prone to opportunistic diseases and so
forth that we would just caution, as policies are being
developed, against drafting them in such ways that would be so
concrete or inflexible that if the medical facts as we know them
now should change, that companies and others would not be able to
respond appropriately.

DR. LILLY: Well, I’m worried about that because it
seems to me that there an awfully lot of things that need
approaching immediately and --

MR. KLEIN: Very definitely.

DR. LILLY: -- I would hate to see issues that we
desperately need policies on be postponed simply because there
may be new information. There may be new polices, too, for that
matter. How do you communicate with the lower echelons of your
organization?

MR. KLEIN: Well, we don’t consider them the lower
echelons because they’re our members. They may feel that way
about us. We have -- among our 180,000 members -- 2700 state and
local chambers of commerce and 1300 trade and professional
associations. Those groups, in turn, of course have hundreds and
hundreds of thousands of members. So we have very well developed
communications methods with them, extensive print and broadcast
media; newspapers, magazines, newsletters, a regular chamber of
commerce department within the U.S. Chamber as well as a trade
and professional associations department within our office to
particularly get information into their hands.

In addition, our communications capacities reach beyond
the U.S. Chamber’s members also in terms of our television
programs and some of our publications which are sold for general
subscription and direct mail matters.

DR. LILLY: I’m wondering how you’re taking advantage
of the fact that some of your member organizations, for example,
in San Francisco and in New York, et cetera, faced the issue very
early, long before your national leadership got into the act.
Eventually that information filtered out to them and now I’m just
hoping it’s going back to these places where you say they need
it and don’t have it.

MR. KLEIN: Very definitely. A number of local and
state chambers have been real leaders in this area because they
have had to deal with, on an immediate basis, the questions that
arise, out of the AIDS epidemic. So they have been an enormous
help to us.

For example, the Minnesota Chamber of Commerce and
Industry has run a number of excellent programs on AIDS in the

174
workplace that have really been a model that we have been able to
point to other local and state chambers that have asked us how
they might pattern their efforts and not reinvent the wheel. So
our interest now is really in getting to all of those other
communities that I spoke about that may not yet be geared up and
pointing to other exemplary companies and chambers that have
really been leading the effort here.

MR. DeVOS: Thanks, Frank. We’re going to go to Kris.

MRS. GEBBIE: I think I’m going to play the role of
designated skeptic this morning. Each of you said something
about this Commission’s report ought to tell every business in
America to have a policy. I think that’s been told to every
business in America by each one of you from your organizations
and probably by several members of this Commission in their
various roles. So how could our saying it one more time in
paragraph 32 of our report be what does it? That is, either
what manner of saying it, or what words should we use or what
carrot or stick should we use, that makes our message the one
that gets through to the small business in every city or county
in this country? Because clearly, I think you all agree, they
all need to do what you just described.

MR. STILES: I/’d like to respond briefly to say that I
think what this Commission advises the government and the country
will become a document of extraordinary authority. That is, you
have been diligent and I expect you’1ll be careful and I think
your message will become something that other people will pay
attention to, not the least of whom might be both candidates for
the Presidency. And perhaps the incoming A ministration might
well turn to your reports and recommendations, if not as a road
map or blueprint, certainly as the collective wisdom of an
extraordinary number of people. It seems to me, therefore, your
recommendations do bring a semblance of diversity and balance and
authority and provide credibility and scope. Many of us in the
private sector are often thought to represent narrow or single or
vested interest in the epidemic. Presumably, you as a
Presidential Commission have no vested interest other than
bringing to the country the strongest, the most powerful and the
most thoughtful recommendations. In that sense I would hope your
recommendations will have a lifetime way beyond the report
itself.

And secondly, I think that your recommendations, like
many of our programs, must say things once more then we all catch
one another saying that every business, every workplace needs an
education program. What we fail to say is that we need a
repetitive and a redundant education program. Doing it once is
not sufficient. And I think what you can do in your combined
wisdom and in the authority of your Commission can be
extraordinarily useful to the rest of the country by saying,

175
"See, one more group of people has looked carefully, objectively
and thoroughly at the question and here’s what they have to say."

MR. MORGAN: I would agree with B.J. I think just
including the recommendation in the report by and of itself is
not what matters as much as in the influence it will have on
others’ actions and the fact that it’s basic the principle of
communications a consistent and repetitious message that you have
to address this issue -- organizations have to address it. And I
think the more we say it, the more different ways we say it, the
better off we’ll all be in the long run. The inquiries we’re
getting on a daily basis are from big companies, small companies,
non-profit organizations. We get them from government agencies,
people looking for more information and more knowledge about the
issue as it affects an organization. And I think including it in
your report, just saying companies need to address the issue of
having a policy, is one of the things that will have an impact.

MR. KLEIN: I would just echo their comments, they put
it best.

MR. STILES: I’d just like to make one other response,
and that is that the recent release of very comprehensive and
balanced recommendations by the Office of Personnel Management
is an extraordinary asset in terms of helping government
agencies and government administrators have a set of documents
that are thoughtful, balanced and has the authority of being an
administratively approved document. And it would seem to me that
your recommendations could have equal potential in terms of
going throughout the system, both public and private, in terms of
setting standards.

MR. DeVOS: Thanks, Kris. Theresa?

DR. CRENSHAW:' I’ve read some and I think it’s just
excellent some of the best that I’ve seen on workplace issues.
There’s one area, however, that I find rarely addressed in regard
to workplace issues that I’d like to explore a little bit with
you. And that’s the issue of secondary infections, not AIDS, not
the transmission of AIDS. And I think there are to facets to
this and I’d like your feedback on whether you’ve given this some
consideration and what conclusions you’ve drawn.

Two facets. One is that someone who is immunocomprised
is suspectable to just about everything and when someone at work
is ill and not too sick to be home but sick enough to still be
contagious, they are a threat and a risk to someone whose
infected with the AIDS virus. And how is that handled? It seems
to me we have a catch 22 by virtue of not being able to protect
someone ill from one of the infections that could very well kill
them at work.

176
The second is that many of the secondary infections are
airborne or contagious in other ways and were easily
transmissible than the AIDS virus itself. And I want to make
very clear for the record I’m not talking about the AIDS virus
being airborne. But there’s an article that came out recently in
the April 8th issue of The Journal of the American Medical
Association that was really interesting and somewhat disturbing.
They did a study on respiratory infections in the workplace, in
the military. And they found that there was a 45 percent greater
incidence of respiratory infections in the workplace in more
modern buildings than in older buildings built in the ’40s and
the ‘50s because of the more efficient recirculation of air.

So it seems to me that we need not only look at
secondary infections and the potential for harm in both
directions, but if these studies have merit and the air
conditioning systems that are being used have this potential to
make a difference that great, it goes on to mention that 75
million doctor visits and $15 billion in direct medical costs
each year are the result of respiratory infections and that
billions of dollars in the social and the health costs. So I’d
appreciate your comments. I’m not very deeply informed on this,
but I’d like to know more about it.

MR. KLEIN: From my prospective, you’ve raised some
very good questions the answers to which may not be known or not
yet developed. I think some of those questions in terms of the
secondary effects was what I was alluding to in my remarks and in
answer to Doctor Lilly’s question about still being unaware of
certain facts, certain scientific matters for which the
development of policies need to allow for the fact that new
information may become known.

I think that in terms of the Chamber’s support for the
idea that an individual with AIDS ought to be allowed to continue
working as she or he is able to do so, the effect on and the
safety and health of that individual in terms of their
susceptibility to other opportunistic diseases and infections may
become a factor in that determination.

We already seem to know and accept the scientific
evidence that the virus itself cannot be communicated through
casual contact, normal contact in the workplace. But these kinds
of considerations are serious and from the perspective of the
health and safety of the person with AIDS we simply need to
approach it with caution. But I wish I had a clear cut answer
for you.

DR. CRENSHAW: There is a growing concern among the
medical community about tuberculosis which, of course, is
airborne and I don’t -- this article doesn’t specifically refer
to whether or not that was one of the respiratory infections

177
involved. But these are things that, it seems to me, would be
awfully nice to have answers to. Anyone else have a comment?

MR. MORGAN: With regard to secondary infection, I
think it’s an issue that’s pretty well handled by the workplace.
If you have an AIDS policy that says you will accommodate
employees with the virus and that you will help accommodate them
if the physician and the employee feels that there’s a problem
with working closely with employees, I think that can be handled
as just part of your normal supervisory practice if you have a
policy.

With regards to the airborne infection, I think it’s
something that needs to be addressed. I serve on our ergonomics
committee at work and we have just hired a wellness consultant to
come in and look at wellness. We also have industrial
hygienists. This is one of the areas they’re looking at, the
recirculation of air and how it effects health. We really don’t
know. I don’t think there’s a whole lot of work that’s been done
yet. So, I don’t have much more information than you do. But
we're looking at it. It is a concern.

DR. CRENSHAW: So it is something that’s on your mind
and that you’re --

MR. MORGAN: It is a concern, yes.

MR. STILES: Doctor Crenshaw, it’s my concern that from
the employee’s perspective, the secondary infection that is the
most lethal is our anxiety and our ignorance about the disease
itself. In time after time in the actual workplace setting, when
the employee is clear about his or her condition, where the
employee’s boss and managers are clear about how they’re going to
deal with it, the rest of the coworkers become part of the human
family of people who are ready to be protective of the diagnosed
or seropositive employee’s welfare -- medically, spiritually,
socially and in every other respect. It’s really the other
setting -- in which the employee’s condition scares, frightens,
offends other people to the degree that they want to isolate
them, when we want to hold them at arm’s liength and we want to
use the anxiety about secondary infection as the excuse to
deprive them of their own ongoing right to work and deprive
ourselves of the opportunity to be associated with then.

I think it’s that secondary infection that really is
pervasive and most destructive in the workplace.

In my own office, in my own work before I entered AIDS,
in working with persons who were diagnosed and who wished to
remain a part of the productive work force, I found out very
quickly that coworkers want to become allies and protectors of
PWAs who may be’ vulnerable to any kind of infection or

178
rejection. And it seems to me that we see policies as an
opportunity to be literate and sensible enough to not allow any
secondary infection which would deprive any of us the opportunity
to make a living, protect our health and be careful of our
coworkers.

DR. CRENSHAW: I agree with you that a lot of aspects
of the AIDS epidemic can be misused to promote hidden agendas.
My concern is that we not go to either extreme and as I’ve seen
in the last six or eight months in the community at large, both
professional and general public, there have been an enormous and
very encouraging response from mainstream thoughtful scientists
and others to take a look openly and objectively at some of these
sssues. So I’d like to stay away from the extremes on both sides
and just face whatever it is that we do need to face here and
take a sufficiently clear look that we can make rational and good
policies that are in the best interests of both the infected
person and others. So I take in your points. I think they’re
very important. Thank you.

MR. DevOS: Thank you, Theresa. Penny?
MS. PULLEN: I don’t have any questions.

MR. DevVOS: Can the audience hear what these people are
saying adequately? I don’t want you to get left out. Beny?

DR. PRIMM: Well, I just read something recently ina
magazine that said that you can only get AIDS in the workplace if
you are doing something that you’re not being paid to do. And in
that regard one of the things that has bothered me considerably
is the lack of attention in the workplace that’s paid to drug
use, sharing of needles, certainly drug trafficking and we see
this continuously all over the country. And all of these things
could make one more suspectable, unquestionably, to transmission
of the virus. And my colleague here just wrote something that’s
really important, the sexual harassment that takes place in the
workplace, are all contributory factors as far as I’m concerned.

I‘ve had in my own corporation to get rid of people who
have continuously sexually harassed the women employees. Some
have been successful in their attempts to seduce persons based on
promotions, based on threats and so forth.

What are you doing at the Chamber of Commerce? I know
what B.J. is doing. I work with him constantly. And what are
you doing, Mr. Morgan and Mr. Klein in that regard?

MR. KLEIN: Well, the U.S. Chamber of Commerce long
before it became involved in the question of AIDS, has been
involved in the question of preventing, stopping drug abuse in
the workplace and drug abuse generally. A colleague of mine on

179
our staff, sort of our in-house expert on it, has published a
book on it, the Chamber has run a number of seminars and
otherwise has disseminated a lot of information on prevention
efforts, again throughout the normal Chamber of Commerce and
membership activities that I described earlier.

This can have, therefore, an incidental effect in terms
of helping our efforts now to slow the spread of AIDS. With
respect to sexual harassment, we also have a very strong policy
on that in terms of the unacceptability of any kind of sexual
harassment activities. Certainly from the U.S. Chamber of
Commerce itself as well as in terms of advising our membership.

I know that right within our own workplace we run regular
seminars on this and it has the highest priority of the U.S.
Chamber’s board and our staff.

MR. MORGAN: With! regard to the drug issue, probably
the best thing we have done on that issue, and a lot of other
similar issues that effect jemployees individually, has been the
implementation of an employee assistance program about five or
six years ago. And, training supervisory employees to recognize
potential problems with employees and encourage them to use the
employee assistance program: This is an outside agency that
deals with the problem, whether it’s a marital problem or
financial problem or drug\ problem, or alcohol problems. The
only report we get back from the employee assistance individual
who handles the program ere reports of usage. And drugs are a
bigger problem than you’d tend to think about, but we don’t get
any information except that, the assistance service is being used.

We have done other things in the drug area, like health
fairs. We just had a health fair again last week where we had
different types of community based organizations in and employees
were encouraged over a couple of days period to go in and talk to
different organizations; whether it was the heart association or
other types of health agencies, or for drug abuse or alcohol
abuse.

We train our supervisors in our supervisory training
courses to look for those types of behavior that might indicate a
problem and encourage employees to seek assistance. And, of
course, we communicate. We spend a lot -- Allstate has spent a
lot of time and money through the years on the most widespread
source of drug abuse, which is alcoholism and alcohol abuse.
And we are doing now more and more on drug abuse as it effects
the workplace. As for the sexual harassment issue, we have a
very strict policy. We’ve trained all of our supervisory
people. They all received a presentation during their
supervisory training and it’s a stated policy, a very
affirmative policy, of what is acceptable behavior and what is
not acceptable.

180
DR. PRIMM: Do your companies do yearly physical
examinations and included in that physical examination is a urine
analysis for a drug screen? Is that commonplace? You don’t do
yearly physicals?

MR. MORGAN: We do not, no.

DR. PRIMM: How then can you recognize the
symptomatology just -- do you recognize just by symptoms or
behavioral symptoms in individuals?

MR. MORGAN: Behavioral symptoms. Yes.

DR. PRIMM: Absences --

MR. MORGAN: And performance.

DR. PRIMM: -- performance, et cetera. But you do no
drug screens on your -~

MR. MORGAN: No, we do no drug testing either pre-
employment or with existing employees.

DR. PRIMM: What about your member companies, Mr.

Klein?

MR. KLEIN: Well, I imagine their practices are all
across the board and are in accordance with whatever the local
law may be and state law where they operate.

DR. PRIMM: I’m under the impression that many of the
Fortune 500 companies now do urine screens for drugs for pre-
employment physical and yearly physical examinations.

MR. CREEDON: That would not be my impression -- excuse
me. I think that increasingly, although I would doubt that it
would be a majority among the Fortune 500. They are beginning to
give tests as a pre-employment matter. But my impression is that
relatively few test existing employees except in specific types
of jobs where they might be a particular hazard. I don’t know,
for example, whether they’re testing pilots now, but they’re
limited. I think there are a few companies that are testing
employees, but I would not think it’s --

MR. DeVOS: Thank you, Beny. We’re going to go on to
Colleen.

DR. CONWAY-WELCH: Thank you. Mr. Klein, I’d like to
ask you to expand on your recommendation that the Commission
should encourage an environment in which AIDS is handled like
other catastrophic illnesses. For example, efforts to amend the
law to require employee benefit plans to handle to AIDS

181
differently than other illnesses should be resisted. This is an
issue that has come in front of the Commission a number of

times, lifting AIDS out of the usual processes by which we deal
with the issues of illness in this country and highlighting it or
doing some special things that are specifically focused as
opposed to attempting to address system issues, if you will. And
I wondered if you could expand on that for us?

MR. KLEIN: Sure. It may even be of questionable
legality in some instances to amend an employee health plan, for
example, for a special limitation on coverage for AIDS vis-a-vis
some other kind of illness. And even if it does not step over
the lines of what’s permissable, it would seem to us inadvisable
to treat AIDS, as I mentioned earlier, to either a greater or
lesser standard than other catastrophic illnesses if the whole
effort that we’re trying to impress upon employers and employees
is that AIDS is a catastrophic illness and should be handled as
such. |

I mentioned in my written statement, for example, the
federal legislation now that would expand upon the continuation
of health care coverage provisions of what’s called COBRA, the
Consolidated Omnibus Budget Reconciliation Act. Again, based
upon what our members are telling me, the compliance with the law
as it currently stands has been an incredible burden for
employers and insurance companies and others who administer
health care plans. Now we look with some concern on this
proposed federal legislation that would expand COBRA and,
although it arguably would apply to all types of disabilities,
the clear intent of the law is aimed at providing special
provisions for those persons with AIDS.

We would certainly encourage the sponsors of that kind
of legislation to consider the enormous ramifications that COBRA
as it now reads on the book has had in terms of discouraging
small and medium size companies from offering health care
coverage at all and to the degree to which any changes in that
law would become an inordinately greater burden, it might have
the, certainly, unintended effect of discouraging employers from
providing valuable health and other insurance protection for
their employees and their families.

DR. CONWAY-WELCH: Thank you.
MR. DevoS: John?

MR. CREEDON: I have a question for Mr. Morgan. I
would like to reiterate what the chairman said about Allstate
having done such a, good thing here in undertaking this work and
I don’t give competitors, credit very lightly. I reada
statement or a speech that Commissioner Pullen sent to me the
other day by Secretary of Education Bennett. The general thrust

182
of his remarks, was that AIDS is primarily a public health
problem and should be approached from that standpoint. And one
of the things that he encouraged is fairly widespread routine
testing for the virus. I think his feeling being that we really
don’t have enough hard data yet as to how many people have the
virus. We have a lot of implications drawn from certain data,

but we don’t know how many people have the virus and he seemed to
feel it was important to try to find out. First because it would
be beneficial to the person who has the virus to know that he or
she has it and be able to take whatever steps can be taken in
light of that. And secondly, that it might be good to know from
a public health standpoint.

I noticed the number of points that were made in the
study that was undertaken, that one of the points made, and I
think you may have reiterated it, was that employers be
discouraged from testing employees for the virus. And I’m
curious as to what the rational for that was in the conference?

MR. MORGAN: That came as a result of a number of
companies that have had experience with AIDS. And basically the
main reason is the invasion of privacy, and do you want to get in
to start testing employees for individual illnesses or Sickness,
or do you want to treat AIDS like any other serious illness or
sickness in the workplace. And you don’t test people for cancer,
you don’t test them for heart disease, you don’t test them for
other things, so why should we test them for AIDS? That’s
basically our philosophy and, we don’t test them for venereal
disease. You know, there’s no precedent to do that any
differently.

MR. CREEDON: Yes. Well, I guess, you know, coming
back a little bit to your point that Commissioner Primm raised, I
don’t know what percentage of employers, at least large
employers, do provide physical examinations now. And my guess is
that fewer maybe than did 20 years ago. But at least in certain
circumstances physicals are provided and I think urine analysis
would be a part of the physical and maybe blood samples would be
part of the physical. So it would be possible where a physical
is being given anyway to expand it if the employee was willing.
I mean I would certainly not do it on a mandatory basis, but ona
voluntary -- here you’re affirmatively saying well discourage
people from encouraging employees to have a test taken. And --

MR. MORGAN: The Fortune survey that we did of
businesses showed about two percent of the companies do any type
of testing.

MR. CREEDON: Any type of testing?

MR. MORGAN: And only eight percent would ever want to
test in the future if they were allowed to do testing.

183
MR. CREEDON: Thank you.

CHAIRMAN ‘WATKINS: The other question really might be a
suggestion. I know one of your recommendations is that the
report be made available to another 25,000 people at the cost
$100,000. I don’t know where you think the $100,000 should come
from, but I was wondering whether (a) Fortune magazine, who was
obviously interested, might somehow participate in making such a
distribution and also the Chamber. I would think this would be
an ideal thing for the Chamber to distribute to 180,000 members
instead of just an additional 25,000 and maybe by Fortune and
Allstate and the Chamber, maybe a few other people getting
together, it could be done. Because I agree with you, I think
it’s a shame not to give it widespread distribution. I think
it’s a really good report and we ought to do it. I’m not sure we
have to look to the federal government for that.

You know, I’m taking Chairman DeVos’ speech here and he
usually says something about --

MR. CREEDON: Metropolitan will join you in that.

MR. MORGAN: We’re not looking for the federal
government to do it. We just think the information needs to get
out and it is a serious national problem. We think the
information needs to get out so more companies, both large and
small, those who belong to the Chamber, those who don’t, know
it’s available.

MR. CREEDON: Right. I agree. I think the cost is not
huge. It seems to me it is something the business community
should be able to get behind and do.

MR. MORGAN: I don’t think it’s the cost as much as it
is the availability, people knowing where to go to get the
information and having it available. The cost is minimal, but
it’s a small business person not knowing where to go when they
have a problem. They may not even belong to the Chamber and who
do they go to? Just having it available, public information, so
that they can get it readily from someone locally. I think the
cost is not an issue.

MR. CREEDON: Well, I suggest Mr. Klein take this under
advisement. Mr. Klein?

MR. KLEIN: Well, in fact, it was along those very same
lines that we decided to develop yet an additional publication
because clearly the one that Allstate has put out is an excellent
one and we refer to it often when we’ve had inquires. But we
also felt the need for a separate kind of publication that would
be particularly well targeted to small companies. You know,
small employers have enough trouble just running their

184
businesses and manufacturing widgets or providing whatever
service they’re engaged in. And big businesses, too. And so we
felt one thing that would distinguish our publication from some
of the others is that it would have.in it ready-made materials
that these companies might use as well as chambers of commerce
and trade associations and B.J. Stiles was a tremendous
assistance to us in terms of advising us how this ought to be
structured, in terms of newsletter articles that a company might
just photocopy right from our publication and put into their own
newsletter and they can go ahead and plagiarize it.

That type of material as well as a very ample appendix
that would list where they might go in their state for further
information on running an education program or simply dealing
with the issue.

MR. CREEDON: Thank you.
MR. DeVOS: Penny?

MS. PULLEN: I apologize that I missed the
presentation part of the panel. Doing business elsewhere. But I
would like to ask Mr. Klein a couple of questions that maybe were
not covered.

Does the Chamber have a recommended or model employee
education brochure on AIDS?

MR. KLEIN: It is in development as a substantial
chapter in our overall forthcoming publication called Aids: An
gmployer’s Guidebook giving employers advice on how they might go
about running such a program.

MS. PULLEN: But you don’t have a pamphlet that can be
handed to the employees as a recommended tool for the employer?

MR. KLEIN: One of the appendixes in this publication
is sample information, for example, from the American Red Cross
or others that will be something that the employer can photocopy
and distribute to their employees.

MS. PULLEN: What would be your opinion of an employee
educational brochure from a corporation which has the message to
ats employees if you use drugs, don’t share needles?

MR. KLEIN: Well, we try very hard to understand our
appropriate role in terms of encouraging employers to do what
they feel is appropriate. So to be honest with you, we’ve not
made a judgment on that and I think those employers who would
determine that to be appropriate or inappropriate, we wouldn™ ©
try to second guess then.

185
MS. PULLEN: I would encourage you to be a little
braver about that.

MR. DeVOS: Doctor Lee?

DR. LEE: Mr. Chairman, with your indulgence I would
like to ask these young people in the back of the room here who
have been watching for two days and they are attentive, they are
not yawning, they are not talking among each other, they’re
listening to us. It’s very unusual. Who are you and -~-

CHAIRMAN WATKINS: Wait a minute. Let me say who they
are. Doctor Lee’s the last one to get the word. This is the
very special group from the Hamilton Southeastern High School
who are honor students and are here from the human genetic
science class. They were here yesterday, they’1l be here today
and tomorrow. And I think it’s a great credit to the leadership
of that school to allow these students to come, different groups
each day, to listen to these sets of hearings.

We’ve been talking about AIDS in the workplace, but
AIDS in the workplace is also AIDS in the high school. And so
when we’re talking education, there’s a continuum, there’s a
bridge between the workplace and the school without any question.
Hopefully the parents are in the workplace. Hopefully the
children are in the schools. The education process that’s needed
in the country, desperately needed, is going to come to fruition
in those two areas primarily and with very special intervention
strategies to go not in the workplace and not in the school.
That’s a whole different set of issues. But you can also
influence that. And so to have the young people of America be
part of the solution, which is what we must strive for in this
nation, instead of the butt of all criticism, is what this class
is all about here today. I think it’s unusual for a high school
to allow their students to participate in something as
sophisticated as this and I think it’s a credit to them as
individuals to be here and to be so attentive as Doctor Lee as
said.

So I’d like to ask the students to stand up and let’s
give them a round of applause for being here today.

DR. LEE: Thank you, Admiral Watkins. I really am very
pleased to see students here. You’re watching a small very
disparate group of citizens try to make a dent in an enormous
problem. You/re watching the system try to work. We’re all on
both sides of the table working at this as hard as we can and we
appreciate your interest, we really do it. We need it.

Mr. Klein, your background is very interesting as a
lawyer specializing in bioethics. That shakes me to my
foundations.

186
The workplace is so vital to the management of AIDS
because one of our major problems and one of the ones which I’ve
sort of taken a pet interest in is the people who have lost their
jobs, lost their benefits, have become basic and can’t get an
apartment and relatively have become charges, societal charges.

Your philosophy that this is just another big medical
problem and should be treated as such. I’d like you to address
the possibility that there are special features to this one, one
of which is this codery of young men who have lost their jobs and
their homes and the problem is discrimination. nd, of course,
the other is that we’re dealing with a group of people who have
no franchise whatsoever, the drug addicts and the society that
whirls around them. And we’re trying to deal with that and the
system to date isn’t dealing with that. |

This Commission can’t turn away from it and we/’re
looking to the workplace to solve at least a small part of it.
In Japan you go to work for a company and you give your life for
them and the company pretty much takes care of the person. In
America it’s very different. It’s the bottom line and so
frequently it’s the bottom line every month which destroys this
bond between the employee and the employer. And with a
background in ethics, how is a chamber of commerce staffer going
to face this problem and what would you have us do?

MR. KLEIN: Well, you’ve hit on a number of very
important questions and assessment of the challenges. I think
the key to what you said, in my view, is that the workplace can
present -- can provide an opportunity to deal with some of those
particular challenges. Clearly it would be easy for employers,
for businesses, to step away and say, "Well, all the evidence
before us suggests that AIDS cannot be transmitted in the
workplace and is it really our responsibility to get involved at
all?" Fortunately, I don’t think most employers who have thought
about this issue have responded that way. They realize that it
has very serious employer and employee ramifications.

Clearly there’s a limit to what the business community
can do in terms of reaching out to those with whom they have
little or no contact. And that may include a Significant
portion of effected populations.

I think that what the Commission can do is outlined in
our statement in terms of encouraging employers to recognize not
only the importance, the value that they can provide in terms of
disseminating information to their employees and to their
families, but also in terms of preparing themselves to
understand all the dimensions of the epidemic so that they don’t
make blunders and mistakes that would lead to illegal dismissals,
for example, or just errors.

187
For example, an employer might believe that it is being
particularly compassionate in terms of notifying coworkers that a
particular individual is infected with the AIDS virus in order to
encourage them to treat this individual well; when, in fact, they
may be violating that person’s confidentiality. So our effort
really is to try to provide warnings to companies as to the types
of issues that they need to think about. And I would just
encourage this Commission to use its structure to continue and
increase its efforts to encourage private and public sector
leaders to get more engaged in the effort.

As I think B.J. mentioned earlier, no one thing that
the Commission say will necessarily make the difference. But in
conjunction with a lot of other efforts, the repetition will
have, hopefully, the desired effect.

I also wanted to, if I may just use the opportunity to
amplify a little bit on Commissioner Conway-Welch’s question
about modifications to employee benefits plans because I can
substantiate some of what I was talking about, the COBRA
modifications, with some hard data, which I’d like to just read
very briefly so it would be officially in the record.

We did a survey of over 6200 companies on their
responses to the increased cost and administrative burden of
COBRA and asked them, among a number of other questions, what
their reaction has been to the requirements under COBRA for the
continued health care coverage.

Fourteen percent said that they have increased employee
cost-sharing. Twelve percent said they’ve modified current
eligibility requirements. Four percent said they modified post-
retirement medical benefits for retirees not eligible for
Medicare. Twenty-four percent said they’ve decided against
improving benefits. Thirteen percent said they have reduced or
eliminated certain types of benefits. Seven percent said they’ve
reduced present benefits. Two percent said they’ve discontinued
the health plan completely. Eight percent said they will
curtail future wage increases and six percent said they would
curtail dependent coverage. I think those are very telling
statistics in terms of how companies are having a difficult time
coping with the current problems and that any ill thought-out
expansions of COBRA might have precisely the reverse effect of
what is desired.

DR. CONWAY-WELCH: Thank you.

MR. CREEDON: May I comment a little bit on that?
Thank you. One of the difficulties, I think, with the COBRA
type legislation is that it puts the employer in a position of
being responsible for people who are no longer employees. When
it’s an employee you can deal with that responsibility through

188
payroll deduction and so forth. But once someone is no longer on
the payroll, it’s a real burden. So you're saying that the
employer for some period of time and some people would make it
forever, I guess, is responsible for the health care costs of
former employees. So it’s a really serious problem
administratively. I think this is what Mr. Klein is saying.

Just the burden of keeping track of people. You take a large
company where there are a lot of layoffs or whatever, and you
have tremendous problems.

MR. DeVOS: Admiral Watkins next.

CHAIRMAN WATKINS: First I’d like to echo the remarks
of my colleagues, Mr. Morgan, on what Allstate has done. You
were kind enough to invite me to speak to your Allstate Forum
earlier this year where you brought in so many executives. It
was a very impressive group and that was at a time when this
Commission didn’t have a great deal of credibility.

And to you, B.J., for your willingness early on even
while we were still on the rocks and shoals from outside
perceptions, to invite us to come in and begin to work with you
early on in the National Leadership Coalition on AIDS and to help
open the doors and access to many individuals. And the
continuing relationship we’ve had with you has been superb and
you’ve been very helpful. We want to thank you for that.

Now, Mr. Klein, what I’d like to know is do you have a
representative on the National Leadership Coalition on AIDS and
if you do not, would it not be wise to consider that when you go
back and have your people take a look? It seems to me the
Chamber should be on that Coalition if it is not because I see in
that Coalition a changing set of missions. At one point,
perhaps, its mission was to raise awareness in the United States
I think that this Commission has demonstrated its credibility in
that regard and will help. Then the leaderhip Coaliton’s mission
is going to be carried out. So I see a changing set of roles
where the private public partnership vested in such
organizations, in this, not to in any way denigrate the
individual organizations, but a cooperative coalition it seems
to me to be the way to go. I don’t know if you are a member or
not, but I would certainly hope that you would be in the future
because of the linkage with the small business and large business
as represented by the Coalition.

MR. KLEIN: Thank you. We are not a member of the
Leadership Coalition, although B.J. has been an invaluable asset
to the U.S. Chamber in terms of the advice and information that
he has given us. The U.S. Chamber’s Board of Directors has
essentially adopted a policy of the U.S. Chamber not joining
other coalitions and organizations only because our scope and our
mandate is so tremendously broad we get asked to join literally

189
hundred and hundreds of them a year. We are, however, on an
informal basis trying to work collaboratively.

B.J. has been, as I mentioned, not only a great help to
us but for example, at these Institutes for Organization
Management, a continuing education program that the U.S. Chamber
sponsors, we'll be providing a seminar on AIDS in the workplace,
and we hope to make available the National Leadership Coalition
on AIDS publication so that we can advise these companies and
chambers of commerce of the existence of the coalition because we
think they’re doing such excellent work.

CHAIRMAN WATKINS: Mr. Morgan, you talked about
confidentiality and I think we would, without any question,
endorse all that. I didn’t hear the next step, though, what
happens in the business leadership when confidentiality is
breached. That is, what is the corporate responsibility to the
worker in the workplace? And let’s don’t necessarily focus on
breach of confidentiality within your workplace. Say it takes
place outside. The person loses their home and perhaps it’s a
small business and they lose their individual health insurance
because there’s no group insurance. Is there a court of resort
for those individuals within the company? Is there a policy in
your pamphlet that goes the next step that says there is a
responsibility and there is concern because of the compassionate
approach taken by the planning and the readiness for receiving a
person in the workplace. Is that something that you have
addressed and talked about in some depth to see if there isn’t
some help to be provided for the person who then is discriminated
against in other ways?

MR. MORGAN: That’s a broad question. I think we tend
to look at benefits, first or benefit policies, and we normally
go by our benefit policies. We veer away from those policies all
the time, make exceptions for individuals, individual cases.

We try our very best to look at the circumstances and
accommodate the employee because the employee is important as
well as his or her family, and it tells other employees something
about the company. We don’t have a policy that says we will do
certain things for different people. I think we look at each
individual. The confidentiality outside the workplace, it’s
tough. I think knowing our work force, it would be pretty much
handled by the other employees. And that’s where I think the
education and awareness of AIDS is developing with employees and
management. An understanding of the virus, how it affects
people, how it can be transmitted, will yield much more
compassion.

The Fortune survey clearly showed that. The more
senior management involvement, the more experience with AIDS, the
more open and compassionate a corporation becomes. The more the

190
policies change as they get more familiar with it and as their

senior management is more aware of it. So I can’t give you an

answer that says here is how we would react. I think it a very
broad topic.

CHAIRMAN WATKINS: No, I think that would be difficult.
I’m talking about do you recognize discrimination in-the
development of a plan within a corporation for dealing with the
AIDS issue to take it beyond the confidentiality assurance. What
is the corporate discussion that’s gone on, how involved will
they get in the attempts to assist that worker to the extent
that’s reasonable?

MR. MORGAN: I don’t think it was really discussed as
part of the task force. Not in any of the notes I saw. It’s one
of those areas that you are aware of but I don’t think it was
even discussed. Breach of confidentiality -- obviously, there
are a couple of factors. One is the legal factor. The company
does have an obligation if confidentiality is breached. There is
some legal recourse the employee has about confidentiality.

And secondly, I think there is a moral obligation that
if something the company does or someone in the company does
something to injure or hurt another employee, that the company
has some obligation. I think it’s more of a moral obligation and
I think it would be handled on an individual case. I don’t see
companies setting up a policy to handle each one of those things
that could occur.

CHAIRMAN WATKINS: Well, the reason I raised it is we
have to face the issue. We’ve had compelling evidence on the
issue of discrimination and whether that breach of
confidentiality has taken place within a medical context, which
generally is not the case. It’s usually some other way it comes
out. But the individual is hurt by it and the fear of exposure
is probably the major obstacle to getting on with -- data and all
the other kinds of things that we talked about.

So we have to come to grips with it and it seems to me
that corporate leadership which the political influence in this
nation can bring to bear on state legislature a sensible approach
to this kind of a set of issues. Unless you are sensitive in the
workplace and work this same kind of issue, I don’t see how the
business round tables or their equivalent in the various states
can come to grips with this issue and put the necessary pressure
in the right way on the system to be responsive. There has been
a hands off policy at the national level, really. People are
afraid to get into it too far. And it seems to me that here is
another opportunity in the workplace for corporate leadership to
come together and find the sensible policies and influence public
policy accordingly.

191
I think it’s a very important issue and I didn’t see it
in your report and it just seems to me that that’s a very tough
and next step to take, but it seems to me it’s time to at least
debate it and see where it might end up among those same 150
entities that came together earlier in the year.

MR. DeVOS: Thank you, Admiral. Everybody is avoiding
-- not avoiding, but walking on eggs about the real issue
involved here which is cost. We have a long history of moving
from an individual one time lived in a company town and was
totally cared for to where government became more benevolent to
where now they’re trying to shift it back to business. Does
anybody here have any idea what the corporate cost is going to be
in education, health planning, increased costs in their health
benefit programs? Did the Chamber do a study? Do they have a
number?

MR. KLEIN: We haven’t, although our research
affiliate, the National Chamber Foundation, is planning now and
developing a survey, again particularly directed for small and
medium sized companies to get a better handle on their responses
as well as their best estimates of the costs. In terms of
insurance costs and others, we’ve certainly relied upon the
expert information that has been issued, for example, by the
Society of Actuaries and others in terms of the life insurance
costs and others in terms of health insurance costs.

MR. DevOS: In other words, you don’t really have an
answer either?

MR. KLEIN: We don’t have our own specific numbers, no.
But implicit in your question is a very critical point and that
is the costs will be enormous. We don’t have a fix yet on what
they’re going to be.

MR. DevoS: Well, that’s why I find everybody walking
on eggs because nobody knows where that leads to and what the
ultimate cost is. And for a little guy and a small business
he’1l go busted. All he needs is one or two cases that cost him
$100,000, $200,000 and his whole benefit program is ruined.
Whatever it is, because he doesn’t have enough people to amortize
it over. The bigger companies may be able to roll with it, but
we're all trying to figure out who is going to pay the bill
around here. And that’s what this Commission is trying to help
fathom out, too. Where is the balance and who has duty and
responsibility. Any commentary you have along that line, long
term, would be appreciated for the benefit of the Commission and
our report.

MR. KLEIN: I would like to add to that point that
although we certainly don’t know what the exact costs are going
to be in dollars and probably nobody does, we have tried to

192
advise our members to consider those costs when they’re planning
their benefit plans, for example, that they need to balance both
their own ability to bear the costs with their desire and need to
provide to their employees and their families certain

protection. That’s the whole purpose for those benefit plans.

Likewise, in terms of what types of benefits should be
covered under a plan, what types of exclusions if any should be
included, the relative merits of self-insuring, which can help
them avoid certain costly state mandates versus the risk that
would be upon them if they go that direction of self-insuring and
understanding the implicit dangers of doing that.

I also just felt I would be remiss if I did not more
completely respond to the question or the comment, rather, that
was made by Commission Pullen in terms of the Chamber should show
more courage in terms of what we might want to tell our member
companies vis-a-vis the use of clean needles if the employee is
a drug user.

Obviously, we don’t look at that at all as a question
of courage but rather as a matter of understanding that we exist
to serve our members and not the other way around.

MR. DeVOS: Well, this is a beginning of a whole day
session and, there are going to be a lot of people talking about
various aspects of it and so we’re just going to move on. Gebbie
has one quick one she said and then we’re going to terminate this
panel.

MRS. GEBBIE: Well, it’s really a follow-up to the
questions that the Admiral was asking you in that whole area of
discrimination. We have heard mixed testimony on the subject of
whether existing statutes dealing with handicapping conditions
are adequate to provide protection to persons with HIV
infection. It’s been interpreted various ways. Some states have
laws. I would be interested in knowing the extent to which you
have considered that issue and whether a new statute or revision
to that statute could more clearly assure that this condition is
covered would be viewed favorably by your membership or would be
viewed carrying things too far. Have you looked at it and think
the present statute is adequate?

MR. KLEIN: Well, very briefly, this is, frankly, the
next step for the U.S. Chamber of Commerce in as much as our main
mission really is legislatively and policy oriented, this is the
-- those are the kinds of questions to which our health care
council is next turning its attention. So I don’t have a
definite answer one way or the other.

I will say that there were some modifications made to
the Vocational Rehabilitation Act of 1973 just within the last

193
couple of months as a part of the Civil Rights Restoration Act
that passed the Congress. But the comments of both proponents
and opponents of that legislation and the particular amendment
dealing with modification to the Vocational Rehabilitation Act as
well as other legal analysis seems to leave more questions than
answers in terms of whether those changes modify, narrow or
reverse ‘the Supreme Court’s decision in the Arline case. So I
think regardless of how we come out, the courts and the
legislatures are going to be dealing with the issue to try to
clarify the question.

MR. DevoS: Mr. Stiles, Mr. Morgan, Mr. Klein, thank
you for coming this morning and sharing with us your insights in
this great problem. And we wish you well in the work you carry
on. And with that, we’re going to dismiss this panel and move on
to our next panel. Thank you very much.

MR. CREEDON: Mr. Chairman?
MR. DevOS: Yes, sir.

MR. CREEDON: Could I make a comment just for the
record, you know, supplementing in part what you were saying
about costs.

MR. DevoS: John, go for it.

MR. CREEDON: Because it seems to me that one of the
greatest concerns of the business community generally right now,
and this is aside from the question of AIDS, is the cost of
health care for their employees. It’s been skyrocketing, for a
number of years. It’s twice, at least twice the general CPI and
it’s an issue that, has to be dealt with somehow. Sol think
your comment is very, very appropriate and especially if there’s
an expectation that a significant part of the cost is going to be
borne by the business community.

We need to understand that. Many of the sessions that
I go to, that is one of the major issues, the skyrocketing costs
of employee benefits and health care costs generally. I’m sure,
Bert, you can echo that?

MR. DevOS: John, and for the sake of everybody else
here, we’re going to be on -- in panel four we’re going to be
working on costs more today, John. And then we can pursue that
whole subject with all of its unknown elements.

Workplace Polices: Development and Implementation
Our next panel this morning consists of Peter
Bertschmann, Vice President, Human Resources, New England
Telephone from Boston, Mass.; we have Anthony Herrmann, Vice

194
President, Employee Health, Safety and Environmental Affairs,
Johnson & Johnson and a sailboat fame. Is that right? Okay. It
doesn’t have anything to do with your testimony, does it?

MR. HERRMANN: No, only the suntan.

MR. DevOS: Only the suntan, all right. Sigrid Deeds.
Good morning, Sigrid.

DR. DEEDS: Good morning.

MR. DeVOS: Doctor, senior advisor, AIDS Programs,
American Red Cross in Washington and Henry C. Ryder of Barnes and
Thornburg all the way from Indianapolis. I presume he’s now the
one who’s late? Whenever it’s in your town you arrive late. If
you’re from out of town, you really get here on time.

In any case, this panel is going to work on
development and implementation. What you heard this morning in
the first group dealt primarily with an overview from
organizations that represent broad spectrums of business. In
this group we’re going to get down to very specific programs for
very specific companies.

And, of course, we also have in this group a man I
choose to save until last, that’s Dwight Sawyer who is Vice
President Human Resources of a company up in Ada, Michigan called
the Amway Corporation. So we’ll get a time in here this morning.
And with that, Mr. Bertschmann, we’ll begin with you.

MR. BERTSCHMANN: Thank you. Admiral Watkins, Mr.
DeVos, members of the Committee, I do appreciate the invitation
although I must say that I got a little nervous when you talked
about terminating the last panel.

I’m the Vice President of Human Resources for New
England Telephone and we’re an operating company under the NYNEX
holding company, one of the seven regional companies formed out
of Bell System divestiture. We serve five New England states,
Maine, New Hampshire, Vermont, Massachusetts and Rhode Island
and we have 27,000 employees.

New England Telephone had a rather public learning
experience about AIDS in the workplace beginning in the spring of
1985 and we did some things right and we made some mistakes.
We’re a lot smarter now and we should have been a lot smarter
then.

One of our installation and repair technicians, Paul
Cronan, an employee with over ten year’s service, identified
himself as having AIDS-Related Complex. One month later this
employee went out on illness disability.

195
Our company at that time was just beginning to explore
the issue of creating an AIDS policy. Senior managers from Human
Resources, Legal, Labor Relations, Medical and Public Relations
had met to discuss a number of issues about AIDS, among them the
medical facts, the legal implications, the union issues and the
history of our company culture. Within a month, that group had
a policy recommendation that was accepted by the officers of the
company, and that policy was and is:

"AIDS is treated like any other illness contracted by
an employee. Accordingly, if an employee is diagnosed as having
AIDS, but is not disabled from working, the employee can return
to work. If an employee has work limitations, the company will
make reasonable accommodations."

A couple of months later and in September of 1985,
after an inquiry from Paul Cronan, the company notified him that
he could return to work when his physician felt he was able.
However, very shortly afterward his diagnoses was changed from
ARC to AIDS, and the employee did not request to return to work
at that time.

Paul chose to go public with his situation and with his
unhappiness with our company, and in December of 1985 he sued the
New England Telephone Company for beach of privacy, employment
discrimination, and violation of his civil rights. He sought
recovery for, among other things, emotional distress.

After an out-of-court settlement in October of 1986.
Cronan returned to work. And.by terms of the settlement, he did
not return to his original work location. Rather, he went back
to a location where he had worked for a number of years in the
past. And based on medical recommendations, he returned to work
on a half-day basis. Not untypical, by the way, for someone
returning from a disabling injury in our company.

The employee’s job as an installation technician
required him, on occasion, to enter people’s homes to do work.
And I might add in going public, Cronan had been very visible on
major Boston television stations. And although he wanted to work
half days, he wanted and we wanted him to assume his normal
duties as much as possible. And upon his return the company
gave Paul Cronan the full range of assignments it gave to other

installation and repair technicians.

Up to that point the company had dealt with the AIDS on
the policy level, without really fully understanding the
workplace implementation issues. And we had not yet learned the
value of company-sponsored education efforts.

Because of the public nature of the case, we asked for
and received permission from Paul to "condition" the work force,

196
that is those employees he’d be working with, before his return
to work. Local union leaders, management and his coworkers were
briefed on the situation and provided with facts on the disease.
And while this was a good first step, it was not enough. Not
nearly enough.

On Paul’s second day back at work 29 of his coworkers
walked off the job. Although not totally unanticipated, we had
a labor relations and a media relations crisis on our hands. We
needed a strategy to make our policy a reality, and we recognized
we had to demonstrate understanding and compassion for all of the
employees affected.

Our objectives were to get our employees back to work,
to get out the media limelight and, to the extent possible, make
sure that such an incident did not happen again. And we
initiated a four-phase education program for about 1,000
employees in and around the area where Cronan worked. Local
management team was involved at every step of the process, as
were our union representatives.

The first day, we showed a videotape on AIDS in the
workplace, produced by the San Francisco AIDS Foundation. The
next day, two doctors, one selected by the union and one Cronan’s
own personal physician, visited the local workplace to answer
questions employees had about AIDS and its transmission. Anxiety
levels began to drop after that session. But our employees were
still on the street.

As a next step, employees and their families were
invited to an evening session at a local hotel. Again, doctors
presented the facts about AIDS transmission and were available to
answer questions. A number of spouses and a number of teenage
children attended.

After that session, we felt somewhat comfortable that
employees had had an ample opportunity to learn and understand
the facts about AIDS and how it is and is not transmitted. And
25 of the 29 employees returned to work. For any employees who
were still afraid, and there were a few, we offered voluntary
individual or group counseling sessions through our employees
assistance program and with professionals. They accepted the
counseling and shortly afterwards the last few returned to work.

We made a decision not to withhold pay from the
employees who had walked off the job, and that is not commonly
our practice in those cases. By doing so we acknowledged our
concern, I think, for all employees and attempted to avoid
punitive or confrontational actions. We learned a lot of things
during these events and they may seen obvious now, but I can
assure you that they weie not then. The first is not to assume
that employees are getting the message from other sources.

197

 
And secondly, that one opportunity to hear the facts is
not nearly enough. Repetition is key.

Third, employees’ fears and concerns must be taken
very, very seriously.

And fourth, employees need to have a chance to have
their questions answered.

And finally, and most importantly, we learned that
education, we think, takes care of 95 percent of the problem
associated with AIDS in the workplace.

And although we made it through our first episode of
workplace AIDS, we realized we needed to put in place a long-term
effort to educate employees. An educated employee, we learned,-
is our best defense against another kind of incident.

As a first step, we sent a brochure on AIDS and its
transmission to our 27,000 employees at their homes with a letter
from our corporate medical director that explained the company
policy on AIDS. The letter included a phone number employees
could call in our medical department for more information. And
it was a letter and a brochure that we wanted everyone in the
family to read.

Medical department doctors have made themselves, and
outside experts, available to talk to employee groups about the
issue of AIDS in the workplace.

And our major educational effort began nine months ago
when we asked area business leaders in Boston to join us in
sharing their experiences about how the disease has affected
their workplace. And last fall, that group became the New
England Corporate Consortium for AIDS Education.

In addition to New England Telephone, the members
include: the Bank of Boston, Bank of New England, Cabot
Corporation, Daka Food Service, Digital Equipment, Lotus,
Polaroid and TEXTRON.

That group agreed to fund production of a localized
videotape about AIDS in the workplace and provide ancillary
written materials, including a program planning guide and a
manual for managers and supervisors.

Golden Green Productions, which won an Emmy for its
NOVA special "AIDS: Chapter One," is producing the tape, and
George Moseley, on the staff of the Harvard University School of
Public Health is writing the material. And Doctor Timothy
Johnson, medical director for ABC News, is our on-camera host.

198
Throughout our efforts we’ve also worked closely with
Boston Aids Action Committee, the American Red Cross and the
Massachusetts Department of Public Health.

When nine major corporations band together on an issue,
you can leverage some action pretty quickly. And we wanted to
deliver a strong message to our employees, other businesses and
to the community at large. That message clearly is that
businesses need to take responsibility for educating their
employees about AIDS.

And if there’s any other lesson to be learned here, it
is that no business, and I mean no business, 27,000 employees or
27, has now a legitimate excuse for not having a clearly defined
policy and educational program posed for the tragic
identification of an employee with AIDS. Thank you again for
the invitation.

MR. DeVOS: Thank you, Mr. Bertschmann and thank you
for the willingness to admit errors made and corrective action
taken. We find that very encouraging.

MR. DeVOS: We’re going to move next to Doctor
Herrmann, Anthony Herrmann, who is Vice President Employee
Health, Safety and Environmental Affairs for Johnson and Johnson
from New Brunswick, New Jersey. Doctor Herrmann?

DR. HERRMANN: Mr. DeVos and members of the
Commission, we appreciate very much --

MR. DevOS: Would you get onto that microphone,
please.

DR. HERRMANN: Let’s do this. How’s that?
MR. DevOS: That’s better.

DR. HERRMANN: Mr. DeVos, members of the Commission, we
at Johnson & Johnson very much appreciate the opportunity to
review with you our programs and involvement in the issue of
AIDS.

Johnson & Johnson is committed to the health and safety
of its employees and family members. That commitment is written
into our credo and is highly visible all around us in the
facilities and programs of Live for Life. Live for Life is an
active partnership of health related services within Johnson &
Johnson that include assistance, benefits, medical, safety and
wellness. This is a coordinated way of providing opportunities
for our employees to become the healthiest in the world, which is
the charter of that program, and to maximize the health and well
being of our employees and their families on a voluntary basis.

199

 
This commitment cannot be met in the 1980s unless we
are willing to join the effort against AIDS, and for that matter,
alcohol and drug abuse as well. AIDS cuts across all segments of
our society. It can be disruptive to our families, communities,
schools and workplaces. Johnson & Johnson offices and plants
are not isolated from it. It has caused everyone to rethink, at
a very fundamental level, our attitudes with regard to life style
and behavior and the appropriateness of the workplace as a site
of educational intervention.

To meet this challenge, Johnson & Johnson has
undertaken a comprehensive AIDS workplace program with five major
components:

1: A corporate AIDS policy position statement.
2: A special Live for Life AIDS Education Program.
3: Benefit plan coverage-expansion.

4: Biohazards guidelines because we do deal with live
virus in some of our research laboratories.

5: Public/community support, where appropriate.

Maintenance and protection of employee health is a
policy of our corporation. Our AIDS policy position statement,
however, complements this policy and addresses the rights to
employment and benefits, confidentiality, testing, biohazards
guidelines and educational initiatives. AIDS testing is
performed only on a voluntary basis.

The Live for Life AIDS education program began with a
special training session for all personnel managers, physicians,
nurses, employee assistance and wellness administrators at each
of our 72 operating facilities to educate and sensitize them to
the AIDS issue. Awareness and education programs are also
available for all employees. Many of these programs are
available for family members as vell.

Our employee assistance and medical departments provide
opportunities for counseling. A variety of videotapes and
brochures have been distributed. The HBO/Surgeon General’s tape
titled "AIDS: Everything You and Your Family Need To Know But
Were Afraid To Ask" and the CDC brochure, "What You Should Know
About AIDS" have been highlighted.

Last fall the National AIDS Awareness Test sponsored by
Metropolitan Life was promoted through desk drops to every
employee in the top 25 viewing markets in the country where this
program was offered.

200
"News for Life," which is an in-house communication
tool, the Life for Life newsletter, is distributed quarterly to
each employee’s home and has included articles on AIDS.

In terms of our health care benefit, the coverage was
expanded to include voluntary AIDS testing and liquid autologous
blood for transfusions for employees and family members.

In terms of community, Ortho Diagnostic Systems, one of
our companies, received a special recognition letter from the
Surgeon General Koop for supporting the printing and distribution
of the Surgeon General’s original brochure on AIDS. We
participate as a member in the National Leadership Coalition on
AIDS, which is a Washington based group that we heard from
earlier this morning. In addition, we support the AIDS Research
Foundation and were cosignatories of the AIDS ten principles
proposed by the Citizens Commission on AIDS.

Active AIDS research is underway in several of our
companies pursuing possible approaches to testing, vaccines and
pharmaceuticals. Johnson & Johnson recently awarded a grant of
$500,000 over five years to Johns Hopkins Medical School in
support of constructing special research laboratories for that
institution’s AIDS research program.

As you know, the Robert Wood Johnson Foundation,
although only indirectly associated with Johnson & Johnson, has
spent $20 million on AIDS programs making it the leading
supporter of AIDS programs among all philanthropies and corporate
donors.

In summary, Johnson & Johnson’s commitment in the area
of AIDS in the workplace specifically and on a very broad scale
generally has been comprehensive, sustained and complemented by
appropriate policies and guidelines.

Johnson & Johnson’s Live for Life program has provided
a marvelous vehicle to communicate with employees and their
family members regarding AIDS. And just a note about that
program, it really was designed to focus on the health end of the
spectrum as opposed to the disease end of the spectrum. Therein
iies the philosophic base for our approach to prevention. We
have been in a position to speak to our employees and families on
lifestyle and behavior issues in many other areas. The ease with
which we were able to approach the issues of drug and alcohol
abuse and AIDS education was, as a result, a very simple task
because the machinery was in place and our employees and families
expected to hear from us on these lifestyle issues. This has been
a very worthwhile experience within J&J.

Even with regard tothe issue of blood supply in the
community and, to a greater extent, in our New York region (John

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Creedon who headed up that until recently as chairperson), we
have used the vehicle of our Live for Life program to promote the
notion of a very broad based expanded participation in doing our
best to help improve the communities’ blood supply. In fact, we
expect to triple the blood donor contribution of our employees
and family members to the public community. The public blood
supply has been impacted to some considerable extent by the issue
of AIDS and the availability of blood.

We’d be pleased to answer any questions and consider
requests for more information. Thank you very much.

MR. DeVOS: Doctor Herrmann, you along with New
England and Johnson & Johnson have been leading the way. We
salute you for that.

MR. DeVOS: Now we’ll go to Dwight Sawyer from Amway
Corporation.

MR. SAWYER: I have some slides to show. If I could
have the first slide, please? I’m sure all of the Commission
know everything about Amway from having Rich DeVos on that panel.
And I appreciate the opportunity as a medium sized employer to
come before this panel. a

MR. DevOS: They know more than they want to know.

MR. SAWYER: First of all, we designed our policy
around life threatening illness rather than specifically AIDS.
That’s primarily because of the advent of AIDS growing impact on
the population in general and the work force in particular. We
did not want to single out this particular illness but to
combine it with all life threatening illnesses. We felt that
employees with any type of life threatening illness should be
treated in a similar manner as it pertains to corporate policies
and procedures. If I could have the next slide, please?

One of the main things we’re interested in, of course,
is fairness and that is how we design a policy. We reviewed
available material from other corporations and w reviewed
general publications on the subject and designed our policy
around what we felt would be fair to all of our employees and
consistent with Amway’s philosophy. Next slide, please?

We recognized there had to be certain purposes as we
dealt with life threatening illnesses. And one of the key
points, of course, was recognition that there were various types
and some of those you’ve already heard from from earlier
panelists. Heart disease, cancer and AIDS, of course. We’ve
also included in there hepatitis B because of the infectious
nature of that.

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We also recognize that there were certain needs of
employees and the wants of employees and we had to design our
policy around a framework where they would accept it -- all
employees could accept it. This, of course, includes ill
employees engaging in normal pursuit including work.

From a work treatment point of view, it was felt the
policy needed to be -- an equitable work treatment for employees
based on all categories of employees. Therefore we assured the
policy contain guidelines on employees meeting acceptable work
standards along with action for those who feel threatened. From
a precautionary point of view, we furthermore felt the policy had
to reserve the right to have employees examined if there was any
question of safety or health problems existing that could impact
employees, other employees, company products or its customers.

Next slide, please?

As stated, anytime there is a disease of life
threatening nature that is relatively new, such as AIDS, there
are a lot of myths, misinformation and misunderstanding as it
pertains to the population in general and, of course, employees
in the work force in more specific manner. Therefore, one of
Amway’s first approaches in this policy was developing a sound
communication progran.

Amway is somewhat unique in this category since we have
a 700 seat auditorium and we hold monthly employee meetings.
Beginning in late 1986 we started covering in some of these
meetings points concerning AIDS. Rich, being a member of this
panel, of course, has participated in covering some of these
aspects of AIDS with our employees.

We have continued in these employee meetings by having
films on AIDS that we feel are very frank and to the point. One
of them happened to be a “AIDS Alert" which was done somewhat in
the cartoon format rather than individual format and it was
extremely well done but very frank and, as I said, to the point.
The whole idea is a continuing education concept.

From our management point of view after we developed
the policy, we held a very long meeting on this subject, went
through the policy with them in detail and in that meeting had
Doctor Richard Tooker, who is currently the Chief Medical Officer
of Kalamazoo County and is recognized as knowledgeable on the
subject of AIDS in western Michigan, make a presentation and
answer questions that came up from the management group.

After that meeting we held a special employees meetings

for all of our employees and we divide those up so that we have
them on each of the three shifts where we have employees.

203
In that meeting we, again, went through the AIDS
policy with our employees and then we followed that up with a
presentation by Doctor Tooker much along the same lines that he
covered with management with questions and answers in that
meeting being given by the doctor.

We have developed a small library of information in our
corporate library, information on AIDS including videotapes,
pamphlets, publications, articles about the subject that
employees can check out. We have a pretty sizeable corporate
library with a video library included as part of that. The
whole purpose behind that is to give them the opportunity to find
out more about the subject so that they can understand it better.

We also have given out to the managers a publication
entitled "What A Manager Should Know About AIDS In The
Workplace" to further give them data that we feel would be
important for them to help answer basic questions on the part of
their employees.

Next slide, please?

Now, another point we felt to be very important was
reasonable accommodation. This was a part of the policy we felt
employees had to know what they would have in the way of
epportunity for the corporation to make reasonable work
accommodations within the confines of availability of business
need.

We specifically included in the policy provisions for
employees with a life threatening illness the opportunity to
transfer into other positions if, and I emphasize the word "if,"
they requested. It would not be requested by the corporation.

For other employees we took into consideration that
they may feel threatened and therefore have established an
opportunity for them to seek transfers, however those transfers
are based on the normal transfer procedures of signing for open
vacancies.

We also recognized as one of the previous speakers
noted that there can be points where employees feel threatened
and therefore refuse to work with a fellow employee who has a
life threatening illness and they walk off the job. Contrary to
the approach that the previous speaker took, we would deny them
pay for that period and if it became a major issue for us, we
would look at it from a point of view of corrective action if
that became necessary.

The policy up to this point contains information on how
things are going to be conducted. We next felt we had to cover
more specific information.

204
If I could have the next slide, please?

One of those points was information on who to contact.
We felt employees had to know specifically who they could contact
for specific information. This would include our medical
department and our HR administrators who are being trained to
answer basic questions on the subject of AIDS and other life
threatening illnesses and also they could go into the library and
get some of this other information that would be made available.

The reference to what is available, of course, the
library is there and, again, we emphasize the medical department.
We have listed the number where people can call anonymously if
they wish to do so to find out more information concerning this
subject.

It became very important to us to recognize that
psychologically many employees need help in any life threatening
illness situation which, at times, can be better provided through
outside agencies. One of our major referrals is an employee
assistance program wherein the employees can be referred without
the corporation having any direct contact or feedback, thus
maintaining the confidentiality of the employee.

Of course, anytime somebody had a condition of this
nature we feel it’s necessary for them to have access to
knowledge as to what benefits they’re going to have available to
them from short term and long term disability as well as medical
coverage. Therefore we publicize that type of information to
them.

The next slide, please.

We also recognize that sensitivity is a very critical
thing in a situation like this. Sometimes if. an employee is in a
life threatening situation the job can be a very strong
motivating factor for them to feel they’re productive people to
the community and to themselves. We feel that is critically
important for us to keep that in mind anytime somebody
encounters something of this nature.

Next slide, please?

Confidentiality is something that is critically
important and you’ve heard others talk about that already this
morning. As a result of this, we have set up a procedure wherein
we have what we term a "Need To Know" committee. That Need To
Know committee consists of representatives, one representative
from medical, one from legal and one from human resources. This
committee is very confidential. They will not allow information
to be passed on. They will guarantee the information being kept
confidential unless the employee has already disseminated such

205
information. The committee can also act as a reference source

on referrals dealing with such things as reasonable work
accommodations, benefit coverage, et cetera that we’ve already
covered. The committee also has responsibility from a safety
aspect to make a determination as to whether any other member of
management need to know the information concerning the illness of
the employee because of the products and the safety of the
employee and other employees or the products and our customers.

Next slide, please?

We have made some recommendations recognizing that we
have had this policy for a relatively short period of time based
on the information that we have developed thus far. We feel
that the policy should be general dealing with life threatening
illness i.e. some other broad base illness rather than just a
specific one.

We feel communication is extremely important, as
already noted. Communication should be in the form of meetings,
should be in the form of publications to the employees at work
and also to the home for their families and also access to
information such as a corporate library.

We also recognize that anytime there is a new disease
identified such as AIDS, we will have to change our policy as
time passes as more information is developed on this and
therefore the flexibility of a corporate policy must always be
there to recognize these changes as and when they come.

Again, we appreciate the opportunity to make this
presentation before this panel. Thank you.

MR. DeVOS: Thank you, Dwight.

MR. DevOS: Doctor Deeds? Doctor Deeds is with the
American Red Cross from Washington.

DR. DEEDS: Mr. DeVos, Commissioners, I appreciate the
opportunity to present the American Cross AIDS prevention
program this morning. My background is in public health and
behavioral sciences and I specialize in large scale educational
change programs and their evaluation. And as such, I serve as a
full time advisor to the Red Cross AIDS program. This is another
side of the Red Cross, the non-blood side of the Red Cross in
education and training. And you may not be aware of the fact
that we provide the largest adult education training system in
the country. In 1987 we gave over 7 million certificates in
health and safety training. And these are delivered by about
500,000 volunteers and staff in the American Red Cross. So the
AIDS program stems from that kind of background and experience.

206
The Red Cross moved into our blood donor education in
1983 and from there into a broad public information and AIDS
program in 1985. We’re now -- because the rate of awareness is
higher, we’re now honing that broad information program into much
more intensive educational effort and we’re aiming at three
priority groups: youth, minorities and workers in their places
of work.

We have a long list of materials printed, audiovisuals
and so forth which we would be happy to provide maybe if you’re
interested in them. And, incidentally, some of them are aimed at
our young people in high schools and several excellent
audiovisuals in that area.

Our work place educational program is called "Working
Beyond Fear," and it’s now available from Red Cross chapters in
all regions, which means that someone from Houston can get the
same information as someone from Lancaster County, Pennsylvania
or in Indianapolis.

The purpose of the program is to provide factual
information to employees about the high risk behaviors related to
AIDS so that they can take appropriate action to avoid exposure
to the virus. It is also intended to allay fear about working
with persons who are HIV positive.

The chapter contact person works with the employer’s
representative to customize the presentation to the specific
business. This is important because there’s great variability in
workplace settings; organizational cultures you’ve already heard
about this morning, the education and interest, the levels of
experience with AIDS. We’re now talking about the whole country
and you know that the levels of prevalence are much different and
the experience that people have already had with AIDS varies a
good deal. So we’re trying to maximize the flexibility of this
program while still retaining a standardized core of accurate
information so that we can insure the quality of the program.

The recommended format is a two-hour workshop, minimum
of two hours, conducted by a trained Red Cross facilitator. This
includes a 30 minute video version of "Beyond Fear" and several
video case studies. These are designed to trigger discussion by
the employees around all of these kinds of issues,
relationships, contacts with coworkers infected with HIV,
confidentiality concerns, management responses.

We also encourage access to all community resources so
that they can get additional help and follow-up after the
program. We provide these programs at various levels throughout
organizations. Certainly starting out with the management with
the benefits and resource people and so forth and then working
down to the employee level is important. And it’s in the process

207
of designing these that we often discuss policies and give
employers resources in terms of helping to shape their policies.
And we’ve used a good many of the materials that have already
been mentioned this morning.

The fees that are set by the chapters recover the
costs that are incurred in providing material and the manpower.
There’s variability across the county, but an average charge is
$150.00 for a workshop for 30 participants.

Examples of the scope of chapter workplace AIDS
activity are the programs that were conducted by the Atlanta
chapter staff and 202 volunteers. In one year half of their 333
programs that were delivered were to businesses and industries in
Atlanta, Georgia, and this included corporations, utilities, a
motel chain and federal workers.

The West Chester, New York chapter found that there was
more demand in their area for middle size companies such as
manufacturers, nursing homes and so forth. They noted that the
large scale corporations used their own medical departments and
training capacities to provide AIDS training internally, so that
we were really providing more education for companies of 500 and
less employees.

Some of the barriers that we have discovered in this
chapter experience is that AIDS is not given high priority by
many companies and this point was well made in the Allstate
survey. Providing company time for education is costly and the
returns may look at the time as very indirect to the employer.
So the companies with hourly wage employees are particularly
reluctent to release those employees for these programs. And we
find that utilizing the employee time, such as lunchtime and
breaks and so forth which is kind of a social occasion often, is
not sufficient time nor the proper place to provide an effective
intervention.

The size of the company is not necessarily a factor.
One of the Red Cross AIDS managers on the west coast has served
work places that range from ten to 27,000 employees and she notes
that the attitude of the senior management is really the critical
factor in terms of the success of the program. and I think this
has been demonstrated this morning, too. The potential benefits
of a quality AIDS education program range from an immediate
general sense of improved morale to an increased knowledge and
attitude shifts. We hope they predispose persons toward the
behaviors that reduce risk and therefore could reduce the spread
of HIV infection. And we do have some preliminary data on our
progran.

The education about the characteristics of the HIV
virus, its transmission routes, patterns, can also lead to the

208
acceptance of the notion of the non-contagious aspects of this
virus. This brings about a compassionate concern for those who
are HIV positive and we feel this is the basis for avoiding work
site crises and panic.

As also has been noted this morning, employees are not
only workers but they’re family members and members of the
community. They volunteer for churches, school boards, members
of service organizations and social groups and they give blood.
And thus, the AIDS education program has a ripple effect
throughout the -- way beyond the employee’s workplace. And just
as the employees represent other relationships, educated
employers in their roles as community leaders, opinion makers,
influences of legislation and resource allocators and
philanthropers is a very important aspect of this. Education has
an environmental aspect and the whole community’s acceptance is a
very important part of reenforcing education.

We have made a series of recommendation to you that are
pointedly about the quality of educational programs. And I must
say that I think the actual content and method of education needs
to be addressed very strongly in these kinds of hearings because
most of our attention has been focused, I think, on other things.

The cost of initiating workplace education includes
both the cost of providing the service, which we previously
mentioned, and the cost of the time of the employees along with
the cost of the employee time and the planning and the follow-up
that was assumed in our previous presentations. And this
various from company to company. But this cost must be balanced
against the incalculable cost of the loss of productivity, work
stoppages, adversarial relationships between management and
employees and the possibility of litigation which can occur if
the employees are left on their own to do their unsystematic ways
of gathering information and opinions about this unprecedented
epidemic. Thank you.

MR. DeVOS: Thank you, Doctor Deeds and to the Red
Cross for continuing to lead in this field.

MR. DeVOS: Mr. Ryder, all the way from Indianapolis.

MR. RYDER: All the way.

MR. DevOS: Legal counsel, I believe.

MR. RYDER: Correct. As Hoosiers we welcome this
Presidential AIDS Commission to Indianapolis. The Mayor, who
will be on your panel later, will give you a more proper welcome

and introduction and he does it very well. But it’s a pleasure
to be before you.

209
I shall try not in these remarks to be repetitive of
what I have included in my pre-submitted written testimony,
except to call attention, as a way of summary, to the five
guidelines for employers found at Tab 10 of our written
testimony. They are, in a way, a condensation of some of the ten
principles you’ve heard before.

One, that employers should deal with employees who are
AIDS victims the same as they would with employees with other
serious or life-threatening illnesses.

Two, employers should adopt a written policy on dealing
with AIDS in the workplace. They should exhibit a strong
commitment to that policy and train management and supervisors
regarding the policy.

Three, that employers should embark upon an
educational program not only to employees about risk reduction in
their personal lives, but also particularly in areas where there
are special occupational settings where employers may be exposed
to blood or blood products, to provide on-going education and
training as well as the necessary equipment to reenforce
appropriate infection control procedures and insure that they’re
implemented.

Four, to protect the confidentiality of all medical
records of employees who are AIDS victims.

And five, except in unusual circumstances where the
occupational setting requires the employee to handle blood or
body fluids, not to screen current employees or job applicants
for AIDS.

These five guidelines or variations thereof are what we
as lawyers in employment law are advising employers, both
directly in the lawyer/client relationship, and in seminars which
are proliferating throughout the country. For AIDS in the
workplace is the hottest of the hot issues in employment law
today.

A bibliography this week in books, pamphlets, videos
and educational materials is incomplete next week.

Policies, samples of which I have included in our pre-
submitted material and which you have seen demonstrated here
today by the other panelists, are being urged upon employers with
the direction "Adopt one." "Commit to it." "Educate your work
force." That is what we are preaching.

What I am going to recommend now to this Commission is
not what we are telling employers. The recommendation will be
controversial for it would mean a change in the law as it has

210
been interpreted to date. Nevertheless, I think this
recommendation needs to be made, for it needs to be debated, and
the underlying problem needs to be addressed by this
Presidential Commission.

My recommendation is this: That the Presidential
Commission recommend the adoption of legislation to permit pre-
employment testing for the AIDS virus and to exempt an employer
from liability if the employer refuses to hire because of a
positive AIDS test. j

Now let me explain this recommendation and justify it
before I get hit with allegations of being unfair, discriminatory
against the AIDS victim and lacking in compassion.

/

First, it is not a recommendation that would alter any
legislation that protects an existing employee who either is or
becomes an AIDS victim. And I use that term AIDS, victim in the
broadest sense, including a person who has tested positively for
having HIV. The recommendation applies only to applicants for
employment. \

\

Secondly, if the employer is to be saddled with the
cost of insuring existing employees who have or contract the
disease, a cost for which estimates range from $75,,000 to
$150,000 per AIDS victim, not including lost production time from
AIDS victims who contract and miss work because of opportunistic
illnesses, is it fair to require that employer to hire persons
as employees because they are infected with the AIDS virus?
Doesn’t the fulcrum of fairness tip the scales the other way when
it comes to the employer’s obligation to hire applicants for
employment?

The issue as pointed out earlier this morning by you,
Mr. DeVos, is one of cost. Should the employer bear the cost of
paying increasing insurance premiums and lost days of production
for non-employees who are AIDS victims and who seek employment?
For many marginally profitable employers and small businesses,
the answer to that question, if "Yes," will spell bankruptcy or
closing. And who benefits from that result?

I am suggesting by this recommendation that the
Presidential Commission on the HIV epidemic come up with some
alternative recommendation for the unemployed AIDS victim rather
than tell the employer, as the law has been interpreted to date:
"It is your responsibility not to discriminate against the
handicapped AIDS victim who applies for employment." All of us,
not just the employers and not just the AIDS victims should bear
the cost of this epidemic until the cure or adequate defense to
AIDS is discovered. I rest my case.

211
MR. DeVOS: Thank you, Mr. Ryder. MR. DeVOS: And with
that we’re going to go to Doctor Primm down in that corner and --

DR. PRIMM: I/d like you to come back to me.
MR. DevOS: Okay. Let’s go right back to Colleen.

DR. CONWAY-WELCH: I/’d like to ask a question of any of
the panelists regarding the educational programs that they have
in place. What kinds of attempts have been made to evaluate the
effectiveness of those programs in terms of the cost benefit
ratio? How do you know that what you’re doing is working?

MR. BERTSCHMANN: Well, I’d have to -- first of all, we
don’t consider the progress we’ve made so far in our education
program adequate. And the major effort, as I indicated, is on
going as part of the consortium. I’m not sure this is an
adequate answer to your question, but -- |

DR. CONWAY-WELCH: There may not be one.

MR. BERTSCHMANN: We have -- I would give you an
example of what I think has helped. We have knowledge of two
other AIDS cases and in one case employees are aware of it. It
follows a rather basic educational program and there has been no
problem whatsoever. That’s a very Limited instance but it does
suggest that even basic education can neutralize a situation.

DR. DEEDS: I’d like to respond to that in terms of
our program. We've measured pre-test/post-test knowledge gains.
We've measured changes in attitudes and also stated behavioral
intention, which is about as far as you can go in the immediate -
-~ in the immediate time zone of providing the program. What we
would like to do is to follow-up over a three to five year period
and look at many of the kinds of indirect benefits that we assume
would come from an educational program and so some quasi
experimental design. Unfortunately, those kinds of research
programs have not been funded to any extent in the AIDS field.
We can cite programs that have been funded in many other places
in health promotion programs, cardiovascular disease, smoking
programs, et cetera and so forth. And Johnson & Johnson have
been leaders in longitudinal data collection for cost benefit
effect. That’s very expensive, it’s long term and it needs to be
done. And that’s one of the recommendations that we had
included in our group and I hope you take -- I hope the
Commission takes that up.

MR. DevoOS: John Creedon? We’1ll come back around if we
can. We going to kind of go fast once.

MR. CREEDON: I would like to supplement what has been
said, especially about Johnson & Johnson and the fine work you

212
all have done under Jim Burke’s leadership. I think it’s
exemplary. I’d like to pursue a little bit the recommendation
that Mr. Ryder has made and I understand the reason for it. But
it seems to me one of the problems is that someone who gets the
virus might be asymptomatic for 12 years, so what does society
do? I mean, do we not employ somebody for 12 years?

I wonder just whether you might think of an
alternative that just occurred to me as you were talking. This
is clearly a societal problem and the question is how do you deal
with it as a societal problem. One alternative would be to
somehow find a way of supporting the employer financially if they
are obligated to take somebody that has the virus rather than say
you’re not going to employ this person. Because there are a
million and a half people out there with the virus and, as you
know, some of the estimates are even higher than that. And the
average period of being asymptomatic may be five, seven or more
years, just a societal matter to say well you don’t have to
employ them, who is going to employ them and what do they do?

MR. RYDER: An excellent point. I intentionally put the
recommendation in its starkest form to really draw your attention
to it because at the moment it is the employer that bears that
responsibility. I suppose it could have been even more stark had
I said just eliminate discrimination laws entirely as it relates
to employees as well. But I don’t think that’s right. I don’t
think that’s fair.

I think there is a loyalty obligation that you owe to
your employees that the handicapped discrimination laws and the
ERSA laws apply and properly should.

I think that when you’re talking about applicants for
employment, we now, as the law is interpreted, direct the
employer not to discriminate against that applicant if the
applicant has the AIDS virus. Now I have a feeling that many
employers are probably skirting that issue by saying, "Will you
consent to an AIDS test? And if the employee -- or applicant
refuses to take the AIDS test, as they very well may refuse, then
that gives the employer the out.

On the other hand, if the employee consents to take the
AIDS test and then if that is used as a reason for not hiring,
then the employer stands subject to litigation and has the
obligation, at least as the law is interpreted to date under
handicapped discrimination laws, to hire that employee and to
bear the consequences under its health insurance plans for any
future risks that arise.

I agree with you. I think there must be some method.
If you’re going to tell the employer, you must hire an employee
who has the virus, then there should be some sharing of the

213
costs, whether that’s some form of indemnity, whether that’s some
form of catastrophic insurance until a cure or an adequate
defense to AIDS is discovered. It’s something that I hope will
generate the kind of debate that is necessary. But it is unfair,
I think, at this point in time to require employers to treat
applicants for employment the same as they treat employees.

MR. CREEDON: Well, I wish you would give this matter
further consideration because I think your proposed solution is
not a feasible solution. On the other hand, I think there’s a
problem here and I think, how do you deal with the problem in a
way that is feasible and acceptable politically and otherwise? I
think it would be helpful if you or anyone that you happen to be
working with in this area would give it further thought because,
the problem could be much more severe aS we go down the road.

MR. DevoOS: Thank you.

DR. LEE: I was going to yield my time to one of my
business colleagues until I heard Mr. Ryder. And thank God Mr.
Creedon came in before I did, because he cooled me off a little.
There’s no way that that proposition of yours will ever be
proposed by this Commission.

John Creedon pointed out some of the problems. First
of all, people can be positive for this virus for a decade and
not be sick. What are you going to do with them?

I work in a cancer hospital. I take care of people
with cancer and this is one of the -- really one of the most
tragic things that I have to deal with is that if people tell the
truth, even though they may have been cured of cancer, generally
they will not be employed. It is probably in the course of their
illness the most devastating thing that happens to them because
like AIDS, they go down the tubes financially, insurance-wise,
family-wise whenever you put this kind of pressure on people who
are also sick, they deteriorate. Husbands and wives go to
pieces, the kids go to pieces and it’s a tough show.

If you were sick with the HIV virus, the doctor for the
company is going to pick that up. If a company wants to say
we're not going to hire you if you’re HIV positive, that’s their
business. But for us to put through a thing saying that across

the board this should be legislated? Holy mackerel.

I’m left without any words, really, and I’m going to
tell you that it isn’t going to happen. We’re going to have to
do something else. I hope we’1ll edge into it. I hope that these
people at this end of the table will help us do it because Mr.
Bertschmann, that story was a tremendous story. You treated a
guy who really did a number on you like Jesus Christ would want
us to treat someone.

214
So I have to commend you tremendously and I hope that
these people at the other end of the table will solve this
problem. And we are willing to work with you to do that.

MR. DeVOS: I’m just going to go on down this end and
we’ll pick up Frank down there.

DR. LILLY: I wanted to ask Mr. Sawyer just briefly. I
was interested in your concept of a need to know committee. And
I didn’t grasp entirely what it was about, how does it fit into
the overall context. And also, if you could give us a couple of
examples of cases that it has dealt with.

MR. SAWYER: Well, need to know committee is a
committee to protect confidentiality of the issue with the
employee. And that committee is designed -- frankly, it’s just
been designed as part of the policy and it has not been called on
as of yet because we have not had any cases that have come before
it. But it is primarily a confidentiality committee. Try to
maintain the confidentiality of a life threatening illness of the
employee.

DR. LILLY: How does the committee come to possess the
knowledge then?

MR. SAWYER: Because the committee is designed and
publicized as being a contact point for anybody who wants to have
some further information and kept confidential.

DR. LILLY: I see. So in a sense this is an advisory
committee for the individual who is HIV positive?

MR. SAWYER: Yes. Yes.
DR. LILLY: And who wants to --

MR. SAWYER: Or any other life threatening illness
that they feel like they want to keep confidential.

DR. LILLY: Okay. I would just pick up on what has
been said in response to Mr. Ryder that I took it for a while
that you were a very strong advocate of the welfare state since
you’re putting an awful lot of people on the dole for many, many
years at a time. And I was thinking that maybe given that
propensity of yours to think in that way, you might want to
propose, instead, socialized medicine.

MR. RYDER: No. The issue that -- let me put this is
perspective. I made this recommendation, and I thought I made
this clear in my remarks, to address your attention to a cost
problem. It is a cost issue. And at the moment, even though
Doctor Lee made the statement that if someone tests an applicant

215

 
for employment and they test positive with the HIV virus, he felt
that it was within their right not to hire that person, that
isn’t the way the law is interpreted today. It is the obligation
of the employer to hire that person. Or to say ita different
way, it is the obligation of the employer not to refuse to hire
that person because the employee tests positive for AIDS, and
then subjects the employer to liability and all of the sequential
problems and cost problems that are involved.

The only point I’m trying to raise to you today is that
it is unfair to attach that cost obligation, which can be
tremendous, to the would-be employer that the applicant picks out
and says, I want to work there.

Now, I think that it'is entirely possible and probable
that some solution to help indemnify or to insure the costs so
that that person can be employed by that employer that he or she
wants to work for. But the present state of the law is, that
employer bears the entire cost of that applicant who seeks
employment from that particular employer.

If it’s a small employer and if that employer should be
unlucky, you’re going to have the employer go out of business.
And what good is that for anyone? So there needs to be a
solution to this problem and it doesn’t have to be the solution
at the other end of the table, even though they represent large
corporations. There are many small corporations in this country
that are affected by the cost issues and will continue to be
affected by the cost issues involved in AIDS in the future. And
it’s to those that I think that this recommendation is made. To
attract your attention to a problem is what I have attempted to
alert you to today.

MR. DevOS: Thank you.
Ms. Gebbie?

MRS. GEBBIE: Just a quick comment to that. You
certainly succeeded in getting the attention of the panel. I
think it’s less than helpful to give us a cost problem with a
legal solution that goes a different direction. I would at
least have been more helped with some cost proposals that might
have spread the burden differently, which I think you’ve just
stated is really your underlying concern. And so if you have
some further thoughts on the cost issue that would be helpful, I
would appreciate receiving them, perhaps at a later date.

My broader question to the whole panel, but
particularly the three gentlemen at this end, the Commission has
found for the society as a whole that this epidemic has surfaced
many problems and provides, as several people say from time-to-
time, a window of opportunity to correct problems that have been

216
around a long time, problems of confidentiality, problems of a
confused illness treatment system. Has that been true in the
business setting as well? That is, has the process of looking at
what you found about this infection led to critiques of other
issues as it affects your businesses or your personnel management
policies and move us in a broader sense toward something
improved? And if so, could you share comments in that regard?

MR. SAWYER: I think personally that it has made us
more aware of the whole subject of life threatening illnesses of
every nature and therefore we have designed a policy that we did
mot have before as a result that has tried to be a treatment -- a
fair treatment program for all employees. So it did make us
aware of an issue that we had not really paid as much attention
to as we should have in the past.

DR. HERRMANN: I know that within Johnson & Johnson
and the Live for Life program that we certainly paid a great
deal more attention to the sensitivities surrounding the AIDS
issue. At the front end of that program all of the management
team that would be likely to interface with this problem likely
to deal with it were specially trained.

i
‘
i

So it did move us in that direction.

MR. BERTSCHMANN: We had set up some interesting
Giscussions, around the issue of privacy, between legal and our
medical people. They’re still thrashing around with those. We
need some help still with that. But let me give you a real
example that involved this case that demonstrates how the whole
issue of privacy -- how the issue has been escalated in our
minds.

If you can picture a foreman in a large organization
who is used to having employees return from medical with a
statement that says "return to work" or "unable to return to
work" of with "return limitations", and that’s all, for some
historical and continuing privacy reasons, think of the foreman
who now has somebody return to work with AIDS who has been
diagnosed with AIDS. And who in 99.9 percent of past cases finds
the employee, obviously, very willing to discuss why he or she is
going to be out. And I can tell you that the issue of privacy
better be addressed or we will be placing more people like
foremen who are used to having employees voluntarily tell them
the nature of their illness and having, by the way, local
supervision probe without much fear or concern. Not out of a
lack of sensitivity as to what the nature of the illness is.

And in our case I can tell you we placed our local
supervision in a difficult position in the absence of a very
clear educational program and information on privacy and what it
means.

217
MRS. GEBBIE: When you say address privacy, do you mean
by education, by policy or by statute in some way?

MR. BERTSCHMANN: By education. By making it very
clear to our supervision that --

MRS. GEBBIE: That’s what I thought you meant.
MR. DevOS: Cory?

COMMISSIONER SerVAAS: I apologize for missing part of
the meeting. I had an emergency.

But I want to tell our panel members about Henry Ryder.
He's a brilliant labor lawyer -- attorney in one of the largest
and most prestigious law firms, maybe the largest, in
Indianapolis and has an implicable reputation in his field. And
I just want all you panel members to know this because he’s known
for compassion and his civic mindedness in the city and he gives
unselfishly of his time and he does take care of the sick and the
poor through the Presbyterian church and he’s an outstanding
member of our community. And so I don’t want you to all think
that he isn’t right on target when he throws out a suggestion.

I’m sure he didn’t do this without a lot of foresight
and he knew that it was going to be controversial, I’m sure. But
he wants us to think about it. And I wouldn’t -- I don’t know.
about labor laws, but I know about small businesses. And I heard
what Henry said about it could be bankruptcy for small business
who had the misfortune of getting one AIDS applicant. And if
they had two or three, you large corporation people wouldn’t
understand that because you can absorb. So I think Henry has
represented some small businesses and he knows very well how
devastating from a cost standpoint.

Now, maybe those who know they’re AIDS positive should
not go to small businesses. They should go to you large
corporations. I don’t know how to answer this. If it’s a matter
of costs.

But I have a question to Henry Ryder and that is, it
recently came to my attention that a man couldn’t fly a
commercial plane for a small company where they charter because
he had gone -- he had become insulin dependent in his diabetes.
And it matters if you take insulin, you cannot fly a plane. If
you don’t take insulin, you can. You can have diabetes and fly,
but not if you are on insulin.

Now, those are personal things and the employee would
keep it to himself and his doctor, but he’d need to not be
flying. My question is, are there very many instances like this
where if we’re making this exception on AIDS that we would make

218
on diabetes or other illnesses that you labor lawyers see where
for the protection of the public the -- it’s necessary for the
employee to divulge that he’s gone on insulin or that when he
applies for a job, to say that he is. How does that effect what
we can do or can’t do in AIDS?

MR. RYDER: Well, that’s a different situation because
the person on insulin would probably not be regarded under the
Arline decision as handicapped. And what puts the AIDS person in
the handicapped category is the determination that it is like the
tuberculosis problem that arose in the/ Supreme Court’s Arline
decision and the determination that that was a handicap and a
protected handicap, thus the discrimination question.

But there is also ~-- there /iis also a provision in the
ERISA laws that provides that you can not make an employment
decision if the purpose of your decision is to deprive an
employee or an applicant for employment from enjoying the
benefits of your either your health plan or your pension plan.
So we do have those two laws that apply.

The thing that I think that makes AIDS a distinction
even from other life threatening illnesses is the fact that it is
of epidemic proportions. No cure or even no adequate defense so
far has been found. And the recent statistics that I have seen
are that those who are infected with the virus will either
develop AIDS or the AIDS related complex, 75 percent of them at
least, within six years. So you’re talking about a problem for
many small businesses who have health insurance programs or even
who don’t, and this may be an indicatibn to many of them that
they should not have health insurance programs if they are under
this obligation, that could mean survival of the business. And
with other employees out of work, then that presents a problem.

An answer needs to be found, but the answer needs to be
directed at the cost allocation. And at the present time the
cost allocation is placed not only upon the employer for existing
employees for AIDS victims, but also for applicants for
employment. And I think that a solution needs to be addressed
and a recommendation needs to be made by this Presidential panel
on who should bear those costs until a cure or an adequate
defense for AIDS is found.

2
COMMISSIONER SerVAAS: Henry, if yeu --
\
MR. DeVOS: Sorry. We got to move on. I’m not going
to get into a debate. We’re going to move and we’re going to go
to Theresa. Thank you.

DR. CRENSHAW: The Red Cross is a really widely
distributed source of tremendous amount of information on AIDS in
recent years and in particular, before then on the blood supply

219
in general for our community at large, particularly for the
general public and physicians. And now you’re moving in with
some really superb programs it sounds like in the workplace as
well. What I am curious to know is to what extent in these
programs do you include information about autologous blood?

DR. DEEDS: I heard your comment yesterday and I was a
little surprised because our focus is really on contagion and on
high risk behavior. One of the reasons that we urge an
education program rather than an information program, and by that
I mean an interaction so that there’s time for questions and
answers and responses, is that it’s in that follow-up period that
employees ask the kinds of questions that they are most
interested in. And quite often they will be about the blood
supply and about autologous donation and so forth. And so it’s
at that point in that educational program that we’re able to deal
with that kind of information.

We do have materials on safety in the workplace, your
job and AIDS, the safety of the blood supply and autologous
donations and so forth. So it does come out, but it’s not the
major focus of that particular two hour program. Hopefully, we’d

like to have time to follow those up if we had more time in the
workplace.

I think that your concern about autologous blood
donation is reflected by our concern and that it is beginning to
be more and more used by the blood regions. There are variations
in the blood regions in terms of how they have worked with
autologous blood.

DR. CRENSHAW: I have seen some changes emerging that I
think are very promising. And yet one of the catch 22s that I
think needs to be highlighted is that when you talk about
autologous donations, that refers primarily to predonation of
blood and the catch 22 is that since most of the general public
has never heard of interoperative autologous transfusion, they
don’t even know to ask the question. So if it isn’t raised, it
won’t come to their attention. And one of the concerns that I
have in terms of the opportunity to get this information across
is that, obviously, it does compete with selling hemologous blood
and we don’t want to put you out of business. Nobody does. On
the other hand, the information is part of the overall spectrum
of blood issues. In your opening statements you were talking
about the universality and the neutrality of the Red Cross and so
forth. Does this put you in any difficuit position or has the

Red Cross figured out how best to negotiate this territory?

DR. DEEDS: Not to my point of view it does not, no.
We have the blood and the non-blood side of the house and you
might get different responses from other people in the

220
organization. But as far as we know, we think this is an
important issue.

I think the whole issue of donating blood requires a
very massive educational campaign. In our analysis of public
opinion polls 94 percent of the people are aware of AIDS now, but
the misinformation is enormous and particularly in blood donation
it’s growing. So I think that all of the issues that you raised
are a part of another needed kind of public education campaign on
blood donation.

MR. DeVOS: Thank you, Theresa. Doctor Watkins?
DR. PRIMM: You were to come back to me, Rich.
MR. DeVOS: Okay.

DR. PRIMM: Mr. Ryder, there are a number of disease
entities that require intermittent hospitalization and certainly
increased health costs, not the least of which is multiple
sclerosis. You did mention the ERISA act today, and you talked
about it relative to an applicant and an employee. I thought it
only -- that act only applied to employees, not applicants.

MR. RYDER: You’re correct in that. You’re correct.

DR. PRIMM: Well, you mentioned it in relationship to
an applicant. The other thing is, if that’s the case and you are
representing smaller companies, that is the first part of what I
just said in terms of many chronic disease entities including
cancer and Bert talked about that, multiple sclerosis,
hypertensive cardiovascular disease, unquestionably other kinds
of cardiac problems where people can work but the disease is
chronic and is really never really cured. Do you recommend that
examinations for applicants for employment include tests for
heart disease and cancer and those people also be excluded for
employment because of the cost that is going to either raise the
insurance cost for the group plan for that particular corporation
or whatever it might be in terms of problems created for the
employer?

MR. RYDER: No, I am not.

DR. PRIMM: Well, then, you know, it bothers me because
all these disease entities, any of them eventually lead to death.
You predict maybe ten years from time of infection to death for
people with HIV infection. How do we know how soon a person is
going to die from leukemia or cancer or multiple sclerosis or one
of the other chronic disease entities that we know that we don’t
have cures for?

221
 

 

MR. RYDER: I have no answer for that. The only answer
I have for you is that this is of epidemic proportion. Those are
not. And that’s why I think something special needs to be done
in this situation because of the epidemic.

DR. PRIMM: We talked yesterday about other viruses of
the same nature as the HIV virus, the HTLV-1 virus that might
soon be a problem for epidemic nature also. So then we’re
beginning to think, you know, from your thinking that maybe all
these things ought to be included.

I want to compliment you, Mr. Ryder, and your company
and Bob Bellamy who is a partner in this company, I know Bob, for
this other document. I think it’s excellent. I’m going to use
it as a resource document because it has in it all the things
that we need and I really appreciate your preparing that.

MR. RYDER: Thank you. Mr. Bellamy was of great help in
preparing that. And you’1ll find -- you won’t find in that
document the recommendation that I’m making to you today because
that’s not what we’re telling employers. We can’t tell employers
that.

DR. PRIMM: I understand.

MR. RYDER: That’s why I’m thinking it has to come -- a
solution has to come from recommendations of this panel.

MR. DevoOS: I think maybe the key on this group is
we're seeking input and we have asked you to come here and tell
us the things you’re doing. And we’re looking for a diversity of
views on those challenges and the things that we’re going to
face. And we thank all of you. Admiral Watkins is going to
wrap it up.

CHAIRMAN WATKINS: Just a quick one for the three of
you over here. The question is are you getting adequate
information flowing down to business to give you the ammunition
you need to build the kinds of educational programs that you
need? Are you satisfied or is there a need for some kind of an
AIDS clearinghouse for businesses from which they would draw
information? Are you current, do you consider the information
either flowing out of the Center for Disease Control, are the
other sources into your health groups able to handle this thing
or do you feel like you’re under the gun here? You have to
really fight for the information? And if you do think there
should be a business clearinghouse that would provide this
information with a better flow, a more continuing flow, would you
tell us how we would recommend a design of such a clearinghouse?

MR. BERTSCHMANN: Well, I obviously have some concern
for what you or probably no one else can do anything about, and

222

 

 
 

 

that’s the wildcat kind of stories and headlines, the scare
things that appear all over the place. I believe at the moment
we feel we’re getting adequate information and good information
and a lot of it.

CHAIRMAN WATKINS: Doctor Herrmann?

DR. HERRMANN: In terms of our Live for Life program
ordinarily and historically we develop our own information
brochures and written materials because of the paucity of
appropriate precentive information out there. On AIDS we’ve just
done the reverse. There has been so much good information that
has come to our attention, we literally have produced nothing
unique with a Live for Life label on. We use American Red Cross,
and the Allstate materials. Literally, I as a corporate medical
director seem to have AIDS information coming over the transon.
However, I think that there is some problem of communication of
information to society as a whole and into our communities. And
we’re concerned about that because we think we’ve been fairly
successful in our program internally because we’ve had a lot of
cultural, if you will, readiness and preparedness to have people
think about AIDS and behavioral/lifestyle issues.

And I think there needs to be a continual, not one time
only, flow of information into the home and into our communities.
This really is going to be necessary to support the kinds of
things we’re doing in the workplace to have it continue to be
effective.

CHAIRMAN WATKINS: Do you think the exchange of
information on workplace policy has been very successful? Is
there a way to share successful workplace policies that we
receive in our office? Who else sees these models within the
business community, leadership community?

DR. HERRMANN: Well, I think it’s one thing for larger
corporations. People are addressing the issue. When you get
down to the small business unit who may not be members of the
Chamber, who might not be members of the National Manufacturers
Association, I think that there is some special need for
communication that you would be --

CHAIRMAN WATKINS: Is there a potential for some kind
of a better partnership between larger business leadership in the
local area and small business to at least offer some of the
benefits of your own AIDS in the workplace policies and open a
forum of that kind?

DR. HERRMANN: We indeed do do that and participate in
those kinds of activity.

CHAIRMAN WATKINS: Is that well participated in by
small business from your experience?

223

 

 
DR. HERRMANN: From my experience, I think when you
get down to the really small business unit you don’t find that
there is as a great and broad base of participation as you’d
like.

CHAIRMAN WATKINS: Do you share those general views
you’ve just heard, Mr. Sawyer?

MR. SAWYER: Basically, yes. We get adequate
information as it stands right now at least. And we feel that
the easiest way of sharing that with smaller businesses is a lot
of communities will put in seminars and ask for panels to be set
up like this. And you can disseminate your particular policies
that they can use as guidelines or not use, whatever their
choice is. But there is not enough participation by smaller
corporations.

CHAIRMAN WATKINS: Mr. Bertschmann, do you have a final
comment?

MR. BERTSCHMANN: Just a quick comment. The
consortium I spoke of is comprised of a number of large
businesses who have contributed quite a bit of money to provide
the educational materials which are still needed, including a
videotape, as a result of a number of people feeling that the
printed material is not enough. But one of the principle
objectives of this is not to provide large businesses, while that
may be one, but it is to having developed this material to then
provide it at basic material cost to small businesses all over
New England at minimal cost because we too here, in addition to
the larger costs of the disease, that the cost of materials and
education is high. So we think we’re involved ina situation
that will.provide small businesses at very small cost the ability
to educate.

CHAIRMAN WATKINS: I just want to close out by sharing
some of the feelings up here on Mr. Ryder’s proposal. I think
that clearly you got our attention, but by the same token we/’ve
had our attention snapped on a number of occasions on this same
issue. And we're looking for other solutions right now. And we
have not given up that there are other solutions to help out.

Where do you draw the line on your proposal? Heart
disease, both parents died at age 40. Is that a risk for
business? What about based on smoking. You have a history of
smoking. It may be that your longevity is within the time frame
of the seven year latency period for the asymptomatic HIV
recently affected. So I think those kinds of things concern us a
great deal more than the problems that we recognize a small
business might have in taking someone on board that’s HIV
positive. We’re getting into now very discriminatory practices
when we begin to select out on the basis of some sort of a health

224
projection and its problems. So we understand the problem, we’re
going to be addressing that in our report to the extent we can.
We can’t solve all the problems from this Commission, but I think
we can send a better direction than that one. We’re going to be
looking at the other side, the flip side of discrimination, which
is the major bar today of getting on with -- finding out where we
stand in the nation on this thing and helping the individuals
helping the public health. And that seems to us to be much
greater concern than the concern for the potential loss in small
business at this point in the epidemic, recognizing it’s a issue.
We're not trying to sweep it under the table, but I think your
proposal is far more extreme than we would consider from all the
compelling evidence of over 600 witnesses that have come before
this Commission to date.

MR. DevOS: All of that tells us that there’s a lot of
unsolved problems here and a whole lot of questions that are yet
to be raised. There’s a big contrast in the workplace between
large and small, but there’s also big contrast between regions as
to what companies are doing in respective areas as this matter
becomes more visible to them and they have to deal with it.

As Dwight is telling you, in our case we’ve been trying
to fashion a policy but we don’t know that we have the problen.
We’re trying to get ahead of it and to get corporate America,
small or large, in every region of this country, to start taking
preventive action. Even if they don’t see it at their doorstep,
AIDS is going to be a challenge, as it always is to get people
to want education when they don’t see the reason to get
educated. And so we’ll have to work harder at that and maybe
this panel could highlight that and bring that to the attention
of more people. And the problems Mr. Ryder talks about are
going to be real problems that somebody’s also going to have to
deal with. I think we’re fortunate to have large corporations in
this country who are ready, willing and able to step over the
line and to spend time and energy in education to train their
management and staff. But for a lot of the others, it’s going to
be a tough thing for them just to find the time to say nothing of
the resources with which to deal with it. Even more important to
get the people ready, willing and able to listen and then to work
toward a solution. So it only highlights the challenge that we
face. We thank you for helping us focus our minds. Each of you
brings a different perspective to our task. And with that, I
won’t terminate this group, we’ll dismiss you and we’re going to
take a break for lunch and I think we’ll be back at 12:30. Thank
you.

(Whereupon, the hearing was adjourned at 12:07 p.m., to
reconvene this same day at 12:30 p.m.)

225
A-F-T-E-R-N-O-O-N S-E-S-S-I-O-N

12:35 p.m.
MR. DeVOS: Good afternoon.

Health Issues and Workplace Environment
Concerns

Our first speaker this afternoon is Yvonne Ellison-
Sandler. She is the manager of Employee Assistance Program for
Levi Strauss & Company. Her responsibilities include:
supervision of all professional psychological counseling,
management training and consultation, and health promotion
services for the Employee Assistance Program, Levi Strauss &
Company nationwide.

Yvonne directs all Levi Strauss & Company AIDS
education, counseling, training and consultation services. She
is chairperson of the Levis Strauss AIDS Task Force and
production coordinator of AIDS education materials and company
spokesperson on AIDS.

Yvonne began her career with Levi Strauss in 1982.
Previously, she had her own private practice in Minneapolis, |
Minnesota, where she was a psychotherapist and consultant to
business on health.

She has held clinical appointments at the University of
Minnesota Medical School and Graduate School of Social Work.
Currently she is on the clinical faculty of the Graduate School
of Social Work, University of California, Berkeley. Yvonne?

MS. ELLISON-SANDLER: Thank you. Good afternoon. It is
my pleasure to be with you today to talk about the San Francisco
Bay Area Corporate response to AIDS. This kind of exchange of
ideas and information is fundamental to any successful
educational endeavor, but it is particularly important with
regard to AIDS because of its epidemic proportions and many
misconceptions that surround this disease.

I’d like to share with you a quote from The Plague by
Albert Camus. “Everybody knows that pestilences have a way of
recurring in the world: yet somehow we find it hard to believe in
ones that crash down on our heads from a blue sky."

AIDS has crashed down on our heads from a blue sky.
Epidemics of life-threatening diseases provoke fear, concern and
enormous anxiety in people.

At Levi Strauss & Company, we believe it’s our
responsibility to not only defuse the fear and anxiety our
employees have about AIDS, but to do what we can to prevent them

226
altogether. Ignorance of the causes and transmission of AIDS
fuels these fears and contributes to myths about the risks and
dangers of contracting AIDS.

At Levi Strauss & Company, we have made a commitment to
educate and inform employees about AIDS based on the best
available medical knowledge to understand the disease. We want
employees to know that a person carrying the AIDS virus is not a
threat to co-workers, since AIDS is not spread by common
everyday contact.

Our objective has been to curb fears, provide
psychological support, and provide financial support. In San
Francisco, it has been a true spirit of cooperation between the
medical, government and business communities which have driven
the development of guidelines to managing AIDS in the workplace.

This afternoon, I would like to discuss our AIDS
awareness program at Levi’s. I will discuss: one, our company
philosophy on AIDS; two, support and education provided through
our Employee Assistance Program; three, financial support through
employee benefits; and four, what we have discovered are the
critical elements to successful AIDS education.

Addressing AIDS in the workplace was not an unusual
responsibility for Levi Strauss & Company to assume. We already
had in place an employee education program in the Employee
Assistance Program that promotes wellness and provides
information on various health issues.

As AIDS became an increasingly serious national health
program, we felt an even greater commitment to take action, to do
what we could to curb fears in the workplace and to stop the
spread of AIDS.

We do not have a policy specific to AIDS at Levi’s. We
have, however, a company philosophy. This philosophy states that
all employees be treated equally, with dignity and respect,
including employees with AIDS. Employees with AIDS are treated
the same as other employees with life-threatening illnesses. It
was this philosophy that guided our response to AIDS

We embarked on an education program before we had our
first case of diagnosed AIDS at Levi’s. It was not an unusual
responsibility for Levi Strauss & Company to take on. We had in
place an employee education program in the Employee Assistance
PRogram that provided information on various health issues and
promoted wellness.

In 1983, we responded to a call from a manager who was
terrified that she could get AIDS from a gay employee she
Supervised. EPA responded quickly to her concerns by offering

227
education about how AIDS is transmitted. We assured her that her
work environment would not be putting her at risk. The

employee, as it turns out, did not have AIDS, but that call
served to alert us to the need our employees had for accurate,
up-to-date information on AIDS. /

Shortly thereafter, when Bob Haas, now the President of
Levi Strauss, stood in the lobby of our home office with
representatives of a local AIDS organization, handing out
pamphlets to employees, the message was clear, that support for
AIDS education was coming from the top.

It was not long after that a workplace package was
developed in coordination with the Bay Leadership Task Force and
the SF AIDS Foundation. These materials were previewed at a day~
long conference hosted by the Bay Leadership Task Force and Levi
Strauss & Company on March 21, 1986. Two hundred Bay Area
businesses had the opportunity to view the videotape and the
associated materials and hear from San Francisco experts on AIDS.

At Levi Strauss & Company, we utilize these materials
in the following ways:

The Employee Assistance Program offers AIDS education
to company departments. By this time, most home office employees
have attended a session. In addition to showing the video, "Talk
About AIDS," and providing further information, a medical expert
is present to discuss any questions. We also talk about the
company philosophy and employee benefits.

A psychologist or social worker from the EPA leads a
discussion of the psychological aspects of catastrophic illness.
The primary objectives of these training programs are to inform
employees of the medical facts, to make sure they understand the
company philosophy on AIDS, and to let them know of resources
available for further information.

Since we know that distributing written material alone
does not guarantee that it will be read, we maintain an extensive
health education library with audio and video tapes as well as
brochures and books. Employees are free to check these materials
out to take home. We have a company health and fitness
newsletter that has a regular AIDS column to continually inform
employees on the latest information regarding AIDS.

We offer confidential individual counseling and
referral services to employees with AIDS, or ARC, as well as
their families and co-workers.

We provide management consultation and department
counseling when a person has or is rumored to have AIDS.

228

 
And we have a company task force which provides
direction and guidance to the company on all AIDS direction.

In 1987, we focused our attention on delivering AIDS to
our field locations, which was a real challenge because they’re
scattered across the South. In three months, we held mandatory
AIDS education for 14,000 employees that cost us about
$60,000.00 in down time and it was extremely well received.

In ’88, we’re planning to focus our AIDS education on
the sales force as well as continuing our efforts in the field
and corporate headquarters. our philosophy of treating all
employees equally and with dignity and respect is echoed in our
benefits philosophy. Employee benefits are the same for anyone
who is ill and it is to go under the short or long-term
disability. Medical and life insurance remains in force and
utilize a case management approach. We offer both home health
and hospice care as alternative to more expensive hospital care.
We encourage persons with AIDS to work as long as they are
medically able and interested in doing so.

Since 1982, Levi Strauss Foundation and Corporation
have made a commitment of financial contributions to various AIDS
organizations. We know from employee feedback that our AIDS
education is being well received and successful. We’re also
aware that AIDS is an ongoing process.

I’d like to share with you briefly now the elements
that we believe are critical to a successful AIDS education
endeavor.

First of all, it’s important to target as specifically
aS possible the employee population that you are trying to reach.
This became clear to us as we attempted to go out into our field
locations and do AIDS education. The materials that had been
developed for San Francisco did not fly in the South in our
smaller facilities. Because it was too geared to the while
collar population, it was seen as a big city effort. There were
really not models on the tape that our hourly employees could
relate to. So, for this reason, we developed a new set of
materials that we have taken out to the field and tailored to a
blue color and a family focus and that’s in Spanish and Chinese
as well as English.

We’ve learned that the speaker must be credible and
confident when delivering AIDS education. For this reason, we
always have a local medical expert on hand. We’ve also learned
it’s important to give the audience regional statistics because
we‘ve learned that people were more interested in learning about
AIDS when they knew what the figures were in their hometown or in
their state. ,

229
Many companies already have in place employee
information programs that provide information on health issues.
We would recommend tapping into that existing program. Employees
and co-workers should treat all medical information obtained from
employees with the strictest confidentiality. If
confidentiality of medical records should be in accordance with
existing legal, medical, ethical and management practices.

We have learned that management is vital to AIDS
education effort. Not only does this lend credibility to the
program, but promotes visibility to employees as well as other
companies in addressing AIDS. Employees with any life-
threatening illnesses, including AIDS or ARC, should be
encouraged to work as long as they are able to. Employees who
are infected with AIDS or any life-threatening illness should be
treated with the utmost compassion and understanding and work
accommodation should be in place wherever possible.

Finally, we have found it’s important to address the
psychological aspect of the disease as well as the medical facts.
Frequently we tend to overlook the grief and loss issues that
confront a department when someone has a terminal illness. Many
employees feel uncomfortable, not because of the fear of
contagion, but rather because they don’t know how to respond to a
co-worker who has a life-threatening illness.

In order to launch a successful education effort about
AIDS, employee fears must be identified, acknowledged, and talked
about. Once these fears are identified, they must be dignified,
understood and respected by managers as well as co-workers.
Creating a climate of mutual respect, understanding and clear
communication will increase the likelihood of success in AIDS
education in the workplace.

We’ve learned that the employees must have enough
information in order to perceive themselves at risk before they
will be receptive to learning about prevention. Once they’re
convinced that this is a problem that does indeed infect then,
employees are able to learn more. We find the most effective way
that we have found to avoid unnecessary disruption in the
workplace is to prepare and education both management and
employees about AIDS before the first case arises.

MR. DevOS: I want to thank you very much and the work
you people have done. It’s apparent Levi Strauss really dug
down in their jeans to deal with this problem.

MS. SANDLER: That’s right.

MR. DeVOS: Okay.

230
MR. DeVOS: Our next participant here is Justin Cc.
McArthur, Assistant Professor of Neurology, Johns Hopkins Medical
Institution from Baltimore. Mr. or Doctor?

DR. MCARTHUR: Doctor.

MR. DeVOS: Doctor. We screwed up over there and we
apologize for that.

DR. MCARTHUR: English training.

MR. DeVOS: English trained. Well, I see all the
stuff if your listing of achievements. I figured you had to be a
doctor to have done all those things.

DR. MCARTHUR: Boy scout too.
MR. DeVOS: We thank you.

DR. MCARTHUR: Well, Mr. Chairman and Commissioners,
I’m delighted to be invited to participate today. Asa
neurologist, I obviously have a particular interest in
neurological impairment and the types of impairment that have
been associated with HIV.

As all of us are aware, there’s been a burgeoning
interest in the neurological problems that have been associated
with HIV infection. Perhaps the most terrifying of all of these
is the dementia, the progressive loss of cognitive and behavioral
function that sometimes is associated with the infection.

Perhaps the one point that I’d like to make today is that this
terrifying dementia is not an inevitable outcome of HIV
infection.

In some patients with AIDS and ARC, we are well aware,
a proportion of them will go on particularly in the later stages
of the disease to develop this dementia and other neurological
problems. But, clearly the dementia is far and away the most
important from a number of personal and work related issues. In
patients with AIDS and ARC, our own clinical experience suggests
that perhaps 20 percent will end up with a clinically significant
dementia. That means that 80 percent do not develop a clearly
Significant dementia.

Now, in patients in the earlier stages of infection,
patients who are otherwise healthy, who are asymptomatic,
patients who are simply HIV sero-positive but otherwise well,
it’s completely unknown or far less certain how frequently the
nervous system is involved from a clinical standpoint. There is
evidence that the virus can gain entry into the nervous system
early, but what it does there and how frequently it does it is
still uncertain at this stage.

231
Recently, in fact less than two months ago, the World
Health Organization convened a consultation specifically to look
at the issues of neurological impairment in otherwise
asymptomatic HIV-infected people, healthy HIV-infected people. I
participated in that conference, and the idea was basically to
pool all of the existing information from a number on on-going
prospective neurological studies and come up with what was felt
to be a consensus.

I’ve included in my testimony some of the minutes from
the consultation. In essence, when the evidence was weighed, the
conclusion was that in asymptomatic HIV-infected individuals
there is no increase in the frequency of neurological impairment
compared to uninfected comparisons.

Now, what that means -- it doesn’t mean that HIV-
infected individuals cannot develop neurological impairment,
because clearly just as in somebody who is uninfected with HIV,
neurological impairment can be a result of drug use, alcohol use,
diabetes, a long list of things which can affect the nervous
system. What it means is that in healthy HIV-infected
individuals, it’s uncommon, very uncommon for neurological
impairment to result solely from HIV infection. I think that’s
an important point. If I can make any point today, that’s it.

Where do we stand and where do we need to go in terms
of --

DR. LEE: Could I have you clarify that? It is an
important point. Are you talking about at the beginning of the
disease, or are you talking throughout the course of the
disease?

DR. MCARTHUR: I’m talking specifically, as far as the
knowledge that we have up to now, from the studies that have
been done which have now looked at over 1,500 HIV-infected
individuals in the earlier stages of disease -- let me be more
precise. These are individuals in CDC groups II and III,
basically healthy asymptomatic individuals with or without
lymphadenopathy. So, these are patients who do not have
constitutional symptoms, who do not have ARC and who certainly do
not have AIDS.

DR. CONWAY-WELCH: Would you repeat your statement
again, then, in reference to that?

MRS. GEBBIE: May I ask for one other clarification
before you repeat the statement? They could be at any number of
months post-infection, as long as they did not have those
constitutional symptoms?

232
DR. MCARTHUR: They could be one, two, four, five, six
years. The only variable is the presence or absence of
constitutional symptoms. You would like me to repeat my
statement?

DR. CONWAY-WELCH: Yes, that precipitated Doctor Lee’s
question.

DR. MCARTHUR: I believe the statement was, or I
believe the statement that precipitated -- I know what the
statement was. The weight of the evidence, at least gauged from
pooling a number of on-going neurological studies, was that
asymptomatic healthy HIV-infected individuals do not have an
increased frequency of neurological impairment. That’s compared
to uninfected controls.

DR. CONWAY-WELCH: Thank you.

DR. MCARTHUR: Where do we go from here, and what do
we need to Know? What are the obstacles to moving forward in
terms of understanding neurological impairment?

The first obstacle is the issue of serological
screening. Again, the World Health Organization, the
consultation came out with a clear statement in this regard. The
statement basically was that serological screening for HIV is not
an effective strategy for detecting functional impairment related
to HIV.

The second point relates to our lack at the present
time of a clear definition of HIV dementia. Different research
groups, different clinical groups may call the same patient
demented or not demented depending on the criteria that are used.
Clearly, this has more than just medical implications. We need
a clear set of definitional criteria for making the diagnosis and
understanding the diagnosis of HIV dementia. This will probably
only come by convening together different professional groups:
the American Neurological Association, the American Psychiatric
Association, et cetera, together to come up with some form of
working group that can attack this problen.

The third point, or the third area that we need to
explore that is being explored at least in one risk behavior
group, is understanding the epidemiological and the clinical
features of the neurological disorders. Most of the studies that
are on-going at the moment are in one risk behavior group, that
is gay or bisexual men. We need to push out into other risk
behavior groups to determine whether the clinical features, the
epidemiological features are the same or different. What other
variables are important in determining whether an individual does
or does not develop neurological disease? Some of those
variables may be amenable to intervention.

233
The fourth point relates to our desperate need for a
sensitive yet specific screening test for detecting neurological
impairment at an early stage. Most of the studies that have been
done up to now and reported up to now have used standard
neuropsychological test batteries. They are not directly
applicable to some populations.

For example, some of the test procedures are extremely
culture-specific or extremely education-specific, so they are not
applicable, for example, to somebody who can not read or write.
They also may not be applicable to certain risk behavior groups.
We don’t have well established norms. For example, for
performing and assessing neuropsychological tests in intravenous
drug users. We need a sensitive and specific screening
instrument.

The fourth, and the final point really relates to an
overall understanding of some of the neurological disorders.
Although we expect that the dementia that’s been linked to HIV
infection is probably from the virus acting within the brain, we
really have very little information about the pathogenetic
mechanisms that underlie the viral infection within the brain.
What precisely is going on in the brain to cause the signs and
symptoms that we see? At the moment, there are a number of
funded studies mainly funded through NIH that hopefully will
address some of these issues.

Thank you.

MR. DeVOS: Doctor McArthur, we thank you, and I
wonder if you could do a 30 second explanation of dementia. We
have a whole lot of young people here and you guys in the
profession tend to use your jargon. Why don’t you try it for
them and see if you can do it real quick for them?

DR. MCARTHUR: Well, dementia really comes together
from a progressive -- and I think progressive needs to be
underlined -- this is something that we understand as changing
over time. So, it gets worse over time. A progressive loss of a
number of mental faculties: memory is the most obvious one,
alertness, attention, the ability to concentrate, all of the
things that we rely on day to day to perform our work or to learn
or to function in everyday activities. Dementia results when the
brain has been damaged either by HIV or by other conditions, and
causes a loss of those faculties.

MR. DeVOS: Thank you. That helped me a lot. I don’t
know about the kids, but --

MR. DeVOS: We’re going to go next to Doctor Rhame
here, who is a medical doctor also, Assistant Professor,
Infectious Diseases Section, Department of Medicine, and

234
Director, HIV Clinic, University of Minnesota Hospital,
Minneapolis. Doctor Rhame, thank you for coming.

DR. RHAME: Thank you. I understand my charge here to
begin a discussion of the implications for the work place of the
potential for transmission of the secondary infections, the
infections of which there are potentially about 30. Those are
actually outlined on the second page of my testimony here. I’ve
set them out in some kind of table just to get some idea of what
the magnitude of the task before me is.

I’ve divided up this issue into basically three
subsets, the three bullets there in the definition or the
statement of the problem on page one.

The first is the extent to which the presence of these
infections in HIV-infected people causes a hazard to the
associates of the HIV-infected people. We’re not just talking
now about the hazard. We’re talking about the excess hazard over
random people, and we’re not just talking about the hazard to
healthy people. There might be some special subgroups like
immuno-suppressed patients or persons or pregnant women or
newborns that might require some special management.

The other side of it is the risk to the HIV-infected
person. I’ve divided that up into the second and third bullet
there: the risk to the HIV-infected person that other people
pose; and the risk to the HIV-infected person that features of
the environment, animal exposures, environmental exposures,
problems which might be occupation related like requirement of
overseas travel and the requisite immunizations and so forth.

Now, if I can turn your attention to that table again,
it’s a classification of these pathogens, germs, by transmission
mechanism. You see first off that most of the transmission
mechanisms involved there are from the environment, so they
really are quite irrelevant. Person to person transmission of
most of the pathogens in that first group doesn’t occur.

I have salmonella down there as a pathogen which mostly
comes from food, although it does come from animals to person and
person to person as well by fecal-oral transmission.

I’ve got some down there which come animal to person,
and then I’ve got four categories which basically transmit person
to person.

The first group is a group of pathogens where spread
occurs readily, but almost all of us are repeatedly exposed and
become colonized early in life. The problem really arises when
your colonizing organisms get out of control as your immune
system weakens.

235
The second group is a group of fecal-oral
transmissions, basically oral consumption of stool.

The third group of person to person transmissions is
where person transmission does occur, but requires prolonged
intimate exposures. Therefore, basically adult transmission of
these doesn’t occur except in people who are having intimate
contact.

And the last group down at the bottom, person to person
spread of airborne disease, namely mycobacterium tuberculosis,
the organism which causes TB; varicella-zoster virus, the
organism which causes chicken pox and shingles and measles, is
probably a little worse in AIDS patients as well, but we don’t
have much of it in the country.

Now, with that background, I’m going to read my
conclusion and recommendations so I get it right.

Workplace transmission of most of the HIV-associated
secondary pathogens is not a problem because:

1) they do not spread from person to person, or do so
only during intimate contact;

2) they colonize all humans from early in life; and/or

3) they do not cause illness in healthy persons.

The most important exception is mycobacterium
tuberculosis, the organism which causes TB. TB is a problem in
this context because;

1) dormant focal infection commonly becomes active in
HIV-infected persons;

2) infectious tuberculosis can be present without
characteristic symptoms; and

3) tuberculosis can be transmitted by the airborne
route to unsuspecting healthy persons.

However, the severity of the problem is diminished
because:

1) most U.S. HIV-infected persons do not harbor
dormant TB foci;

2) the type of tuberculosis which develops in HIV-

infected persons is less infectious than that which develops in
other persons who get TB;

236
3) M. TB transmission is less common in the workplace
than in the home;

4) astute physicians should detect and treat
tuberculosis before it becomes very infectious;

5) TB is uncommon in exposed contacts who receive the
proper post-exposure prophylactic management; and

6) active TB, should it develop in a contact, can
almost always be successfully treated.

The other conclusion: special precautions for HIV-
infected persons in all other circumstances are either not
necessary or, in certain unusual circumstances, can be
accomplished with minimal disruption and without significant
increases in infection hazard to HIV-infected persons or their
associates.

Three recommendations:

1) HIV-infected persons should receive attentive
medical care by physicians who recognize their increased
tuberculosis risk and are knowledgeable about diagnosing
tuberculosis in this context. When active TB is recognized in
any person, careful evaluation of contacts in cooperation with
local health authorities is necessary.

2) It is probably desirable to exclude HIV-infected,
varicella-zoster virus susceptible persons, those are persons who
have never had chicken pox before and that only is about two
percent of adults in this country, from situations of intense
chicken pox exposure. A hallmark might be a person working ina
school, a teacher in a school during a school outbreak of chicken
pox.

3) There are unusual, occupation-related hazards which
pose risks to HIV-infected persons which are sufficiently greater
than the risk to healthy persons that special counseling with
optional self-exclusion is appropriate.

These special situations include:

- overseas travel to areas of poor sanitation or
increased transmission of certain exotic pathogens;

- environmental exposure to soil in areas of
coccidioidomycosis endemicity;

- exposure to cryptosporidium, which might occur during
large animal veterinary work;

237
- exposure to toxoplasma, which might occur in work
with cats or exposure to animal flesh.

Known HIV-infected persons should not receive oral
polio vaccine or BCG vaccine.

And finally, the magnitude of the increase in the risk
to asymptomatic HIV-infected persons in these situations is
insufficient to constitute a basis for anti-HIV screening.

Now, the balance of the written testimony basically
deals with a half a dozen of these things, some of them as
prototypes of larger issues.

Thank you.

MR. DeVOS: Doctor Rhame, your ability to pronounce
some of those words is amazing.

DR. RHAME: I earn my salary that way.

MR. DeVOS: I do those -- I just slide through then.
You pronounce them. I thank you.

MR. DevoOS: Our next presenter is Martin Schneiderman,
partner of Steptoe and Johnson, from Washington. As we said
earlier, don’t step on any toes. .?

MR. SCHNEIDERMAN: Can’t promise on that. I ama
partner at Steptoe and Johnson in Washington, D.C. My specialty
is personnel consulting with employers, and I also do government
contract work. I am an adjunct professor at Georgetown
University, teaching EEO litigation.

I point out that I’m here representing my own personal
views and not in behalf of any particular client or interest
group.

I did want to mention a brief story about, perhaps, the
impact of this Commission. Some time ago, I was on a trip to New
York to speak at a commission -- not a commission, at a seminar.
And I was traveling by train and happened to be preparing my
materials and looking at some AIDS-related materials,
particularly regarding safe sex.

I don’t know if you’ve all recognized this phenomenon,
but I’m sure it’s true. There are three events that happen on
common carriers.

First, there is some interchange of communication in
some fashion.

238
Second, there is an inherent drive of all people who
are not necessarily nosey to necessarily look at what the other
person is looking at. I find this to be nearly universal.

The third is that hidden negotiation about that
armrest. You have the arm, the front, and this happens all the
time.

Well, on this particular trip I had my AIDS-related
material. This gentleman looked at what it was. Meanwhile, I
had a cold that day, and I will tell you there was no
communication. I will tell you that he did read what I was
reading. And I will tell you that I had that whole armrest the
entire trip. When I coughed, he was way over in the other end.

I tell that story because it is typical of some of the
hysteria that we confront. We may have different views about
what is happening in this epidemic, but one thing is clear.
There is no room for discompassionate and hysterical reaction to
events.

I will say that on this trip today, what brought that
story to mind is, I had my papers open and a young attractive
lady sat next to me, looked over, and I said, "Here I go again."

She said, "You’re going to the President’s Commission
meeting in Indianapolis, aren’t you?"

And I said, "Well, there’s the impact of the
Commission right there."

So, you’re doing a good job as far as I’m concerned.

This epidemic obviously is fraught with challenges ina
number of disciplines; in medicine, ethics, law, public policy.
And your job is formidable indeed. I’m here just to focus on my
specialty, namely employment law questions.

When you deal with employment law questions, the
preeminent law, as has been discussed, is the handicapped law.
Very interestingly, unlike the laws on sex, race, national
origin, and age, which applies generally to the population with
very limited exceptions through federal legislation, there is
federal law here, but it only applies to very limited, but
nevertheless large sectors of the population, federal employees,
government contractors and subcontractors and those receiving
federal assistance.

In addition to that, you have an array of 49 of the 50
states have their own laws on handicap. In addition, you have a
whole group of local ordinances. So really, it’s a very
difficult and messy situation. I will say, most of these laws

239
follow the federal motto, but that’s not entirely true. So, you
have a real problem, I think, with some possible inconsistencies
in terms of coverage.

I have already submitted to you a detailed discussion
of the implications of the line decision in the handicap laws.

I should add, and I’ve written on these other laws,
there are other federal laws of import. The NLRA deals with
concerted activity. ERISA, which has been referred to, relates
to prohibiting termination of employees to avoid incursion of
health and medical costs. Then you have OSHA, of course, which
provides a general duty of employers to provide a workplace free
of known defects.

Because my time is so limited, I have been asked to
focus in on three perhaps different views that you’ve seen, and
one I was asked to specifically deal with secondary infection and
I will do so. But I will talk about three general policies, one
I think that’s working well, one I think that is just wrong and a
third which seems to be in need of development of further
exploration in terms of medical and possible legal implications.

First, the policy that seems to be working right. The
federal government took on, I think, a very early objective
allaying concerns about transmission of AIDS. We wanted to calm
hysteria in the workplace or everywhere, in society generally. I
will tell you that in my consulting with many employers, the
reaction was not, "How do we fire persons with AIDS." The
primary concern of employers is, "How do we deal with hysterical
reaction of co-employees, of supervisors and of customers?" I
think much has been done.

Earlier testimony has highlighted the importance of not
only the federal contribution, but the company contribution. In
every one of my speeches in this area, highlight, number one, the
importance of the company’s taking its own responsibility in
terms of dealing with educating the workforce. Honestly, in
this area, I don’t think I vary much from what has been the
preeminent view of medical and legal scholars and public policy
experts.

The second one, I will say that I find myself in the
minority in terms of expressing a view in this regard, and that
would deal with a particular employment setting in the health
care industry. When patients come into hospitals and they’re
about to be treated with invasive techniques, it is common to
have a broad panoply of blood tests taken. This is one area that
it doesn’t seem to me as if we’re following a public health
dictate. The policy of the government has been to follow
universal precautions. Such precautions are appropriate but it
seems to me that health care providers ought to be able to

240
function on real rather than assumed risk. And given the quality
of the tests that are currently available, I don’t see why they
should not. I would say there’s a flip side to this. I would
also think that a health care provider organization would have a
right to know the status of its employees who will be performing
invasive techniques. Not that they should be terminated, but
perhaps they ought to be transferred to positions where they are
not going to participate in invasive techniques.

I had been asked by a company whether -- they were
providing health care providers employment and they asked me, "Is
it reasonable for us to test those persons?" Quite honestly,
every instinct in me says this is entirely reasonable and I’m
considering the legal implications where a federal agency is
discouraging that very testing. I find that difficult. So, I
think that’s a policy that you all ought to consider very
carefully.

The third policy that I would talk about now is one
that has been alluded to. It is one that I do not regard as
having any definitive evidence at this stage. I want to
highlight that right off from the beginning. But it deals with
this question of secondary infection and secondary effects.

There has been, as we said in the beginning, a very
appropriate focus on common hysteria in the workforce by showing
that AIDS is not transmitted in the casual setting of the
workplace. That’s a very appropriate, very important public
policy.

It seems to me at some point in time there needs to be
a close look at whether persons with AIDS, because their immune
system is compromised, are vulnerable not only to the types of
diseases that do not pose risks, but other types of disease. TB
is one. I think there are parasitic and bacterial causes of
diarrhea, for example, that one might want to at least closely
monitor in some industries like the food industry.

I have seen in some hospitals that they preclude nurses
from working with AIDS patients because of concern about CMV. I
ask whether this is concern in the workplace and some doctors
privately give me very different views on this issue.

I see a related issue in the dementia issue. I’m very
well impressed by the information to date as developed. If it’s
conclusive, it’s conclusive. I will tell you that my concerns
stem from a New York Times article in which the military was
relying upon some information which seemed to suggest as it was
reported, now I have not read the base data, that there is some
concern that dementia may be one of the early symptoms. Now, I
think a demented lawyer may be a help to most clients, but I
think there are some other types of positions, airline pilots,

241
train locomotive engineers, that we really ought to look at this
a little bit more carefully.

I think after we’ve developed a calming influence in
the population generally and we’ve been able to make some
progress, there may be some time necessary to focus in on these
secondary important -- not as important as the transmission of
AIDS, but nevertheless real issues that we are to deal with.

Thank you.

MR. DeVOS: Good. Thank you very much, Mr.
Schneiderman.

MR. DeVOS: With that we’re going to go over here to
Doctor Lilly. You okay, Frank?

DR. LILLY:: Well, I’m a little stunned, but I’1l
recover.

Let’s see. Ms. Ellison-Sandler, I’d just like to get a
little clarification about one sentence that you said and which
is also in your write-up, which is, "We provide consultation and
department counseling when a person has or is rumored to have
AIDS." Could you expand on that, tell me just what that means,
what happens precisely?

MS. ELLISON-SANDLER: Sure, I’d be glad to. If there
is concerned rumors about someone having AIDS, that may come to
our attention by a co-worker, an employee of that work group or
by a manager or a supervisor. What we have felt strongly about
is that if we did AIDS education on a routine basis, hopefully
all of our employees would have a basis of education and then
when a rumor came up we could move in again and talk about what
their concerns are and go through the process of reeducating
them, addressing talking about what their concerns are and kind
of bringing it out into the open and really demistifying what
usually is kind of a hysterical response around whether someone
has AIDS or ARC in the workforce.

DR. LILLY:: Okay. So, this is a general educational
response that you’re talking about?

MS. ELLISON-SANDLER: That’s right.

DR. LILLY:: I just wanted to make sure it wasn’t that
you’re calling in the person or finding out to what extent that
might be --

MS. ELLISON-SANDLER: You mean calling in the person
whose rumored or actually has AIDS?

242
DR. LILLY:: Yes. Right.

MS. ELLISON-SANDLER: No. If they choose to come to us
and talk about their medical condition, then we follow through.
But that is clearly a matter of choice and one of
confidentiality. If they don’t want to be involved in anyway, we
don’t get involved.

DR. LILLY:: Okay.

A question just about a detail for Doctor McArthur. I
wonder if you can just list a little bit some of the other
neurological problems that I don’t think fit under the category
of dementia, such as the blindness and hearing loss, for example.

DR. McARTHUR: Well, there’s a whole host of very
diverse, and some of them quite novel, neurological disorders
affecting not just the central nervous system, the brain and the
spinal cord, but also the peripheral nerves as well. One of the
intriguing features of the neurological disorders is that some of
them occur at specific stages of HIV disease. That is, some of
them, some of the more unusual ones particularly, the peripheral
nerve disorders, can occur at a very early stage of infection.
The other ones and the more important ones, the ones that effect
cognition and memory, like the dementias --

DR. LILLY:: Are these peripheral neuropathies or are
they actually based on central nervous system problems?

DR. MCARTHUR: No, these are clear-cut peripheral
neuropathies which respond to treatment and act just like some
types of peripheral neuropathy that occur in individuals not

infected with HIV.

MR. DeVOS: Thank you, Frank. 1
\

oa
DR. LILLY:: I’11 leave Mr. Schneiderman to --
MR. DevoS: Gebbie? \

MRS. GEBBIE: I’m going to address the question
actually to all four of you. Although you each presented
somewhat different views, I didn’t hear clearly really from any
of you what it is you think would be the most perfectly brilliant
thing this Commission could say that would help you pursue what
you need to do in the work side in academic medicine or wherever
in the legal profession. So, I’d like to hear each of you give
us what you think is, from your perspective, the most critical
recommendation we could make.

As you do that, I’d also appreciate if Doctor McArthur
and Doctor Rhame could give us some sense of whether if we had

243
5,000 doctors in here they would generally tend to agree with you
or whether you think you’re presenting a somewhat peripheral view
in the general medical spectrun.

MS. ELLISON-SANDLER: I would like to see a
recommendation made to all businesses, small and large, in all
regions across the country that they be strongly encouraged to do
AIDS education from a preventive kind of focus.

DR. McARTHUR: Let me just comment as to my
eclecticism. The opinions that I have are my opinions, but I
think they are mirrored by many other clinicians and researchers
in the neurological, psychiatric field. One of the Commissioners
-- I think it was not a commissioner -- had mentioned the
military’s decision at the end of 1987 to ground HIV positive
pilots.

That was, in large part, based on a study generated
from San Diego by a very well respected researcher there, a
psychiatrist called Igor Grant, who I know and who I’ve discussed
the results of his study with. The important point from that
study which looked at neuropsychological tests in individuals
infected with HIV, some with AIDS, some with ARC and some
basically asymptomatic, was that one could find, if one looked
hard enough, neuropsychological test abnormalities.

But Doctor Grant also says, both publicly and in the
paper, that none of the individuals were demented. I think one
important point that the Commission can make is that
neuropsychological test abnormalities by themselves do not mean
that somebody is demented or incompetent or incapable of working
or incapable of making up a will.

The second point, I think, that the Commission should
and can stress hopefully is that serological testing,
specifically for HIV, should not become a surrogate for
functional assessment. Can a person do their job? Sorry to use
up time, but the third point relates to other causes of
neurological impairment. Drug use, alcohol use, anxiety are all
very potent causes, some transient, of neurological impairment.
We can’t ignore those in dealing with this population.

MR. DeVOS: Good. Doctor Rhame?

4
DR. RHAME: My conélusion or my recommendation is

almost that you don’t take any action in this area. Really, TB,
in my opinion, is the only significant problem in this area and
there is a finite increased risk of your being exposed to TB if
you work with an AIDS patient or an HIV infected person. But
that risk, for all the reasons I go into in some great lengths,
is not large and is manageable should it occur.

‘

\
244
So, my recommendation to you basically is that there
doesn’t need to be any particular action resulting out of the
secondary infections. Maybe you should state that, I don’t know.
You’re probably a better judge than I am about how big an issue
it is.

I think that, in general, when you think about this,
this issue, and that’s what I’ve tried to do the way I put that
table out, each and every pathogen has to be considered
independently. One of the great jobs of infectious diseases is
that each of these bugs seems to have developed its own way about
getting around the world. When you just say, "There’s a problem
which is meningitis," you can’t think about the problem of
meningitis. In fact, the meningitis problem that AIDS patients
get is cryptococcul meningitis and that has never been shown to
spread person-to-person, ever, once.

So, you have to think about it very much pathogen
oriented. Whether or not there’s a societal need for a statement
that outside of TB there is no problem and TB is manageable,
that’s really not ~~ I don’t know if I can make that
recommendation to you.

MRS. GEBBIE: You didn’t comment on the centrality of
your views in the medical community. I think that’s important to
have on the record, one way or the other.

DR. RHAME: Yes. I presume that it’s fairly central.
I’ve shared my written testimony with a couple of people I
respect most nearby and most of them think I’m even making too
big a deal out of some of the issues, like the
coccidioidomycosis in the dirty grader in Arizona. I think I’ve
really split a lot of hairs even to the extent to which I’ve done
it.

MR. DeVOS: Thank you, Doctor Rhame.

MR. SCHNEIDERMAN: I will say that my recommendation is
only that there needs to be further medical exploration of these
issues. We’ve heard differing analyses and conclusions taken by
the military establishment. I will tell you that hospitals have
different views about CMV. I have had doctors differ in seminars
that I have chaired on the issue of CMV as to whether it’s a good
idea to have pregnant nurses and pregnant employees working
closely with AIDS patients.

I will tell you that I can’t question these doctors on
the medical issues, but I will tell you that I have talked
personally with a number of doctors who have different gray
areas, not major differences. This is not a major issue of the
same ilk, of transmission of AIDS, but it is an issue that we
should not close our eyes to. I think we need further

245
exploration of it. TB, in particular, is one because it is
growing dramatically in New York and some other locations. We
ought not wait until all the cases are there before we say, "Aha,
we have a problem." I think we ought to be exploring it more.

MRS. GEBBIE: Thank you very much.

CHAIRMAN WATKINS: Let me just clear up one issue on
the military. When the report that Doctor McArthur mentioned here
earlier came out in the paper, we happened to have hearings that
day from some of the best minds in the world on neurological
damage and early symptoms who gave us rather strong evidence that
supports Doctor McArthur’s position.

In addition, the knee-jerk response out of some in the
military moved rapidly to do what you suggested. The decision by
the Secretary of Defense wisely turned it off, said, "Now, wait a
minute. We don’t have the data. The best in the country is not
giving us that information." I don’t know the extent that that
was exposed to peer review and had a good solid review by all the
proper people in the medical profession, but I can assure you
that it’s the kind of knee-jerk response on the basis of spurious
reports that come out without the kind of licensing that goes on
in peer review that get this thing confused.

We had a pretty clear indication that in fact there
were many other debilitating things that would down a pilot long
before we go to HIV positive asymptomatic considerations, such
as, "When did you have your last drink? How old are you?" and
other important questions.

I want to put it in context because the military has
not made a move on that. There have been lots of pushes by the
services to stop people flying expensive aircraft if, in fact,
early neurological damage is in fact the case. But that has not
been the case. The military has not made a decision. So, I
want to clear that for the record.

MR. SCHNEIDERMAN: And I just wanted to mention that
the evidence that is most tenuous indeed, and I agree with you,
is the issue of dementia of people who are asymptomatic. I think
there’s very weak evidence on that. As to people who have full-
blown AIDS, I think the numbers are fairly dramatic that this is
a concern. How we apply --

CHAIRMAN WATKINS: But, Mr. Schneiderman, let me tell
you this. We have extensive annual physicals that test the motor
responses and all the other responses of our aviators in all
services. They are far better able to decide performance on the
basis of neurological damage. Those kinds of things are in
being and working all the time. So, it isn’t as though we’re
ignoring the issue, but we’re looking for more clear symptoms

246
that there has been some performance damage which to me'is a more
sensible criteria along the lines that Doctor McArthur
mentioned.

MR. SCHNEIDERMAN: I haven’t in my recommendation said
that the private sector should adopt the military standard. I am
just pointing out as to the question of is there a central
uniform view that there appears to be on this issue. Unlike
transmission of AIDS, there seems to be more uncertainty and
disagreement. The scope of that is something for you all to
decide.

MR. DeVOS: All I can say is it was spoken like an
admiral. Okay, Cory?

DR. SerVAAS: Like the Admiral, I’m confused on --
well, not confused. I need some clarification from Doctor
McArthur and Doctor Rhame about an interview we had with Doctor
Richard Price of New York City. I understood when we researched
this that he’s very well respected by the CDC in his work. My
question to you is, when he reported that 25 percent of patients
first present -- HIV patients he sees, HIV infected patients
first present with neurological or psychiatric symptoms. Could
either of you or both of you comment on his work? Is he
controversial or is he not mainstream, Déctor Richard Price, in
this testing and research? a

DR. MCARTHUR: I know Richard Price very well and we
collaborate together on a number of projects. In fact, his
brother works at our institution. Doctor Price was really the
first neurologist to recognize that p tients with AIDS developed
or could develop dementia. He really] opened up the whole field.
There’s no question but that he’s very respected and is the
expert in the field. I’m surprised he’s not here today.

But one of the points that he makes when he talks is
that his experience is from a very selected group. He’s working,
as you know, at Memorial Sloan-Kettering and sees basically
patients who are referred in for neurological assessment. They
have a relatively small group, a selected group there of
patients. It’s not a large in-patient service and it’s just
confined to basically one risk behavior group and not many.

As I indicated in my written testimony, there is a
range to our current understanding of how frequent this dementia
is. Doctor Price’s estimates are at the top end of the range.
That’s not to say that his estimates are wrong. I believe that
they’re correct for the population that he’s dealing with and
for the criteria that he’s using to diagnose dementia. Other
groups see a different spectrum of disease in a different
spectrum of patients and maybe using different criteria. This is
one of the obstacles.

247
If we’re going to understand this, not just the
clinical manifestations but the epidemiology, we all have to be
talking the same language. So, no, he’s not wrong in the advice
that he gives you.

DR. SerVAAS: Doctor Rhame?

DR. RHAME: Doctor Price is the preeminent person in
this area. We’re vigorously courting him to be the Chairman of
our Department of Neurology at the University of Minnesota, in
fact.

DR. SerVAAS: Okay.

DR. RHAME: Let me add something to it because I think
it’s been perfectly well stated. The issues for the future are a
little more complex. It is plausible that after 50 years of
infection, 50 percent of the people will be immunologically
intact, but 80 percent of the people will be neurologically
damaged. We may find that the neurological damage occurs in a
higher fraction of people, but takes longer. It may as well be
that therapies are going to a better job of protecting the immune
system than protecting the CNS. So, although I think it’s
perfectly stated in the current situation, we have a few hurdles
yet to go before we know how it’s going to play out.

DR. SerVAAS: Thank you, Doctor Rhame. Thank you.

MR. DeVOS: Thank you, Cory. You’re going to be next,
but I want to see if anybody has anything for Ms. Ellison-
Sandler, because she has to leave promptly and catch an airplane.
Does anybody have anything special for her? If not, you’re
going to get caught up in the regular flow here. Okay? And if
you feel you have to leave, then go, and we thank you for being
here. Theresa?

DR. CRENSHAW: Doctor Rhame, is that correct?
DR. RHAME: Rhame, like tame.
MR. DeVOS: He’s the fame of Rhame.

DR. CRENSHAW: Okay. In hearing you discuss the
secondary infections, if I understand you correctly, in the
health care and workplace setting the other infections play a
trivial role in terms of cause for major concern. Tuberculosis
has some, but is manageable. And that AIDS patients get a
different form of tuberculosis than most health care workers or
others would be susceptible to.

On the other hand, there’s an article on an Urbana
epidemic where 12 Urbana nurses caring for patients suffering

248
from both AIDS and tuberculosis have tested positive for TB. Is
there any follow-up on that situation, or are you familiar with
it?

DR. RHAME: I’m not aware of that situation.
Tuberculosis --

DR. CRENSHAW: I mean, that doesn’t seem like
something that other people don’t catch.

DR. RHAME: TB transmission in a hospital does occur
from patients that are not properly isolated and who have not
been started on therapy. The infectiousness of TB diminishes
rapidly as soon as therapy is started.

I don’t mean to say it’s an ignorable problem. There
is a real, albeit small, increased risk to being associated with
AIDS patients or other HIV-infected persons. The magnitude of
that risk is really not great enough to require special
restrictions on the behavior of HIV-infected people, in my
opinion, for the reasons I outlined.

But, that problem is not one that you can just dismiss.
You’ve got to spend a lot of time thinking about it to get to the
place where I am on that. I didn’t have time to really expand on
exactly why, other than that very brief summary, I think the
problem is not of sufficient magnitude to require special
restrictions. But, all those things do play into it.

It is, for instance, the case that people under medical
attention do generally get therapy pretty quickly before they
become very infectious. It is generally the case that the types
ef TB which develop in HIV-infected people are the disseminated
vB throughout the whole body, or TB in some other place than the
lungs, neither of which are very infectious. It’s the focal
infection of the lung that occurs most of the time in non-AIDS
patients that is the most infectious form of TB.

So, it requires a lot of thought to get to the point --
a fairly rigorous analysis to get to the point where I am on
that. And it’s certainly not one I want to dismiss, and there
certainly will be more transmissions in this country from the
average HIV-infected person than from the average non-HIV-
infected person in the next decade.

DR. CRENSHAW: It seems to me that there are two issues
on this point. One is that it gets so incestuously linked up
with what are we going to do about it, that it makes it very
difficult for people to look at just what is really happening.
And if we look at 12 nurses in one small hospital in a small city
getting TB, that isn’t minimal issue for health care workers
certainly.

249
DR. RHAME: No, no. I don’t mean to dismiss it.
About two percent of AIDS patients will get TB, and that’s going
to be a big issue.

MR. DevOS: Okay. Thank you, Theresa. John?

MR. CREEDON: Mr. Schneiderman recommends that the
present policies which discouraged testing in advance of
invasive medical procedures be reconsidered. I mentioned this
morning that I recently read a paper by Secretary Bennett, the
Secretary of Education. He recommends, among other things, in
that paper that testing generally be encouraged on a more
widespread basis and specifically in the hospital setting. I
forget now whether he would mandate it in connection with
hospital admissions.

I wonder if Doctor Rhame and Doctor McArthur have a
view on that specific subject either with respect to surgery or
with respect to admissions to the hospital generally.

DR. RHAME: In my former life, I was an infection
control person. Let me start on that. I don’t think the issue
here is voluntary testing. In our hospital -- and this is the
way it is in most parts of the country, outside of the coasts.

If a surgeon wants to test his patients, he can test his
patients. I don’t think there’s anything wrong with that as long
as he observes --

MR. CREEDON: Without asking them?

DR. RHAME: No. As long as he observes the consent
and counseling issue, there’s nothing wrong with that. The
issues really are, if he wants to take the time and the effort to
do that for people who are extremely unlikely to be infected.
The people who get surgery by and large are elderly and not HIV-
infected. If he wants to take all the trouble for that, if he or
she will as well go ahead and operate on the person who refuses
testing without testing them, that’s fine. I mean, nobody would
object to that.

The real question is whether or not it’s worthwhile in
terms of the number of people you’re going to turn up, and in
terms of those rare circumstances, if any, where you can’t do for
everybody that which you should do for the HIV-infected person.
As long as he observes that willingness to counsel and consent
and go ahead and take care of the person who refuses the
serology, that’s where the only issue lies.

MR. CREEDON: Well, I interpret what you said that you
would not require testing for people admitted to the hospital,
nor for people who were having surgery. You would not require it
as a matter of course?

250
DR. RHAME: In my opinion, the issue boils down to, if
a surgeon could make a case for me that there’s something he
needs to do for the HIV-infected person that he can’t practically
do for everybody -- and I haven’t really had that case made to me
persuasively --

MR. CREEDON: But, what about the risk of his own --
his own personal risk as a result of the operation?

DR. RHAME: Well, are you saying that if a person’s
positive he shouldn’t do the surgery, or are you Saying --

MR. CREEDON: Well, I’m not saying he shouldn’t @o it.
I mean, if I were a surgeon and I were about to operate on
someone, I think I would rather know whether or not the person
had the virus. I might be a little more careful, I’m not sure,
just with respect to the possibility of infection or whatever.

DR. RHAME: And there’s nothing wrong with that, in my
opinion, as long as you do the counseling -- and this is the way
it is in most hospitals. As long as you do the counseling and
consent, and as long as you’re willing to go ahead and operate on
a person who’s --

MR. CREEDON: But, you would leave it up to the
particular surgeon and not require it as a matter of course?

DR. RHAME: I would not require it. I would not want
my hospital to get behind this effort and to take on, for
instance, the burden of doing the counseling and consent, unless
that surgeon had made a case for me.

\

Let’s say there’s some kind of surgery, the prototype
usually mentions cardiovascular surgery because that’s probably
the most bloody, where he really could make a case that there
were some things he was going to do for the HIV-infected person
that he shouldn’t be doing for everybody. If he really made
that case for me, then I would feel, as the hospital
epidemiologist, that I would want to get behind his program and
make sure of the counseling and consent, take the responsibility
for doing it and take the responsibility for doing the testing.
I haven’t had that case made to me well enough yet by any
surgeon.

‘

\

MR. CREEDON: Doctor McArthur? \

DR. MCARTHUR: Well, we’re in a different part of the
country, and our population at Hopkins is a bit different. But,
I would echo your sentiments exactly. We do not support
mandatory universal screening for all hospital patients.

MR. CREEDON: How about for surgical patients?

251
 

 

DR. MCARTHUR: We do not support universal mandatory
testing for surgical patients either, simply because half of the
patients that we operate on are women who are quite likely to
have false positive test results. Our counseling system would be
totally swamped dealing with false positives even before we got
to the true positive infections. So, we do not support universal
mandatory testing.

We are fairly liberal in allowing serological testing
for patients who are having surgery, either elective or on an
emergency basis if the surgeon wants to know or if the patient
has a risk factor for HIV-infection. There is a practical reason
to know, because the surgeons do different things in the
operating room for HIV-infected patients in terms of procedural
things, how they prepare the operating room, the number of
personnel who are assisting, the type of personnel who are
assisting.

MR. CREEDON: You want to respond, Mr. Schneiderman, at
all?

MR. SCHNEIDERMAN: Well, I prefer -- the policy I was
referring to had a CDC policy which generally contemplated the
concept of universal precautions, and that was it. If I
understand, the substance here is they would prefer not to have
universal mandatory testing. I would prefer to see a procedure
that encourages testing, but is not necessarily mandatory, and
informs patients in advance.

I think evidence has also indicated here that it is
very worthwhile information to know by doctors and health care
providers. Again, I think given the overall reliability of the
tests, and I’m talking about the sequential tests, ELISA twice
and Western Blot, I think it is a reliable test that we ought not
close our eyes to.

MR. DeVOS: Thank you, John.

DR. RHAME: There’s a wrinkle, I might just say here.
The question in part -- at the University of Minnesota Hospital,
about 300 anti-HIV serologies are done a month in this context.
It’s been that way for a long while because we’ve never
restricted people from doing it.

MR. CREEDON: How many a month?

DR. RHAME: Three hundred a month on patients.

MR. CREEDON: Out of how many operations?

DR. RHAME: I think they do around 16,000 operations a
year, or something like that. It’s a pretty good sized facility.

252

 

 
 

 

MR. CREEDON: So, out of 1,500, 300 are done?

DR. RHAME: Not one has turned up an HIV infection ina
person who was unexpected or had no known risk factors or no
conceded risk factors. So, it’s really very inefficient in many
parts of the world in terms of getting to it.

What is interesting, and the wrinkle I want to put
forth to you is to what extent is the hospital obliged to make
sure that the individual surgeon is, in fact, doing the
counseling and consent correctly. There is evidence which has
been produced in St. Paul Ramsey Hospital in the Twin Cities area
to suggest, and I think it’s my experience as well, that the
hospitals are -- that oftentimes there is no evidence in the
chart that there has been adequate counseling and consent.

So, to my mind the issues are, what do you do with the
person who refuses the serology, and what are you going to do as
a hospital? To what extent are you obliged to make sure that the
individual doctors in your hospital are observing the things that
I feel should be done ethically in approaching the patients?

MR. SCHNEIDERMAN: Can I just say that I’m not against
refusing service at all. That’s not at all what I have in mind.
I will say that one day, given even the infrequency of this
event, if a person goes into a hospital for a hip operation and
comes out with AIDS because of blood transmission through the
surgeon, there is going to be one major law case. I’m not sure
we ought to wait for that. But, I think these are concerns. We
have to deal with frequency over balance against the tragic
results.

DR. RHAME: There will be an HIV infection
transmission to a surgeon for sure. If you’re lucky, it will
happen while your Commission is no longer in existence.

MR. DevVOS: Penny?

MS. PULLEN: Mr. Schneiderman, you said, "I am not
against refusing service." Did you mean, I’m not for refusing
service?

MR. SCHNEIDERMAN: Yes. I’m sorry. Thank you very
much for that correction, if we’re on video tape in particular.

MS. PULLEN: I didn’t think you wanted a misstatement
on the record on something like that.

MR. SCHNEIDERMAN: I appreciate that.

MS. PULLEN: Doctor Rhame, in your paper you indicate
that people whose immune systems have been compromised can render

253

 

 
a false negative on the tuberculin skin test. How difficult is
it to diagnose someone's tuberculosis if they are HIV-infected or
otherwise immune compromised, and are there diagnoses missed on
this?

DR. RHAME: It can be very easy to miss. There are a
couple elements which go into the hazard side of this thing.
One is that TB is sometimes the very first manifestation of
illness in an HIV-infected person, so you may not even know
they’re HIV-infected at that point. They can be skin test
negative by virtue of their abnormal immune system, because it
takes a normal immune system to produce the red lump that
develops in those of us who have a positive skin test.

So, it can be very difficult to diagnose, particularly
if it’s disseminated and doesn’t produce an abnormal chest x-ray.
You might not get it for a while. It is, however, those cases
which are the most difficult to diagnose which are the least
likely to be infectious. Because, that person without any
abnormality in the chest x-ray is probably hardly infectious at
all. .

TB infectiousness is extraordinarily variable, so you
will find that case where you get one extremely infectious person
who can infect a whole bunch of people around them. The
majority, probably 80 or 90 percent of TB patients are hardly
infectious at all. But, that’s absent AIDS. It’s probably even
higher in the AIDS context. So, it can be very difficult to
diagnose for sure.

MS. PULLEN: Do you see any implications relating to
the TB connection concerning the placement of people who are HIV-
infected -- whether they are AIDS patients or sick for some other
reason and are HIV-infected and may be carrying tuberculosis and

may not have been diagnosed -~- putting those people into nursing:
homes?

DR. RHAME: I think that --

MS. PULLEN: I mean, in terms of with elderly infirm
people, not in terms of a nursing home that is there for AIDS
patients.

DR. RHAME: Or even worse, around children. Because, I
think TB is a bigger hazard to those under six than it is to the
elderly.

MS. PULLEN: Well, in your paper you do indicate that

old age can be one of the aspects of the difficulty of fighting
off a TB infection if one picks it up.

254
DR. RHAME: For sure. I think there is an increased
risk of exposure on the part of people in the workplace around
HIV-infected people. It’s not large, but there is definitely an
increased risk.

I’m just basically arguing that I don’t think the
magnitude of the increased risk is high enough. It’s counter-
balanced by the relative infectiousness, and if the HIV-infected
person gets adequate medical care the diagnosis will be made and
the treatment started before the infectiousness gets to a point
where it’s substantial.

We will have to do contact evaluations of the people
around those HIV-infected people who get TB to make sure no
transmissions have occurred. So, --

MS. PULLEN: One of the policy considerations that’s
going on right now in terms of the care and treatment of people
with AIDS is whether they should be placed in nursing homes,
whether nursing homes that already have an elderly population
should be encouraged or given incentives to take and treat AIDS
patients.

It has been presented to me that one of the problems
with that is that nursing homes typically do not take people who
have infectious conditions and consequently don’t have the
training and the equipment and the policies and procedures for
infectious conditions.

But, beyond that, what I want to ask you is, in such
policy considerations about placement of AIDS patients in nursing
homes, should the risk of tuberculosis transmission to the other
patients in that nursing home or to the care providers and then
to the other patients be a consideration in that policy?

DR. RHAME: It should certainly be considered, but I
don’t think it’s substantial enough to keep those patients out of
nursing homes. Nursing homes are probably a little better off
than other work places actually, because by and large they’ve got
baseline skin tests on all of the employees and clients in the
nursing home. So, they’re actually probably in a little better
Shape for managing those exposure episodes which occur. Those
episodes will occur and they will require management.

MS. PULLEN: Does that mean at least we'd be able to
find out whether it was because of that because we already know
the person used to be negative?

DR. RHAME: Right, exactly.

MS. PULLEN: I/’d rather prevent the infection.

255
DR. RHAME: We do have -- in this country today, one
out of every 10,000 Americans gets TB every year. 50, even
independent of the HIV infection we all have some risk of being
exposed to TB.

MR. DevOS: Thank you, Penny. We’re going to move on.
Burt?

DR. LEE: A note for Doctor McArthur. We did have Dick
Price here. Our opening gun in New York, he was a featured
speaker in last September and a lot of his reprints were
submitted for the record. He was unable to be here today,
actually. We invited him again, which was unusual.

I am fascinated by this problem, though. I was there
for that whole neurologic/psychiatric meeting at Rockefeller and
Memorial last October. I don’t know if you attended it. But,
the statistics there were so striking, because it was 80 to 90
percent of the people who die of AIDS are going to end up with
some kind of neuropsychiatric manifestation, and 20 percent of
them are going to present with that feature according to some of
the observers at that conference.

And then, we hear from the military -- and they were
strong about it -- a month or two ago. They didn’t buy it, and
you don’t buy it. It’s a very key point. Obviously, what you’re
looking at are the really higher integrated functions, the
judgement, the memory, maybe affect, et cetera, the first things
that you start to notice. I know the tests can’t be that good.
How firm to you feel about your position on this point?

DR. McARTHUR: I feel a lot firmer having discussed
this within the last two weeks with Richard Price. I wish he had
been here, because I think he could clarify some of his more
recent thinking on this.

Let’s just take two groups of patients, the
asymptomatic HIV-infected persons first. Basically, what we’re
saying, or what I’m saying representing at least on on-going
study -- what the U.S. Air Force is saying, and I’ve referenced
them in my written testimony, and in fact what Richard Price’s
group is saying, is that asymptomatic HIV-infected individuals
don’t have clinically significant dementia, on the basis of HIV.

DR. LEE: Until other things happen.
DR. McARTHUR: Yes. But, of course --

DR. LEE: In other words, it’s never the first thing
that happens.

DR. MCARTHUR: "Never" is not a word one uses much.

256
DR. LEE: Yes.

MR. DeVOS: For a guy that young-looking, Burt, he
knows a lot.

DR. MCARTHUR: "Never" is, you know, a relative tern.
But, in terms of policy statements, in terms of health policy, in
terms of implications for the population, my belief is that
asymptomatic HIV-infected individuals do not have clinically
significant impairment.

That doesn’t mean that if you run four hours of
neuropsychological testing, one out of those 30 tests might not
pop up as abnormal. That has no relevance in my view for their
day to day function.

DR. LEE: How many of ARC cases have it?

DR. MCARTHUR: Well, that’s the one group. I said I
wanted to talk about two groups, because the information is
better for the groups at the most extreme ends of the spectrun,
the asymptomatic healthy infected individuals and for the
patients with full-blown AIDS.

There’s been less work done in patients with ARC,
partly because people disagree as to exactly what ARC
constitutes, exactly what the symptoms are that make ARC. We
have to bear in mind that all of these definitions are somewhat
arbitrary. They are just words. Maybe what we should be looking
at is a more systemic evaluation, they’re degree of immune
compromise, their level of T-helper lymphocytes, rather than
these arbitrary words.

But, anyway, the second group is the group with AIDS.
Doctor Price and the Memorial Sloan-Kettering group and our
group, if we do full neuropsychological testing, if we apply all
of the tests in our books to patients who are in the hospital
with, say, pneumocystis carinii pneumonia, we’ll find
abnormalities in 80 to 90 percent of them. But, as I. said
before, that doesn’t mean, in my book, that they are
significantly demented, necessarily. It’s very hard sometimes to
explain exactly what is causing those test abnormalities. Could
it be a result of what’s going on in the rest of their body? It
doesn’t necessarily mean that they’re demented.

Just one last sentence. I think there is less
disparity in the observations that are being made by Price, by
Grant, by us, by the Air Force, than would appear at first sight.
I think we’re basically coming towards a consensus. The numbers
may be a little different. Some groups may say five percent,
some groups 15 percent, but I think the overall message is
relatively clear.

257
DR. LEE: Could I ask, Doctor Rhame, just one thing?
You omitted amebiasis and hepatitis from your schedule there. It
was a beautiful article you wrote. How about food handlers? Did
you omit it for reasons?

DR. RHAME: My answer there is that in my mind the
answer there is that ordinary hygiene on the part of the HIV-
infected person should prevent the issue. Food-borne amebiasis
transmission is not very common, but salmonella could. There
certainly are chronic salmonella excretors probably a little more
commonly among the HIV-infected people and other persons.

But, it really takes a gross breach of ordinary hygiene
on the part of the food handler for that to be a problem. I
think that’s the protection we have. One percent of Americans
have salmonella in their stool, so we’re not -- it’s a big
background in which there might be a slight increase in
salmonella excretion.

DR. LEE: Thanks.

MR. DevOS: Thanks, Doctor Lee. We’re going to go to
the Admiral a moment.

CHAIRMAN WATKINS: Doctor Rhame, we’ve been seeking
Some source of advice to those that are HIV-positive that would
give them both hope on the one hand, and also better advice as to
what to do with themselves on the other in terms of exposing
themselves to operantistic infection opportunities.

Now, you’ve given us a menu of things here. It’s the
first time I’ve seen this, but then I don’t read the Journal of
the American Medical Association and the New England Journal of
Medicine and all those sorts of things. Is the list that you
give all inclusive? Has it been well accepted, at least at this
point in time, as the kind of advice that HIV-positive
individuals should be advised of?

It seems to me that if you could take that and convert
it to English, such as coccidioidomycosis endemicity. Is that
some kind of a little parasitic mealy bug or something? And
can’t we say it that way so people would really understand, and
where is it?

I mean, in other words, is there a way to convert this
into a menu of recommended health practices that a person that’s
HIV-infected could follow and enhance his deterrence to getting
opportunistic infections of the type you listed here? And is
there something being worked on within the medical profession to
come out with something that’s accepted across the nation, at
least at this point in time to the extent we know it?

258
DR. RHAME: I don’t know that any such set of
recommendations has been prepared for HIV-infected people. The
list is my own. The AIDS-defining pathogens are out of the CDC’s
AIDS definition, but the right-hand column is my own.

CHAIRMAN WATKINS: Is it worthy of us recommending that
we should ~- that the proper authorities should come together and
produce such a thing? It seems to me it’s another point of
sensitivity to those infected, that we’re trying to do the best
we can. We’re somewhat short-changed, I think, on our ability to
deal with can you build a set of their own health practices that
enhance their lifespan. That hasn’t been that clear from anybody
that’s come before us.

On the other hand, you’re telling them, "These are
opportunities you should not expose yourself to."

DR. RHAME: That’s an extraordinarily good idea. The
most common question that I get as a physician caring for HIV-
infected people is, "What can I do to maximize my health
opportunity." And the bottom line, basically, that I wind up
saying, unhappily, is, "Basically, do whatever everyone should
do. You know, get enough sleep and exercise and don’t smoke and
don’t drink too much and, you know, think peaceful thoughts, and
have a good diet." I mean, that’s basically what you say.

But, I think you could produce, in fact, some concrete
statements out of it. I think this list isn’t all-inclusive,
because it really trails off to pathogens which have only a
Slight, very slight increased hazard to HIV-infected people. So,
you could draw the boundaries. Some people would want to throw
nocardia off this list, because the number of extra infections
which occur in HIV-infected people is not great. But, it’s
probably a little bit, so I put it on.

All those common things, like influenza and colds and
so forth look like they probably aren’t any worse in HIV-infected
people than they are in anybody else, or aren’t any more problen.
So, I think that as far as just going out into society, there’s
really no reason the HIV-infected person shouldn’t have a
totally normal existence in that kind of thing.

These weird things I have in recommendation 3 there
probably apply to 1000 of the 1,000,000 HIV-infected people in
this country.

CHAIRMAN WATKINS: I see.

DR. RHAME: I mean, there really are very specialized
kinds of things. Although you could prepare a list which says,
"Don’t change your cat box if you’re toxoplasma sero-negative,"
that is, if you’ve never had it before, and "Don’t handle raw

259
steak without washing your hands." I mean, you could make a few
things like that.

CHAIRMAN WATKINS: Well, you’re making a
recommendation to us in your written document. That’s what I’m
trying to get at. Are you telling us, then, that it’s not a
significant recommendation?

DR. RHAME: No. I think you could produce, and it
would be desirable to produce a set of recommendations which
would not be applicable to a large part of anyone’s life, unless
you happen to be an earth-grader in Arizona where there is that
particular fungus, coccidioidomyces, growing in the soil.

So, for most people it would be a fairly minor change
in their lives, but it would be a good idea to have such a list
of things, official recommendations for maximizing your health if
you’re HIV-infected, and I don’t think it’s been prepared.

CHAIRMAN WATKINS: What about it, Doctor McArthur?

DR. McARTHUR: I think it’s very important for the
Commission that we don’t make the mistake that collectively the
medical profession did two or three years ago when we realized
the routes of transmission for HIV to health care workers. Many
of us became rather cavalier in terms of our approach to
patients, "Oh the risk is so low we don’t need to worry about
it." Then, along came the splash cases where health care workers
became infected through non-needle stick exposures, through
splashes on mucosal membranes.

I think both for the HIV-infected person and for the
non-infected health care worker treating them, the more we can do
to maximize health -- I realize the risks may be small and I
applaud Doctor Rhame for drawing up the list -- I think we need
to take it from here and I think it needs to be expanded into a
definite set of recommendations. Even though the risk may be
very small, I think it’s definitely worth spelling it out in
black and white on paper.

CHAIRMAN WATKINS: Who should be brought together to do
that, what leadership specifically?

DR. McARTHUR: Doctor Rhame should take total
responsibility --

CHAIRMAN WATKINS: Okay, I’ve got the picture. Thank
you.

I just have one other quick question. I’d like to get
just a specific answer if you have it. If you don’t, it would be
useful for me to get it.

260
When we were at San Francisco General, I asked a
specific question. How many times have surgeons going into
operations with patients indicated that this is in the best
interests of the patient to know the HIV-positive in a
confidential patient to doctor relationship. That has been
presented, and in no case that they could give me was that turned
down by the patient.

That is, specter of the patient refusing is always
there and thrown out on the table. I want to know how many times
you have had this situation arise where it’s in the best
interests of the individual to know, irrespective of the health
care provider or the surgeon doing the operation, and that
patient has turned it down. "I refuse to be tested, even though
you have advised me it’s in my own best interests because of the
operating procedures and the kinds of things that I may be
exposed to." How many?

DR. RHAME: There certainly have been -- we’ve had two
refusals that I know about in our hospital.

CHAIRMAN WATKINS: Out of how many?

DR. RHAME: Probably 2,000, something like that. Both
of them, I think, were refusals without -- in people who had had
no risk activities actually. They heard the counseling shtick
and they just said, "I don’t want to do it."

CHAIRMAN WATKINS: Doctor McArthur, how about in your
case?

DR. MCARTHUR: We’ve had several refusals, partly
because we’re so close to D.C., where people are extremely
concerned about having on their medical records the results, even
if they’re negative, of an HIV blood test.

CHAIRMAN WATKINS: Out of about how many, would you
say?

DR. MCARTHUR: Well, we’ve cared at Hopkins for about
800 patients with HIV infection.

CHATRMAN WATKINS: And you’ve had several?

DR. MCARTHUR: But, these by and large are probably
not infected patients. I mean --

DR. RHAME: I’m saying only -- now, the asymptomatic

screening context, to my mind the issues are very different in
the person who has symptoms --

261
CHAIRMAN WATKINS: But, I’m getting back to this point
of mandatory. Even under certain conditions, is it not -- within
the patient to doctor relationship that we have now -- isn’t it
doing most of the job, when it’s necessary from a medical point
of view?

DR. MCARTHUR: I think voluntary testing and
counseling works 99 percent of the time. If you explain to a
patient why you think it may be important to do the blood test, I
would agree with you, it’s very, very uncommon for them to
refuse.

CHAIRMAN WATKINS: Thank you.

MR. DevOS: We would like to thank all of you, Doctor
McArthur, Doctor Rhame, and Mr. Schneiderman, for joining us
today, and for your insightful views on this matter. We
appreciate it very much. Thank you very much.

We will immediately go to our next panel, and we/re
going to deal on the economic impact of all of this. We started
out this morning with an overview of AIDS in the workplace. We
moved on to specific examples of what various companies were
doing. We went from there to this panel on some of the possible
methods of further transmission of secondary diseases that are
affecting all of this. And finally, there’s a price tag for all
of that, and that moves us on over to the economic impact of some
of these things in the work place primarily.

We have one more panel later this afternoon, and that
panel will deal with public sector issues outside of the
Washington scene or the federal government, which we will be
taking testimony on next week in Washington. So, we will deal
with it as it relates to local communities and other state,
county, and municipal employees. So, we will be talking about
that at our next panel.

Economic Impact

This panel deals with economic impact. We have with us
the Honorable Frank S. Swain, Chief Counsel for Advocacy, U.S.
Small Business Administration, from Washington. Doctor David E.
Bloom, Professor of Economics, Columbia University, New York.
And Ms. Patricia A. Wiley, Managing Consultant, A. Foster Higgins
and Co., Inc., from New York.

So, we have three distinguished people who will deal
with the economics of all this, and we’1l begin with the
Honorable Frank S. Swain, Chief Counsel for Advocacy, U.S. Small
Business Administration, from Washington.

262
MR. SWAIN: Thank you very much, Mr. Chairman, and
members of the Panel. I’m indeed pleased to be asked to
participate in the Panel’s very important deliberations.

I’ve been able to follow some of the statements here
today. I understand this morning there was quite an extensive
discussion of the implications of the AIDS situation for the
workplace.

I think it’s important to point out, and our statement
attempts to make, basically three points: first, involving the
overall lay of the land, if you will, on where small businesses
are and how they operate; secondly, how that leads to some
implications on the challenge of informing employers and
employees of the various manifestations of the AIDS situation;
and third, how that leads, in our opinion, to some implications
involving the ability of small employers to cover their employees
with health insurance.

I’d like to summarize the high points of my statement.
I appreciate, as I mentioned, the Commission even taking a look
at the issue of small business. Because, it really is quite a
bit different than taking a look at how larger managed operations
deal with any given labor or personnel issue, whether it’s AIDS
or anything else.

Most of -- of course, it goes without saying that most
of the businesses in this country are very small. They do have a
Significant economic impact. The President issued a report
yesterday, his annual report on the state of small business,
which documents that through this most recent decade two out of
three of the new jobs in our economy, the net new jobs, came
from small firms.

Small firms in this country are defined as firms with
under 500 employees, although I might add that if you changed the
definition to under 100 it wouldn’t alter the statistics all that
much. Small firms employ over half of the non-government work
force and contribute about half of the gross national product.

I also might state that there is a strong labor
economics series of articles on the issues of labor mobility in
small business, which I think is relevant to this Panel to the
extent that small businesses do a lot of starting and failing.
They do a lot of growing and shrinking. They do a lot of hiring
and firing. So, although I don’t treat it formally in my
statement, to the extent that the issue is whether the employer
can, should, or must test or do anything else, bear in mind that
for every person that’s actually hired by a small firm there is a
lot of other hiring decisions going on. So, this is going to
have a particular impact on the smaller employer.

263
Now, small firms, I think, relative to the Panel, have
some different ways of operating than large firms.

First of all, you asked that I indicate what the
economic impact of the AIDS crisis is on small firms. Well, of
course we don’t know for sure. We can always take the statistics
and extrapolate from some total estimates of loss of productivity
and extrapolate in small firms. But, I think that I’d like to
focus the Panel, if you will, on the ability of small firms to
deal with the financial consequences of the AIDS situation.

First of all, most small firms have a relatively small
scale of income and profits. Therefore, the way they deal with
external factors, whether it’s AIDS or anything else, differs
very much from larger firms. The growth of AIDS cases may
exacerbate difficulties small employers already confront in
establishing employee benefits. It’s likely that health and life
insurers, aS we’ve seen some evidence of already, will tell you
of underwriting restrictions for small firm employers and
employees.

Secondly, small firms that are able to provide employee
benefits do not enjoy the benefits of a large pool, a large
underwriting pool. Because a small firm’s risk pool has fewer
employees among which to spread costs, one case of AIDS in the
work force could raise costs for experienced-rated benefits to
the point where the benefit is prohibitive for all employees.

Thirdly, large and small employers differ in their
ability to absorb other less measurable AIDS-related expenses,
such as costs for complying with legal requirements related to
discrimination, testing, and confidentiality. I mention this
because in preparation for our statement, and certainly other
witnesses have advised the Committee -- most recently, Mr.
Schneiderman -- that there is not only one federal law which may
or may not apply because the Rehabilitation Act applies only to
government contractors at the federal level -- but, there are 49
state laws that may or may not apply to businesses at various
sizes and that may have differing definitions of what exactly is
regarded as a disability or a handicap. And, in addition, there
seems to be some increased trend toward municipal or county level
laws.

The potential for all employees within a small firm to
learn that a co-worker has AIDS is greater than within a large
firm. I think the potential for workplace discussion and
apprehension is a great deal larger. In effect, the small firm
manager is in a considerably different legal environment and I
think management environment than a larger firm.

In particular, we would like to point out the fact that
small firms in certain industries may well have greater

264
difficulties working within a competitive health insurance system
in the sense that there is some evidence that a number of
insurers are avoiding coverage of certain industries where they
make a judgment that those industries may be highly populated by
employees that may have a particular sensitivity to AIDS.

We’re not making a statement of whether there ought to
be employee testing or there ought not to be employee testing and
not making a statement on whether carriers ought to do testing or
not. What I am saying is that for carriers to write off an
entire industry or entire industries that are highly populated by
small firms because of some rather summary judgments about the
likelihood of losses because of AIDS in certain specific
companies, I think is inappropriate and certainly falls against,
as we read them, the guidelines of the National Association of
State Insurance Commissioners.

To summarize, we make two types of policy
recommendations, one involving awareness for small employers and
the other involving issues relating to underwriting. Just as the
economics of management are different in small firms, the
economics of delivery of information are different. I
congratulate those many companies that are preparing some very
sophisticated materials. Usually small firms can’t afford to buy
sophisticated materials and so the very essence of how one
delivers information to the small employer is considerably
different.

We would suggest that low cost or free education
materials providing general legal AIDS related information
specific to small firms should be disseminated to small
employers. The question naturally arises, who and how and who
will pay for it? In trying to think about this issue, I’m aware,
of course, that Doctor Koop is about to mail to every household
through HHS a flyer of general information on AIDS.

The Social Security Administration and the Internal
Revenue Service are the only two sources of the names and
addresses of every employer in this country. There’s no private
sector organization that has it. There are lots of companies
that sell lists and Dun and Bradstreet, of course, sell lists,
but it seems to me at least worth discussing that if the
Commission is interested in getting the word out on the workplace
implications of AIDS and AIDS policies, that it may well look
into whether IRS or SSA, which after all keeps employer
identification numbers -- you can’t hire a person in this country
without applying to the IRS for an employer identification number
-- might be an appropriate way to disseminate a basic brochure on
workplace responsibilities.

After. all, there are about five million employers.
There are about 13,000 companies in this country that have more

265
than 500 employees and all the rest have fewer than 500. So, if
the challenge is getting the word out, then just as HHS seems to
feel it appropriate to send to every household, it may well be
appropriate to send to every employer through the IRS or through
the Social Security Administration. Of course, our agency and
several others could assist in writing or producing such a
brochure.

Secondly, we suggest, of course, that National
Leadership Coalition on AIDS and other representatives that are
interested in the AIDS situation pay particular attention to
attempting to focus their materials and dissemination of their
materials to smaller firms.

In the area of employee benefits, our testimony, our
statement points out what I think is a particularly vexing public
policy issue, that is to say that there are about eight million
people in this country who work who don’t have any health
insurance at all. About six million of those eight million do
work for small firms. So, whether we’re talking about AIDS or
any other health issue, there are a lot of people that work for
small businesses that don’t have health insurance coverage.

Now, I say that fairly directly because I think it is
due to the fact, and we’ve taken quite a close look at this
issue. It is due to the fact that the people that don’t have
health insurance coverage tend to be working for firms that are
generally start-up firms or the very smallest firms, firms of
fewer than ten employees. In fact, 40 percent of the companies
that don’t have health insurance problems are mom and pop grocery
stories with fewer than ten employers, literally the corner store
that may well be a family type business.

So, the issue of how to solve the access to health
insurance for all employees is not a simple one. As a side bar
to this discussion, I personally do not agree with the approach
that the government can mandate that that insurance coverage be
provided because I think it’s just going to end up trying to
square the circle. There are a lot of these companies that
cannot afford coverage now and a government regulation saying
they have to provide it is simply not going to solve the problen.

But, of course, when one is discussing on how the AIDS
crisis will impact small firms, one can take a particular look at
the issues of non-provision of benefits in small firms and we
think that that’s why you have to take a look at a variety of
options that would seek to encourage coverage by small companies
of their workers. That’s why we’re particularly concerned about
whatever trends there may be about insurers pulling out of the
market of writing small firm coverage. A very large company does
not, generally speaking, have medical underwriting. There’s such
a large pool that it may well be self insured or, if not insured,

266
that the carrier will feel that everything actuarially evens
itself out and there won’t be medical underwriting.

All literature says that most small group plans are
medically underwritten. So, if there is a discovery of an AIDS
case or a potential AIDS case in a small group plan, the results
for underwriting are going to be, I think, immediate and much
more significant, either withdrawal of coverage absolutely or
significant increase in the premiums.

I think that the issue is whether carriers are carving
out entire industries that are largely populated by small firms.
One can argue that there’s a lot of insurance out there and they
can always buy it someplace. But the point is that if you’re
trying to encourage small employers to cover their employees
with insurance, they need to have a variety of competitively
priced options. And if there are just one or two companies
writing insurance in a particular industry, then I think that
discourages the tendency of small firms to cover their employees
where they don’t already have the insurance.

MR. DeVOS: Mr. Swain, I’m going to ask you to
conclude and then we’re going to move on here in a minute.

MR. SWAIN: Well, I got just about to the end of the
statement, Mr. Chairman, except to note that we think the
Commission should urge states to adopt the insurance
commissioner’s model underwriting guidelines. I think that would
solve some of the problems that we’ve noted and take a closer
look at the issue of how small firms are underwritten and
certainly also take a look at the results under state risk pools
which have been established in ten states.

Thank you, Mr. Chairman.

MR. DeVOS: Thank you. You’re going to have more
chance to talk. We/’re just going to try to get everybody in
here.

MR. SWAIN: That’s quite all right.

MR. DeVOS: Doctor Bloom is Professor of Economics, I
believe, at Columbia. We‘re honored to have you here this
afternoon.

DR. BLOOM: Thank you, Mr. Chairman. My name is David
Bloom and I’m a professor of Economics at Columbia University and
a Research Associate at the National Bureau of Economic Research.

I’m primarily a labor and population economist and I’ve
been working on economic aspects of the problem of AIDS for a
little over one year now. I’ve come to Indianapolis with my

267
colleague, Sherry Glied, who is sitting just behind me and who is
available to help answer any questions you might have.

MR. DeVOS: Why don’t you bring her up and let her sit
over here so we can see her a little better, okay?

DR. BLOOM: Okay. I think that would be quite
appropriate.

MR. DevVoOS: That’s such a low down seat back there
behind you. Why don’t you introduce her again, so they can all
see her better?

DR. BLOOM: My colleague, Sherry Glied, who is a PhD
candidate in the Department of Economics at Harvard University,
and a specialist on the economics of legal issues.

MR. DevVOS: Okay. We want to welcome you as well.

DR. BLOOM: We/’re here to report to the Commission on
the preliminary results of an on-going study that we’re
conducting on the impact of the AIDS epidemic on the American
labor market.

The results we have to report today are in many
respects quite disturbing. Our analysis of data contained in the
Census Bureau’s 1980 and 1987 current population surveys reveals
some evidence that the AIDS epidemic has led to labor market
discrimination against single males over the age of 30 in the
City of San Francisco.

Now, let me relate to you right at the outset the
principal facts supporting this conclusion. In San Francisco,
the unemployment rate of males aged 18 to 65 was identical in
March 1980, what we refer to as the "pre-AIDS era," and March
1987, what we think of as the "present AIDS era." In both years,
the unemployment rate among males aged 18 to 65 in San Francisco
was 6.1 percent.

But, the unemployment rate of males age 30 and over who
were not married increased by a factor of five between those
years, from 2.3 percent to nearly 12 percent, 11.8 percent. This
is a remarkable increase in the unemployment rate that occurred
between the pre-AIDS era and the present AIDS era. In contrast,
the unemployment rate of all other adult males in San Francisco
actually declined between those two years by about a third, from
6.8 percent to 4.6 percent.

\

Now, this finding does not constitute direct evidence
of discrimination. Although we don’t find evidence of such
dramatically different movements in male unemployment rates in
other cities in the U.S., this finding does provide some

268
indication that the labor market is responding to the AIDS
epidemic by discriminating against individuals who are either
known to be members of high risk groups or are perceived to be
likely members of such groups.

There are two main reasons why we think this finding
reflects discrimination. First, the most natural alternative
interpretation of our result, namely that the unemployment rate
for single males in San Francisco increased because many were too
sick to work, that alternative interpretation is not supported
by another analysis we did of labor force participation data.
Moreover, the definition of unemployment itself requires that
someone be available for and actively seeking employment.

The second and really the main reason why we think our
finding reflects discrimination is that it can be quite costly to
a firm to employ an individual who subsequently develops AIDS.
These costs can include increased health and life insurance
premiums and lost investments in hiring and training, as well as
less visible costs that arise from the fears and perceptions of
co-workers, customers and employers themselves.

Our rough estimate of the expected, of the perceived
cost to an employer of employing an individual who is known to be
a homosexual or a bisexual male in San Francisco or New York City
is in the range $3,200 to $14,000. This reflects a lower bound
estimate of the additional cost over the expected duration of
employment that a typical employer is likely to perceive when he
or she compares the cost of employing a member of that high risk
group to the cost of employing an otherwise comparable
individual who is not a member of that high risk group.

Now, before I conclude this statement, I’d like to draw
attention to one other prominent feature of labor market
discrimination resulting from the AIDS epidemic. That is that the
group of individuals suffering this discrimination consists of
all individuals with demographic characteristics that make them
likely members of high risk groups. The group discriminated
against is broader than the group of individuals who are truly at
high risk for the development of AIDS. It is even more broad in
comparison to the group of individuals who will ever test
positive for HIV. And it is considerably more broad than the
group of individuals who will ever develop AIDS.

In other words, many, many individuals who will never
develop AIDS are being discriminated against as a consequence of
the way the labor market is dealing with the epidemic. They’re
being discriminated against because of two key features of the
current legal environment. First, because in most jurisdictions
employers cannot legally discriminate against workers who
actually have been diagnosed as having AIDS or AIDS related
complex. Second, because employers can in most jurisdictions

269
legally discriminate against individuals who are not otherwise
known to be HIV positive.

The American economy operates primarily on the profit
principal. Thus, our reasoning in this matter is very simple.
The AIDS epidemic gives employers an incentive to discriminate
against individuals perceived to have a non-trivial risk of
developing AIDS because the epidemic increases the cost to
employers of employing such individuals.

Put another way, because employers generally do not
know whether an employee will ever develop AIDS and because the
law prescribes discrimination against workers who are ill, the
law effectively encourages employers to make guesses about who
will become ill and to discriminate accordingly.

Now, let me conclude by saying the following. What Ms.
Glied and I have produced are some plausible facts about the
impact of the AIDS epidemic on the labor market. Our analysis is
not an invitation for industry to discriminate. It is just
iuformation on what actually is happening. If our basic message
is upheld in further analyses, and if American society is
sufficiently unhappy about the content of that message, it seems
absolutely clear to us that market forces will have to be
actively redirected to alter this situation. Thank you.

MR. DeVOS: Good. Doctor Bloom and Ms. Glied, we
thank you for your contribution and your fine work in this field.

MR. DevoS: Ms. Wiley is next and she comes from New
York City and the firm of A. Foster Higgins. Welcome to you.

MS. WILEY: Thank you, Mr. Chairman. We are a
management consulting firm and work primarily with employers,
large employers as opposed to Mr. Swain’s discussing smaller
employers. These are companies who usually have more than 500
employers and anywhere up to probably a quarter of a million or
more employees.

I was asked to talk about the practical issues for
employers who are facing increased workplace costs due to AIDS.
My focus is primarily on the costs of employer sponsored benefit
plans, that is their life, disability, and health insurance
plans.

My comments are based on the written data I submitted,
including a survey Foster Higgins conducted entitled, "Company
Practices and Procedures: AIDS and Benefit Plans," and my written
testimony and recommendations. The statistics 1/11 cite today
are all from this survey. If there’s any myth I’ve encountered
in the non-business world about how business treats AIDS it’s
this, that employers and insurance companies will go to any

270
length to avoid paying claims if the cause of the death or
disability or medical expense is AIDS. Well, this is simply not
true. Most companies are not avoiding the challenge of the cost
of AIDS. A solid majority, 81 percent, believe that employers
should bear the major cost of treating AIDS for the participants
in their own benefit plans. An even greater number, 87 percent,
believe that AIDS should be covered by their benefit plans the
same way any other life threatening illness is covered.

This evidence points to acceptance by employers of
their economic responsibility and their recognition of their own
benefit plans as a major funding source for medical treatment.

The real concern for business over the next several
years will be finding ways to manage those AIDS related expenses.
While I’m pleased to report that for the most part employers have
accepted a financial role in the AIDS crisis, we do worry that
employers are missing opportunities to manage those anticipated
cost increases. And AIDS will inevitably bring cost increases to
employers because the cost of AIDS related benefits eventually
rests with the employer.

If an employer has to pay them now or later, and as
that later gets nearer to each employer as the number of AIDS
cases increases, why not have employers seize the opportunities
that are available now to manage those costs?

I thought I’d highlight for you a couple of things we
see as the opportunities for employers. First is an ability to
measure the potential cost to the organization. It is possible
to estimate the number of workers and their dependents who might
become infected, to estimate the hard dollar expenditures for the
life, disability and medical programs, and at least begin to
measure some of the soft dollar issues like worker productivity.

Employers can also write and communicate a management
policy for catastrophic illness and we’ve heard a lot about that
today. But then also use the management tools that are available
to them to help control their costs.

Probably the best example in medical plans is the case
management program. Medical case management programs are
designed to help patients experiencing catastrophic illnesses by
having an assigned case manager work with the patient and their
physician to outline the alternatives to acute care, arrange for
the care itself and facilitate payment for that care through the
employers benefit plan. The patient has an advocate and help
getting services and the employer can be sure that they’ve
provided cost effective benefits.

Next, employers can recognize just how effective a
communicator they can be. As a very credible source of

271
information for employees, their families and the public,
employers can control short-term costs like employment disruption
and long-term costs like medical expenses by educating about the
disease. Our surveys show that 82 percent of employers thought
they should be involved in AIDS education but only 28 percent
were doing so.

Finally, there are still many companies who do not
recognize that AIDS is very much the business of business. Their
involvement needs to start with top management because AIDS will
eventually impact their bottom line.

So, despite the fact that AIDS means talking about
something that usually doesn’t come up in polite business
conversation, like sex and drug use and death, it needs to be
addressed in business, preferably before the employer is
literally faced with AIDS. If you wait, you lose the advantage
of a planned policy and you spend more time and money catching

up.

The last point is that employers really do need support
to meet their challenges and look toward government in some
areas. For example, hospices, home health care and extended care
facilities are a cornerstone to an employers management of their
health care costs. An employer can hire a case manager to
determine the appropriateness of the alternatives to acute care,
but what does that employer do if there’s no hospice in an area,
if a nursing home won’t accept an AIDS patient or if there are
not enough home health care workers to meet demand. This is an
area where employers would like to see some government
stimulation or possibly regulation to open up those things.

I’ve tried to highlight some of the challenges we see
employers facing and our recommendations for meeting then.
Personally, it’s been occasionally frustrating, but for the most
part gratifying for me to work with my corporate and non-profit
clients to help them meet the dual demands of AIDS, of balancing
their financial or economic concerns with fairness for their
employees. I want to thank the Commission for having me here to
testify.

MR. DeVOS: Good. Thank you, Ms. Wiley. Beny?

DR. PRIMM: No questions.

MR. DevOS: Okay. Colleen?

DR. CONWAY-WELCH: No questions.

MR. DevOS: John? Mike please, John. We don’t want to

miss the voice of Metropolitan.

272
MR. CREEDON: Doctor Bloom mentioned that his studies
suggested, I guess -- the conclusions were not clear -- that in
San Francisco there may be some discrimination in employment
taking place. I wonder whether you’ve thought about how we might
deal with that if it does in fact exist.

DR. BLOOM: That wasn’t the primary concern we had in
the project so far. I guess I don’t feel that we’ve thought
about it enough to make any in-depth recommendations. We/’re just
interested in establishing that yes, there seems to be some
discrimination out there and it makes sense.

MR. CREEDON: Not enough at this point to be
concerned? Is that what you’re saying?

DR. BLOOM: I think we should be very concerned. The
unemployment rate of single males over the age of 30 in San
Francisco quadrupled between 1980 and 1987. So, I think we
should be very concerned. I think we can expect to see that
spread beyond San Francisco in the coming years and I think it’s
an indication of how the American labor market is responding to
the AIDS epidemic. I think it’s a very serious issue.

MR. CREEDON: Well, I guess my question is, do you have
any suggestions as to how to deal with it?

DR. BLOOM: No, I heard your question the first time.
I can give you a menu of options, but as I say, I don’t really
feel capable of going into the pros and cons of each. There are
things like anti-discrimination legislation, government --

MR. CREEDON: Well, there is such legislation now.

DR. BLOOM: There is such legislation now, but as I
mentioned, while it prohibits discrimination against people who
are actually diagnosed as having AIDS, it doesn’t say anything
about people who you suspect of being likely to develop AIDS. So
there’s no legislation that prohibits discrimination in most
jurisdictions. There are some exceptions.

As a government health insurance to cover AIDS, for
example, covering AIDS under Medicare such as the exception
that’s made for end state renal disease. That would be another
way to limit the costs that employers would have to face if they
employed individuals who eventually developed AIDS. By limiting
those costs, there would be less incentive for employers to
discriminate.

There are a variety of possibilities. It’s still an
early stage of the research, so I don’t have much more to say.

MR. CREEDON: Thank you.

273
MR. DevVOS: Burt?
DR. LEE: I/’11 pass. I wasn’t here.
MR. DevOS: Frank?

DR. LILLY:: Well, I was extremely fascinated with your
research so far. We’ve already heard a great deal about AIDS
related discrimination in this panel. I’m not sure that we’ve
heard what your message is. I think it’s one that we need to
hear.

I want to pick up where Mr. Creedon left off in
questioning what we might do about this. I wonder if it is
adequate -- I personally doubt that it is -- but what do you
think would be the impact of stating in legislation or
regulations or whatever about AIDS related discrimination that
not only can one not discriminate against people with AIDS or
with HIV infection, but one cannot discriminate against people
perceived to be in those two categories? What would be the
effect of such recommendations?

DR. BLOOM: Well, there is actually some legislation
along those lines that is already in effect. Going the
legislative route to try to outlaw discrimination is quite
difficult. Number one, it’s very difficult to prove
discrimination. Number two, I think the experience of women and
blacks in this country indicate that that hasn’t been very
effective. We all know that there is legislation in Title VII of
the Civil Rights Act of 1964 which prohibits employment
discrimination against women and blacks, et cetera. I don’t
think it should be a surprise to any of us that there is still
persistent discrimination against those groups.

DR. LILLY:: Yes. I don’t think the Ten Commandments
eliminated sin either somehow. On the other hand, I’m not sure
that I agree with you that the federal anti-racial
discrimination statutes have failed to do any good whatsoever.
Certainly they have not solved the problem, I agree with you.

DR. BLOOM: Actually, it might be useful if Ms. Glied
would just say a word or two about the type of statutes -- I mean
there are some examples of the kind of thing that you’re
mentioning. Maybe she could just say a word or two about that.

MS. GLIED: Actually, San Francisco has a municipal
ordinance that does prohibit discrimination against both
homosexuals and people who are perceived to be at high risk for
AIDS. That doesn’t seem to be completely solving the problem.

There’s also the problem that if you define the law
quite narrowly -- however narrowly --

274
DR. LILLY:: Is it possible that the problem would be a
lot worse in the absence of that?

MS. GLIED: Oh, it’s entirely possible that it would be
worse. But there is this sort of additional problem that if you
define the law to protect a narrow group, employers can always go
one step back and just find some other characteristic that’s
correlated with --

DR. LILLY:: “You smell bad."

MS. GLIED: Right. So, you can only go so far as long
as the economic incentives are there for the employer to
discriminate. They’re going to try and do it if they can.

DR. LILLY:: So, you think the situation is pretty
hopeless?

MS. GLIED: No, I think the law.can certainly be
helpful, but I just don’t know whether it can solve the whole
problem.

MR. SWAIN: May I make a comment, Doctor Lilly?
DR. LILLY:: Please.

MR. SWAIN: This month’s issue of Inc. magazine, which
of course is a magazine that’s targeted on managers of small
firms, I think has a questionnaire, "Fear of AIDS," and it
relates that 40 percent of the personnel managers ranked co-
workers fear as a major factor, but only 11 percent ranked
potential for increased health insurance costs.

So, I think the point is, why do employers
discriminate regardless of whether the law says it’s right or
wrong and whether it can be proven? It seems to me that there
are at least two reasons, and maybe in certain industries, food
and so on, there are third reasons. But the two primary reasons
seem to be co-workers’ apprehension and health insurance costs.

The solutions to each of those I think are quite
different. The result is the same, discrimination, but the
solutions are different. The seems to me the co-workers
apprehension solution is a bit more possible. That is increased
information, as we’ve had some discussion on here today and I’m
sure you have at your other sessions, on how you get AIDS, how
you transmit it to co-workers, customers, clients and so on.

The solution to the health insurance issue is entirely
different and much more complicated. So I think that one
approach is strengthening laws. For the reasons that have
already been cited, that’s not a perfect approach. But another

275
approach is trying to solve some of the basic reasons on why
discrimination exists in the first place. Perhaps if there were
wider awareness among smaller employers in particular of the
consequences, and in many cases the entirely benign consequences
of hiring an individual that has AIDS or AIDS related syndromes,
then that might eliminate some of the economic reason for the
discrimination in the first place.

DR. BLOOM: Perhaps I could just make a footnote to
that comment. That is that many small businesses are not very
experience rated when it comes to their health insurance. Ina
sense, they don’t end up paying the costs in terms of higher
premiums or it’s spread over a much, much wider group. I think
perhaps that’s the reason why a relatively low fraction of
companies in this survey indicated that increased health
insurance premiums are not a major concern. In that respect,
there’s a big difference between large firms and small firms
because the extent of experience rating is much greater in large
firms.

MR. CREEDON: But that could be very temporary because
the number of cases that have surfaced so far in relation to what
will surface based on projections is quite small.

DR. BLOOM: I don’t understand. Why does that make it:

temporary that small firms are less experience rated?
\

MR. CREEDON: No, I’m saying that the impact of AIDS on
small business health insurance premiums hasn’t really been felt

et. .
¥ \

DR. BLOOM: Even) if there’s an increase in the number
of cases --

MR. CREEDON: Ten years from now it’s going to be quite
different.

DR. BLOOM: -- they will not be paying--

I mean the personal medical care costs of treating AIDS have been
estimated between $40,000 and $80,000. Now, if you’re not
experience rated, you don’t end up paying that. You pay a
portion of it--

MR. CREEDON: Yes.

DR. BLOOM: -- but a much smaller portion. I think
that’s a big difference between small firms and large firms.

MR. CREEDON: Yes, but if there are a couple of million
people out there that have it and come down with it, that’s
significant.

276
MR. DeVOS: Okay. Kris?

MRS. GEBBIE: This is going to be a somewhat muddled
question, I think.

What I’ve heard this afternoon is a little bit
different than what we’ve heard a couple of other times and
places. Particularly, this morning we had a witness who affirmed
that the direct economic consequences of HIV-infected employees
were so dire for small businesses, were so overwhelming to so
many small businesses, that some fairly large-scale effort
needed to be mounted to protect them from going under. The
particular suggestion made didn’t make a lot of sense to at least
several of us on the Commission, but the point was clearly made.

Yet, as I listened to what’s been said here, I hear a
need for education, which is consistent with what we’ve heard at
other times and places and not particularly unique to small
business although we have to find a new mechanism to give it to
them.

And then, the point that the illness insurance costs
for their employees need to be dealt with, but that that’s not an
AIDS-specific issue. That’s a small business cost of doing
business related issue, and I haven’t heard anything that says
AIDS adds a particularly unique burden to that process as
opposed to the employee with coronary artery disease or the
employee who got run over by a runaway van in the parking lot.

So, help me out with whether I’m missing something you
were telling us about the unique burden of AIDS on small
businesses, or whether that is somewhat of a false alarm to us
and we should be focusing on some more generic things with small
businesses, if we focus on them at all.

I don’t mean to exclude you from that, Ms. Wiley, if
you have comments on it. But, these folks were the ones who more
particularly talked about small businesses.

MR. SWAIN: Well, I wasn’t here for your witness this
morning. I think there is no evidence that I’m aware of, any
demographic or statistical evidence, that more AIDS cases have
occurred among small employers than large employers. The only
even allusion to that was my statement that in certain
industries, carriers have said, for whatever reason, "We’re going
to decide not to cover any business in that particular industry."
And in many cases those industries tend to be industries that are
made up of lots of small firms.

I’m not sure that I’m ready to say that right now AIDS
is a tremendous crisis today for small employers. But, I think
that as we observe the expansion of this virus and its effects,

277
that if we were to have this meeting five years from now my
answer might be entirely different.

But, I think that the reason that it’s a problem has
more to do with the fact that the one unique situation is that
small employers do tend to hire more young people and more people
without a previous job, more people coming off unemployment, and
more minorities. Frankly, larger firms tend to have more white
males of prime working age, and small firms tend to hire
everybody else in the work force, proportionately.

So, to the extent that there are risk groups that are
made up primarily of those employees, those types of workers,
then it’s to some degree potentially a large or small business
problem. But, it’s primarily a small business problem, because
most of these small employers don’t have a lot of cash flow,
profitability, flexibility to handle the AIDS issue when it comes

up.

MRS. GEBBIE: But is that unique to AIDS or is that the
issue of the small employer with any kind of a sick employee?

MR. SWAIN: No, I don’t think that’s unique to AIDS. ~
As you suggested, it’s not unique to AIDS anymore than coronary
artery disease. I think the sort of workplace management
personnel issues are unique to AIDS and I think they are handled
somewhat differently in a small firm perhaps than in a larger
firm.

DR. BLOOM: I think it’s a good question that you’ve
asked. In many respects, a lot of the analyses you’ve heard are
applicable to coronary heart disease as well as to AIDS. But
there are two distinct features of AIDS that are important.
Number one, AIDS is quite expensive to treat. It does tend to be
more expensive than most other serious illnesses, or certainly at
the high end of the range. In addition, it happens. relatively
early in a worker’s life cycle, which means that you -- how do I
put this? For an economist, you care more about things that
happen right away than that happen in the future because money
has different value if you look at it at different points in
time. So, something is going to happen if someone has a risk of
coming down with heart disease 35 years into the future. The
cost to you today, the present value of that cost is reduced
substantially as opposed to if you know they’re going to have
some problem like that in the next year or two. A $1,000 cost 35
years from now is much less meaningful than a $1,000 cost one
year from now.

MRS. GEBBIE: AS I said, my question was fuzzy. I want
to try and pin it down. I didn’t hear anything in the last
little while that makes me think we need to pose an economic AIDS
specific solution for small businesses. We might need to be

(278
proposing a health insurance or illness cost insurance proposal
that’s relatively specific to small business. Is that a fair
statement? Again, am I missing something?

MS. WILEY: Can I just add? There are two ways that
small businesses who have health benefits for their employees get
those benefits. One is to buy insurance and the other would be
to self insure. If you buy insurance from someone, as Mr.
Creedon said, over the long-term, and it might not be this year
or next year, but over the long-term, those costs are going to go
up because of AIDS, because insurance carriers are reacting and
increasing their premiums. So, that is AIDS specific, I think.
The other is that --

MRS. GEBBIE: But not unique to small businesses.

MS. WILEY: Yes, more than large business. Large
business does not have the same problem because large business
pays their cost anyway.

MR. CREEDON: Well, I think there are a lot of small
businesses that do not carry insurance for their employees. So,
I don’t know to what extent the answers to some of the questions
you got reflected that. I think you said that there were eight
million people employed who do not have insurance of any kind.

MR. SWAIN: That’s right.

MR. CREEDON: There are 36 million people in the United
States, that’s an estimate, who have no health insurance of any
kind. So, I think Mr. Ryder this morning, his emphasis on small
business going bankrupt, I think it would be more likely that
they’d just drop the health insurance rather than go bankrupt if
that became a problen.

I agree. I don’t think that the health insurance alone
right now for small business is a huge problem because of AIDS.
But I think if you look down the road to five, ten, 15 years,
whatever, then it could be very significant.

MRS. GEBBIE: Yes, but the solution might not be AIDS
specific. It’s the illness insurance coverage piece, I think.

MR. CREEDON: Well, health insurance generally has
problems right now, but AIDS will exacerbate it.

MRS. GEBBIE: Yes.
MR. DeVOS: We’re going to listen to Doctor Bloon.

DR. BLOOM: Thank you. I think it’s important to
recognize that there are differences between small firms and

279
large firms when it comes to the impact of the AIDS epidemic.
They’re not all in the direction of increasing the costs that
small firms face. So I think your conclusion that we don’t need
separate policies is probably correct.

In favor of small firms is the fact that, number one,
they are less experience rated in their health and life insurance
benefits.

In addition, and please, Mr. Swain, correct me if I’m
wrong on this, but I believe that small firms are less likely to
offer benefits and less likely to offer as much benefits.

Now, against the case of small firms -- I mean what
makes things more difficult for small firms is, as Mr. Swain
mentioned before, that the perceptions and fears of co-workers
are probably a much more serious problem, and also that the
financial cost of an AIDS case developing is potentially more
meaningful just in terms of the viability and the continued
existence of a small firm.

MS: WILEY: Can I add the one caution for small
business which is over the past few years many businesses have
self insured their benefits rather than purchasing insurance.
I’ve done some work with employers in New York who have been
encouraged over the past few years to self insure. Ina place
like New York, if you self insure, you could meet financial
devastation by having one or two workers out of a population as
small as 100 contract AIDS. That’s one place I would say that
small business. should get a recommendation.

MR. SWAIN: I’d just like to make one point. I’m not
sure -- and Doctor Bloom and I can carry on this conversation
another time. I think I would disagree with one thing that he
said. The evidence that we have is that small firms are more
likely to be experience rated than large firms and that’s a trend
that’s going to continue. We cite the Office of Technology
Assessment study in our report.

Be that as it may, I think that’s the trend.
Experience rating is an increasing trend. So, whether it does or
doesn’t happen much now, I don’t think that tell us that it’s not
going to be a problem in the future.

The other factor, of course, that Doctor Bloom
suggested was in small firm’s favor, that many of them don’t
provide insurance in the first place, doesn’t help us solve the
AIDS crisis.

I’1l mention one final factor which we outlined in our
statement. I think there’s been some previous testimony before
the panel on that. That is the federal COBRA law, well meaning

280
in its intention to provide continuous coverage, has indeed
resulted in some cases in the phenomena I think Mr. Creedon
alluded to, which is that when the costs go up, the response is
that firms don’t go bankrupt, they simply discontinue their
coverage for their hard cost reasons or paperwork reasons or
whatever.

MR. DevOS: Theresa?

DR. CRENSHAW: Forgive me if this was answered in your
testimony and just let me know that. Of both large businesses
and small businesses, what percentage of the insurance premiums
are directly paid by the employee and what percentage are covered
by the employer and what are the implications for the future when
insurance premiums go up to absorb the. additional health costs,
whatever they may be, of the AIDS epidemic? Anybody.

i

MS. GLIED: It’s actually not that different for small
firms than large firms. It’s between 11 and 16 percent of
premiums are paid by employees. But you would expect that if
premiums go up a lot for employees who are not in high risk
groups, they may demand higher wages for working with people who
are in high risk groups because they realize that their own
payments into the health plan will go up.

MR. DevOS: Theresa, all premiums are paid by
employees -- are all paid by customers. They’re all paid by
customers who are the final user of that product. In some form
or another, it gets to the customer.

MS. GLIED: Just to confirm this thing on experience
rating, experience rating is probably increasing for small firms.
But since large firms tend to be more self insured, and self
imsurance is like 100 percent experience rating, the effect of
that is that small firms are less experience rated than large
firms. If you take --

DR. CRENSHAW: What does experience rated mean?

MS. GLIED: Say a firm has an AIDS case. Their
insurance company pays out a certain amount of money. The
question is, how much does the firm’s premium go up after it has
one case. Insurance companies consider the size of the firm in
deciding how probable it is that since you’ve had one case,
you’ll have more cases.

DR. CRENSHAW: It seems that ultimately then what we’re
really talking about is as simple as what Mr. DeVos said in that
it comes out of the consumer who purchases whatever the product
is and the taxpayer for what dimensions we cope with on the
taxpayer federal level. We’ve got to cover it somehow through
these two sectors.

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MS. GLIED: And the take-home pay of workers.

MS. WILEY: There’s definitely a trend toward
increasing that sharing with employees of the premium too. It’s
been going up the past few years.

DR. CRENSHAW: Getting them to pay more?
MS. WILEY: Yes.
MR. DeVOS: Admiral Watkins?

CHAIRMAN WATKINS: Mr. Swain, do you have any
documentation to date where specific cases involving AIDS in the
workplace for small business has eventuated in the demise of that
particular small business? We have not had that brought forth to
the Commission. There were allegations this morning that there
was a specter hanging over the nation and we were about to go
under and we should have some discriminatory laws put into effect
right away to take away the small business employer’s liability
for any individual that might come for new employment with them
that might have the HIV and to allow them to do the testing in
order to hire.

Are we at that point in the nation where we have that
kind of serious problem where we need to have discriminatory
laws?

MR. SWAIN: In our office, or I think within the Small
Business Administration experience, we do not have in our records
any extensive documentation of businesses that have actually
failed because of AIDS. I’m not saying that it hasn’t happened,
but I --

CHAIRMAN WATKINS: Have you seen any articles anywhere
in the nation that have come to your attention about it?

MR. SWAIN: The articles that I’ve seen tend to be
along the lines of how employers cope with AIDS and how employers
are apprehensive about AIDS. I can’t think of any articles I’ve
personally seen about actual AIDS cases and how they’ve been
handled. The issue of testing I think is a different issue. A
small employer does want to know what is legally appropriate and
not legally appropriate. But I think that that’s not necessarily
to be connected up with --and I think that’s a legitimate issue
for the panel to consider. But that’s not necessarily to be
connected up to the small firm issue.

In fact, if I may analogize this to the drug testing
issue, most of our inquiries about drug usage has been, "What do
I do once I find out an employee is using it? Not whether I’m
allowed to test that employee or not," because in most cases

282
testing is very experience, it’s time consuming and except for
certain industries I’m sure, it’s not a salient factor for most
hiring decisions.

CHAIRMAN WATKINS: Have you had any input from the
National Association of Independent Businesses or whatever the
association is that says that, "This is such a big issue now that
we are proposing the following very significant legislative
actions to protect small business in American from the HIV
epidemic"?

MR. SWAIN: I’m not aware that the National Federation
of Independent Business or any other major small business group
is proposing a law that would require testing or -- I think that
those laws have pretty much been handled on a state by state
basis. I’m not aware of any national consensus on that within
the small business community.

CHAIRMAN WATKINS: At this point in time, is Small
Business Association in any way recommending to the Commission in
any of your documentation to us that there be legislation that we
would propose in favor of small business preferentially at this
point in time regarding the HIV epidemic?’

MR. SWAIN: No, we’re not proposing that you recommend
any federal legislation whatsoever. We ate proposing that you
recommend as an option some federal information dissemination and
we are proposing that you recommend that states adopt the
National Association of Insurance Commissioners Underwriting
Guidelines on avoiding discrimination in sales of insurance.

i

CHAIRMAN WATKINS: Thank you.

MR. DevOS: I don’t know whether it’s Doctor Bloom or
Mr. Swain relative to this matter of discrimination. The
Admiral is zeroing in on whether cost is the real bug-a-boo in
small business hiring such people or whether there’s other fears
that are far greater than that. We’ve talked: about feelings of
other employees. But in the kinds of businesses you’re talking
about, right down on Main Street where they i interact with the
customer everyday, I think there’s a very big fear on the part of
those people as to who they hire as to the reaction to the
customer. That’s not going to be resolved until you get down to
talking about general education to get rid of\the fear in a very
broad spectrum. This little guy who’s got a ma and pa and two or
three employees, he doesn’t have hiring policies. He doesn’t
have practices. He doesn’t have anything. He just hires
somebody he thinks will do the job that will be favorable and
meet the customer and do well. The last thing he needs is
somebody that would turn the customer off. I don’t think he
understands costs or any of the rest of it. He’s just trying to
survive.

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So, I’m not being critical of where you are. I’m just
saying, you run your numbers out and then beyond the numbers
there are other things that are so great you can’t put your hands
around them. So, the greatest thing this Commission can probably
do is raise this level of awareness right down to that customer.
Then I think you’re going to do it.

You're all shaking your head. I’m not trying to make a
speech. You’re confirming what I’m saying, that there’s those
other factors that you can’t put your hands around and you can’t
legislate it. Not that I know of. When ma and pa decide they
want a guy or don’t want a guy, if they don’t like him, they’1l
get their son, they’1l get some other relative. That’s just the
way those things react. Do you want to say something to that?

DR. BLOOM: Just that I completely agree. But I don’t
think it’s something we can get our hands around and we are in
the process of trying to look at changing composition of the
labor force in firms of different sizes, including all the way
down to the ma and pa shops on the corner.

MR. DevOS: Fine. I have 7,000 employees around the
world and you have all these departments, you have policy and
procedure, but that isn’t the way I started. You hired somebody
that looked warm. He’s all right. You put him in there. If he
didn’t work, he left because you didn’t get along. He knew it

and you knew it. It wasn’t discriminatory, it’s just you didn’t
hit it off.

It’s a difficult thing when you get down to small
businesses where the owner is also the manager operator and try
to cope with it. He doesn’t have lawyers. He doesn’t have a
staff of people to know whether he’s discriminating or not
discriminating. He just doesn’t feel good, so he didn’t do it.

But I’m not disinterested in that. I’m just saying
that’s the huge problem of education at the lowest ‘levels because
of the impact customer to that employee. That’s the kind of
shops you’re talking about. [ runa big hotel as well and when
you start staffing restaurants and all those things that
interface directly with that customer, you begin to ask yourself
all those other questions.

But I want to get over with you, Ms. Wylie, just for a
moment and then we’ll conclude. That has to do with cost.
You’re talking to us about cost savings and how we can do that.

As we've looked at some of these programs, and number
one is education, and I don’t know whether you can put cost
savings dollars to that or not, but we had to work on fear within
the organization first of all, just so they didn’t panic as a
general human being. I don’t know what the impact is on that,

284
how many conversations you save, how much efficiency you gain in
a company because the people aren’t worried about what’s going to
happen next or is this person contaminated or isn’t he. The
decrease in efficiency has got to be fantastic as to coffee shop
time and all the rest of it.

The next thing is the discriminatory issue. Are you
willing to work with somebody and how are you going to get along
together and how are we going to make that mesh so that fear
disappears? But the last part of that thing is what we’ve been
trying to work on, that is prevention. There are, I think, some
major cost savings if you can alert your employees to
methodology and their behavioral conduct to really reduce the
epidemic in general. I haven’t heard a lot about that when we
talk about corporate education, but it is a major portion of the
educational job. I think the cost savings to that company will
be fantastic, if they will all tend to that with their
employees. It shows love, it shows care. First of all, you have
a policy that will care for them. Then you begin to talk about
how you can conduct yourself to avoid this.

MS. WILEY: For the most part, when we talk to
employers, we talk about predicting their costs from now until
1991. When employers ask about costs beyond 1991, the word is
education. Really what’s going to happen in the workforce and
with your employees dependents is set by their behavior of the
past years. To get into the future, beyond the next four or five
years, it depends on behavior and behavior is education. So,
that’s phase two of cost savings.

MR. DevOS: I just hope that in whatever you’re
training your people to do and talking to them about it, you’re
really working on that prevention thing and behavior modification
so that we prevent the spread. But I’m always intrigued with
cost discussions and how somehow the company is going to pay, the
employee is going to pay. I tell you, the customer pays every
time, no matter what the equation is or the employee has to give
up. If an employee is going to pay more taxes, he has to give up
something personal and you all know that. So, it finally gets
down to the bottom line. It means the average American citizen
pays or the worker just has less to have. So, these are big
issues. We want to thank you for being here today. We
appreciate your concern and your input and the knowledge you
bring to bear on the problem. The Commission is grateful to you.
Thank you very much.

Public Sector Issues
CHAIRMAN WATKINS: We have in the next panel today a
little different focus. The focus of the last panel is going to
be on the public sector. wWe’ll be looking at issues in concern
to the state, the county and municipal employers and employees.

285
The Commission will cover issues concerning the federal
sector at our upcoming meeting next week, May 16th. Today’s
witnesses will include the Honorable Mayor of the city of
Indianapolis. He has indicated that he will be a little late
arriving. I’d like to ask the indulgence of the other witnesses
and we’ll proceed with the hearings, continue with whoever is
speaking at the time the Mayor arrives, if in fact we have not
completed all your testimony, and then allow the Mayor to pick up
and, knowing he probably has time constraints on him, to allow
him to have some flexibility. Is that satisfactory with the
witnesses?

So, we'd like to have Mr. Jordan A. Barab,
Occupational Safety and Health Coordinator, American Federation
of State, County and Municipal Employees, AFL-CIO, Washington;
Mr. Richard M. Duffy, Director, Department of Occupational Health
and Safety, International Association of Fire Fighters,
Washington, D.C.; Mr. Dewey R. Stokes, President Fraternal Order
of Police, Columbus, Ohio; and Mr. Don Novey, State President,
California Correctional and Peace Officers Association,
Sacramento, California, if he is here. It looks like he may not

be here yet.

If you’d take your places at the panel and we’ll
proceed with the statements starting with Mr. Barab.

MR. BARAB: Thank you. My name is Jordan Barab. I’m
the Occupational Health and Safety Coordinator for the American
Federation of State, County and Municipal Employees. AFSCME has
over 1.1 million members across the country, many of these
including hospital workers, mental health, emergency care,
corrections, law enforcement, custodial and waste water
treatment, who commonly have on-the-job contact with blood and
body fluids.

The purpose of my remarks today is to address the
concerns of public employees. As you will see, the concerns of
public employees are very often no different from private sector
employees, except for two areas. First, there are more public
employees in such occupations as health care, corrections and
other jobs which may have significant direct contact with
persons with AIDS.

Second, to the extent OSHA is stepping in to protect
the health of care givers, it should be remembered that except
for in 24 states which have federally approved OSHA plans, public
employees in this country are not covered by OSHA and therefore
do not fall under the OSHA’s targeted inspection progran.

AFSCME has been dealing with AIDS since early 1983 when
we received an urgent request from members of a local
representing mental health workers. They had just received their

286
first resident who was known to have AIDS. Management was trying
to keep it secret and no training or education had been done. We
were asked to come in and do training for the workers at the
institutions.

Since that time, information on AIDS has been AFSCME’s
most requested item. As we began to write fact sheets and do
workshops for health care workers, mental health, corrections and
others, we found a shocking pattern of disregard for basic blood-
borne infectious disease precautions. Workers had not been
trained, equipment had not been provided and work procedures had
not been adjusted.

For this reason, AFSCME petitioned the Occupational
Safety and Health Administration in September of 1986 for three
items: an emergency temporary standard covering blood-borne
diseases such as AIDS and hepatitis B; inclusion of infectious
diseases into the OSHA hazard communication standard; and a
generic OSHA standard covering all infectious diseases.

AS you may be aware, OSHA rejected all three of our
requests in favor of a targeted inspection program covering
blood-borne infectious diseases in health care workers. As
health care workers are not the subject of the hearing today, I
will not concentrate to any great extent on the problems of
these employees. I/’11]1 address the remainder of my remarks to
those public employees who are not hospital workers.

Corrections and mental health. Corrections officers
and mental health workers across this country have expressed an
enormous amount of concern about AIDS. As the population of most
prison systems contains large numbers of HIV drug users, there
were a large number of prisoners with AIDS and with the HIV
infection. Furthermore, Corrections personnel frequently
experience violence where there is exposure to blood as well as
unsanitary conditions where urine and feces is thrown at them.

Mental Health personnel also face these conditions, in
addition a number of person who cannot be responsible for their
actions. Furthermore, as cases of AIDS related dementia
increase, more and more persons with AIDS will find their way
into mental health institutions.

Institutional employees are in dire need of training.
Traditionally, management’s first response is to say as little as
possible, tell everyone not to worry and go on about their
business. This approach only increases whatever panic was
already forming among the employees. We are frequently called in
on an emergency basis to educate workers about AIDS.

The second problem is that management often does not
make protective equipment available, even where obviously needed.

287
This includes rubber gloves for cleaning up blood spills and
resuscitation masks for artificial respiration. Unfortunately,
as correctional personnel are not classified as health care
workers, they do not fall under the OSHA directives. Similarly,
cpc has no guidelines for correctional institutions.

Custodial employees. AFSCME represents a large number
of school and other custodial employees. While it is not
immediately obvious that these persons should be concerned about
AIDS, in fact whenever a child is injured or ill, it is the
school custodian who must clean up. While this does not have to
be a high risk venture, it is important, nevertheless, that
these workers at least be provided with gloves and training on
how to clean and disinfect. Custodial personnel as well as
groundskeepers in other buildings report finding used needles in
the trash or on the grounds. Again, they need training on how to
deal with such occurrences.

We feel that blood, where it is found, should be
treated like a toxic substance and that workers need to be
trained to deal with it safely. Like corrections personnel,
school and building custodians do not fall under OSHA guidelines.

\

Sanitation. As Bill Borwegen from the Service
Employees International Union will make clear tomorrow, the
infectious waste management procedures at many hospitals have
completely broken down. This leads to infectious waste being
tossed out with the regular trash. We receive frequent reports
from our members who are sanitation workers about finding red
bags full of bloody materials, needles and sometimes even body
parts.

Giving workers the right to know about chemicals they
are exposed to in the workplace has been one of the major health
and safety items of this decade. Dozens of state and local laws
and a major OSHA standard give workers the right to know about
chemicals they are exposed to. AFSCME feels that employees also
need to be trained about the infectious diseases they may be
exposed to. While it is obvious from my previous remarks that
this is true for AIDS as well as hepatitis B, it is also true for
other @iseases which should peripherally be the concern of this
Committee.

For example, many persons with AIDS are developing
active cases of tuberculosis. TB is an airborne disease and the
precautions used around persons with TB are therefore very
different from those to be used around persons with AIDS or any
other blood-borne disease. Workers who work around persons with
AIDS therefore also need to be trained about TB.

I should also mention cytomegalo virus here which is
known to cause birth defects in pregnant women. That’s also a

288
disease that occurs with many persons with AIDS and it’s
something that workers who are pregnant or are planning to be
pregnant at least need to be educated about.

Universal precautions. The bottom line is that it’s
impossible to determine solely by a person’s job title whether or
not he or she will be exposed to body fluids. It is therefore
essential for all employers to analyze an employee’s potential
for exposure according to the actual work he or she does in order
for them to be able to take the universal precautions that the
CDC recommends. This approach is endorsed by the joint advisory
notice issued by the Departments of Labor and Health and Human
Services.

Testing. AFSCME opposes any mandatory testing of any
employees in any occupation. Aside from the obvious civil rights
problems such testing could cause, there is no evidence that
infected employees are a threat to anyone else. There has been
considerable controversy within our union, however, about testing
prison inmates and mental health patients. Some feel that given
the level of violence and unsanitary conditions in these
institutions, such testing may be warranted in certain
Situations. Others feel it is unnecessary or, at most, it should
only be done if there has been direct contact.

Civil rights. One area I have not covered in my oral
remarks is workplace discrimination against persons with AIDS. I
believe that’s been covered in other hearings before this
Commission. AFSCME believes that AIDS or infection with HIV
should fall under the provisions of the Rehabilitation Act of
1973 and a reasonable accommodation should be made for all who
need them. I’ve not gone into great detail in this area of
testimony because the concerns of public employees are not unique
in this area.

In conclusion, public employees do much of the most
important and dangerous work that this country needs to make life
safe and enjoyable. In the case of AIDS, we will increasingly
provide the bulk of the care givers in hospitals, prisons, mental
health institutions and schools. For the service, we need to
receive proper education, training and protection which will
enable us to do our jobs with the energy and caring that the
public and persons with this terrible disease have come to
expect. Thank you.

CHAIRMAN WATKINS: Thank you, Mr. Barab.

CHAIRMAN WATKINS: Mr. Duffy?

MR. DUFFY: Mr. Chairman, Members of the Commission, my
name is Richard Duffy. I’m the Director of Occupational Health
and Safety for the International Association of Fire Fighters.

289
On behalf of our organization, which represents 175,000
paid professional fire fighters throughout North America, I
appreciate the opportunity to address the President’s Commission
on AIDS. Fire fighters as a group are at risk of contracting HIV
and other communicable disease transmitted through their contact
with blood and body fluids. In fact, there are very few fire
fighters in our country who do not come in contact with injured
and bleeding victims of fires and other accidents, often ina
dangerous, uncontrolled environment where changes for exposure to
these diseases are greater.

Unfortunately, much of the attention within the medical
and scientific community has focused on protecting hospital
workers from infectious diseases, particularly AIDS.

Insufficient attention has been paid to protecting emergency
response personnel who work in unsterile environments that are
less easily controlled than a hospital or a clinical environment.

According to a survey of occupational deaths and
injuries that our organization has been conducting for well over
30 years, about two percent of all fire fighter injuries received
during emergency operations were contraction of a contagious
disease. Contracting a contagious disease was more prevalent
than cardiac abnormalities, cold injuries, heat exhaustion and
heat stroke among injuries received at an emergency scene by fire
fighters.

The above documentation indicates that this Commission
and the Reagan Administration can no longer ignore the needs of
emergency personnel as it develops its policies and standards on
occupational exposure to HIV and other communicable diseases.

At the IAFF, we’re extremely proud of a recent
publication that we developed on guidelines to prevent
transmission of communicable diseases during emergency care for
fire fighters, paramedics, and emergency medical technicians.
This was the first set of guidelines specifically adopted for
emergency response personnel. It has been well received, with

more than 30,000 copies already distributed around the country.

Additionally, the National Fire Protection
Association, a voluntary consensus standard-making organization
for the nations fire service has recently taken action to publish
a document almost identical in context. We believe these
guidelines represent a rational and a practical approach to the
prevention of communicable diseases during emergency care and
victim rescue. In an emergency care setting, the infectious
disease status of patients is frequently unknown by both
providers -- the fire fighters -- and patients themselves.

For example, in Phoenix, Arizona, fire fighters and
paramedics responding to a call, found a man lying ina parking

290
lot near a bar. The man had been beaten, injured, was
unconscious and was probably drunk. What the responders, the
fire fighters, did not know as they eased him onto a backboard
was that he was also a carrier of hepatitis B. As the victim was
being strapped to the backboard, he was revived and became
violent. While thrashing, his nose began to bleed. He also spat
at the fire fighters and paramedics. During the struggle,
several fire fighters suffered cuts and abrasions.

I give you this example even though it involves
hepatitis B. It forced the Phoenix Fire Department to initiate a
complete contagious disease progran, including the full
inoculation of all personnel with hepatitis B vaccine as well as
putting in a full-time contagious disease officer. It was their
position that if one of these paramedics or fire fighters
contracted hepatitis B, the cost for that one injury alone would
have been offset by having a full contagious disease program
which they have implemented. It’s one of the first fire
departments throughout the country to do so.

Since in an emergency care setting, the infectious
disease status of patients is frequently unknown by both
providers and patients themselves, the IAFF believes that this
Commission and the Reagan Administration should insure, through
its policies and regulations, that all patients be considered
infectious.

Prior to any contact with patients, emergency response
personnel must be required to cover all areas of lacerated,
chapped, irritated or other damaged skin with adhesive dressings
and emergency response personnel with extensive skin lesions or
severe dermatitis must be required to refrain from any direct
patient contact and from contacting, using or handling patient
care equipment until that condition is healed.

We also believe that it is imperative that all
needlestick/cut/slash injuries be recorded by emergency response
personnel and other health care workers in the OSHA log or a
system developed by the fire department. Proper documentation of
such exposures needs to be maintained.

Workers who suffer needlestick injuries, other
penetrating wounds or are somehow exposed to blood or body fluids
should be offered medical attention immediately. Such medical
attention must include post exposure counseling, voluntary
testing, prophylaxis, medical screening to determine a worker’s
status and this should be provided at no cost by the employer to
the employee.

The worker should also be offered a follow-up test at
an appropriate interval to see if a conversion has occurred.
Exposed employees and their families should be offered medical

291
 

 

counseling in order for them to deal with the situation. Medical
records should remain confidential between the employee and the
medical personnel conducting the screening, counseling, et
cetera.

In the area of protective clothing for emergency
response personnel, our union believes that structural protective
equipment must be worn, especially in a situation where rough or
sharp surfaces are likely to be encountered, such as removing
victims from automobile accidents. We also believe that the use
of disposable latex or vinyl gloves must be used and required for
all personnel prior to initiating any emergency patient care.
Mechanical resuscitation devices, such as bag-valve masks and
oxygen-demand resuscitators, must be available to all fire
department vehicles that respond or potentially response to
medical emergencies or victim rescues and they should be used.
Mouth-to-mouth resuscitation should not be used, whatever the
case may be. These mechanical devices must be available and
utilized by these personnel.

We also believe that masks, goggles and gowns must be
present at all times and all fire department vehicles that
respond to or potentially respond to medical emergencies or
victim rescue. The employer must make sure that not only this
clothing is provided, but that they are donned and used in
situations where blood or blood splashes may occur.

We also strongly believe that puncture resistent,
shatterproof, disposable containers be required on all fire
department vehicles for placement of all sharp objects.

In the area of cleaning and disinfecting, a concerted
effort must be made to ensure that bleach is never used on any
fire fighter protective gear, coats, trousers, fire fighter
gloves and fire fighter station and work uniforms, contrary to
the policies that have been put out on the street now, especially
those by the Centers for Disease Control. Bleach does compromise
structural integrity and/or fire retardancy of the fabrics that
are used in fire fighter’s equipment. When contaminated clothing
cannot be cleaned with a mild detergent in a hot wash cycle ina
front-load washing machine, then the clothing must be disposed of
in a proper fashion.

We also recognize and acknowledge that the training of
emergency response personnel across this nation is haphazard and
not uniform. I give you this example. Two fire fighters in
Barre, Vermont are currently under investigation for possible
serious disciplinary action because they put on gowns and gloves
prior to treating a prisoner who attempted suicide and had
admitted in open court that he had AIDS. No formal training was
ever provided to these Barre, Vermonth fire fighters who now face
disciplinary action and have had their emergency medical

292

 

 
 

 

certification removed--at least temporarily--because they decided
to utilize gowns.

A written bulletin from the Vermont Department of
Health to emergency responders advised using individual
discretion when treating potentially infectious patients.
However, a nurse transmitting on a radio to fire fighters at the
scene informed them--not knowing the condition involved, that
gowns were not necessary when treating any patients that have
AIDS.

It is evident that a uniform training program for
emergency response personnel must be an important policy
consideration. Incidents such as the one that recently occurred
in Prince George’s County in Maryland where fire fighters were
denied knowledge of a patient’s HIV status by the hospital after
responding to a situation where a massive amount of blood was
present and fire fighters were exposed to should be prohibited.
Fire fighters learned that the patient was HIV-positive through
indirect, informal sources. The individuals that transport
infectious patients should not be denied information available to
others who treat that same patient in the hospital.

Most hospitals have systems in place, either formally
or informally, to notify their own personnel who have had a
significant contact with a patient who, in the normal course of
their treatment, is disclosed to be infected. Several states
have already adopted legislation mandating hospitals to extend
this same protection to the field. Emergency response personnel
are at equal or perhaps even at a higher risk of exposure.

Ironically, in the state of Maryland, where the P.G.
County case had happened, the state promulgated a notification
law. However, because of political considerations, the bill was
doomed if they included HIV in it. Thus, HIV was exempted from
the notification law. Many other states have adopted hospital
notification provisions for emergency response personnel.

Although out union believes that confidentiality
provisions should be incorporated, we do not believe that an
issue of privacy should deny workers the right to know about a
patient’s health status. National notification procedures
should be a priority of this Commission’s recommendations.

As we have mentioned, many in the medical community
have minimized the risk of exposure for emergency response
personnel to disease such as AIDS. However, these risks exist
with consequences not always strictly medical.

For example, in Southern California, a fire fighter
responded to an auto accident which required emergency medical
care. The auto and the patient were located at the bottom of a

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cliff and fire fighters at the scene had to repel with ropes down
the side of the cliff to reach the emergency scene. THe victim
was found to have stopped breathing. Instead of waiting for
mechanical resuscitation to be lowered down the side of the
cliff, CPR, which included mouth-to-mouth resuscitation,
commenced. Despite this effort, the victim died. It was later
determined that it was a suicide and the victim did have AIDS.

When the fire fighter explained the situation to his
wife, she immediately became hysterical. Separation did and
still continues to this day with that family and friends,
including fellow fire fighters avoiding any contact with this
individual. Even though the blood testing for this individual
performed thus far has shown no signs of the AIDS virus, this man
had very real fears and very real concerns.

The impact of AIDS in the fire service has another
dimension as well. That is fire fighters who contract the
disease, whether due to occupational exposure or personal
lifestyle. While we are in agreement that casual contact at most
work sites posses not threat of transmitting the AIDs virus, we
believe that the workplace environment confronted by fire
fighters does pose a potential treat of transmitting the AIDS
virus to fellow workers and the general public.

The emergency environment faced by fire fighters is
often uncontrollable with many, many hazards. According to our
data through our death and injury survey, 20 percent of all
injuries of fire fighters at the emergency scene are lacerations
and contusions. Furthermore, almost ten percent of all fire
fighters throughout this country can be expected to suffer a
laceration or contusion at least once during the year. This high
probability of attaining a cut during emergency procedures must
preclude the employment of individuals with AIDS to do active,
emergency fire fighting duties and, of source, emergency medical
duties.

That is not to say that our union or the fire service
lacks any compassion. In fact, one of our locals in Warrenville
Heights, Ohio recently negotiated a contract with the provision
that provides that any fire fighter with AID shall be insured of
his entire salary and benefits until his death or normal
retirement age. It is a policy that recognizes the risk of
emergency operations and exposing fellow fire fighters and the
public to blood contaminated with the HIV virus. It also
recognizes the responsibility to reach out and assist those

victims of AIDS.

Before closing my remarks, our union hopes that this
Commission will utilize its influence to support the enactment of
H.R. 3418 which is currently in the U.S. House of
Representatives. In summary, this measure would require

294
hospitals to transmit notification to the employers of emergency
response personnel who transport a victim to a hospital and is
found to be infected with AIDS, hepatitis B, hepatitis non-A/non-
B, pulmonary tuberculosis and meningococcal meningitis.

It also provides funding for the development of
training curriculum by the Centers for Disease Control for
educating emergency response personnel with respect to the
prevention of exposure to infectious diseases. It establishes
three grant programs totaling $25 million for states to implement
the CDC training curriculum, to conduct demonstration projects to
provide vaccines and to make voluntary AIDS testing and
counseling available to emergency response employees notified of
an exposure to an AIDS patient. It also insures emergency
response personnel maintain confidentiality and non-
discrimination protects for AIDS patients.

Once again, we appreciate the opportunity to address
this Commission. It’s our hope that this Commission and the
Reagan Administration will ensure that emergency response
personnel, including fire fighters, paramedics and emergency
medical technicians are adequately trained, provided protective
equipment, vaccinated if there is availability, and notified
after any of their exposures.

CHAIRMAN WATKINS: Thank you, Mr. Duffy.

MR. STOKES: Mr. Chairman, Members of the Committee, I
am pleased and privileged to have this opportunity appear before
you and to speak on behalf of 190,000 full-time law enforcement
officers in the Fraternal Order of Police.

The spectre of AIDS has obviously been a matter of
great interest in both the public and private employment sector.
With the possible exception of the health care community, I can
think of no profession that is more critically concerned with the
issue than the members of the law enforcement community.

If is my intention today to be very brief and identify
the principal concerns of the members of the Fraternal Order of
Police and in understanding the context in which the law
enforcement officers deal with the AIDS syndrome.

It is not my purpose, and I hope there is no need for
me to list to you the various ways which law enforcement
personnel most often become exposed to the AIDS virus. It should
enough be to say that our members are asked to confront, control
and often confine members of the public generally and members of
the highest risk groups specifically under the circumstances that
are extremely dangerous in all senses of the word. Whether
administering first aid to a bloody roadside accident victim of
collecting evidence at a bloody crime scene, there are, or at

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least we have reason to believe that there are, great dangers in
our job because of this deadly virus.

We’re an extremely dedicated group of professionals who
have voluntarily assumed the responsibility and the risk of
fighting crime. We used to know what we were up against. We
knew what would happen if we were careless. Our collective
experience helped us to confront these risks. We are training to
accept the facts of life.

AIDS and the fear of AIDS, however, is something
totally different. Wee read the newspapers, we listen to the TVs
and we hear the horror stories and we believe that we have reason
to be concerned. It’s hard for us to do our job when in addition
to other concerns that we have learned to deal with, we must deal
with the uncertainty of AIDS.

We want to perform our duties fully and without
reservation. However, it is not easy to do so without some
degree of assurance and protection against the real, and in many
cases, the imagined threat of AIDS.

In addition to the fear of contracting AIDS, there are
also the practical and human consequences of exposure to the
contraction of AIDS. These are some of the most common question
that we are asked as an organization. "Can I really get AID?
How? Is there anything I can do prevent it? Is there equipment
to protect me? Who will pay for the equipment? What is an
employer doesn’t have the money? What happens if I’m exposed?
What happens if I get AIDS? Will I lose my job, will I die?
What do I tell my family? Who will pay the bills and who pays
the doctor and the hospital? And if worse happens, will my
family be taken care?"

Much general information is being distributed to the
public. Many police departments have AIDS policies, almost all
of which are similar and tell us to be careful, to wear gloves
when able, to handle evidence carefully. Yet these policies
rarely tell us what will happen if. We don’t ask for the
impossible. We simply want the truth about AIDS, getting it,
preventing it and dealing with it. Three general areas of
concern exist, contraction, prevention and assistance.

Contraction: How do you really get AIDS? Can you get
AIDS from a crime scene, a bite or a fight? If any, how many
law enforcement officers have contracted AIDS in the line of
duty? How reliable are the statistics we’re reading about? Who
has or hasn’t contracted AIDS? Should education or informational
efforts be directed the police officers, their spouses and their
families? It’s a growing concern that officers may become
exposed to the virus, bring it home and infect his or her family.

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Prevention: What are the most effective means of
prevention? If there is equipment to minimize the risk of
exposure, will governmental employers have the funds available to
buy the necessary equipment? Are present policy policies
adequate? Are they the product of last year’ s medical studies?
What steps should be taken to identify carriers of virus who may
be exposed to police officers during a confrontation? Are our
female officers who may be pregnant at a greater risk?

Assistance: What are the legal and factual
consequences if a police officer is exposed to or contracts AIDS.
Will he or she be suspended? Will they lose their job? Will I
be considered injured on duty? Will I be considered disabled?
How long will the sick or injury leave last? Then what after
it’s concluded? Will my health insurance cover everything? Will
there be deductibles? Will health insurance be available? Is
getting AIDS covered by workers compensation laws? What
assistance will be available to me and my family after I learn
that I have been exposed to the virus? Who will help us deal
with the fear and the stress? Will counseling be available to me
and my family? Who will help us through the testing period? And
if I contract AIDS, will there be a family counseling available
to help me keep my family together?

I’ve just listed a few of our most pressing concerns.
I noted just this past week that the New York Appellate Court
threw out a lower court’s ruling that a woman who bit a deputy
sheriff could not be tested for AIDS. How do you deal with the
fact that often the courts will do noting to assist in those
circumstances where a real possibility of AIDS contraction
exists?

One common denominator exists for all of us, education
and information. We’re bombarded with news about AIDS, yet we
are confused. Through a comprehensive focused educational
program which is supplemented routinely and focused specifically
for law enforcement personnel, many of these issues I have raised
could be addressed. Through the collection and analysis and
distribution of real and factual data, I believe many of the
fears pervading law enforcement can be quieted. An educational
program based on current data will allay fears, improve the
precenton of AIDS exposure and contraction and assist officers
and their families to cope with the fears and the facts about
AIDS.

Accordingly, we have a number of recommendations I
would like to briefly list here. Data should be collected
through mandatory reporting requirements of all law enforcement
related AIDS incidents. This would include job related exposures
and contractions of the virus as well as underlying data
concerning the circumstances of each case. While this data need
not identify specific officers, the data can identify the most

297
frequently occurring incidents and thereby assist in focusing our
attention on the highest risk activities and their prevention.

A specifically focused enforcement educational program
using the data collected on incidents and most current medical
data available concerning the contraction and prevention of the
virus.

Third, subsidy or assistance should be offered to
public employers to insure that effective protection equipment is
available, despite the perpetual financial problems public
employers operate under.

Fourth, a national policy should be established to
standardize the response of public employers to public employees
who have been exposed or have contracted viruses. Specifically,
this should include guidelines, recommendations and requirements
concerning the issue of relating to health, disability insurance,
workers compensation, disability pension and aftercare. Should
law enforcement personnel who contract AIDS in the line of duty
have to pay for their own tests and treatments or be subject to
deductibles? We hope not.

On behalf of the 190,000 members of the Fraternal Order
of Police, I want to thank the Commission for its interest and
this opportunity to present our views on this most troubling
subject.

CHAIRMAN WATKINS: Thank you, Mr. Stokes.

CHAIRMAN WATKINS: We’re very honored at the arrival of
the Honorable William Hudnut, III, Mayor of the City of
Indianapolis. We thank you for taking time to come today, Mr.
Mayor.

We also appreciate the warm and friendly relationship
that your people have extended to us here during our stay. It’s
been a great visit and these facilities are probably the best
we've seen. We very much appreciate the attention of the local
media and the interest shown by your high school students and
others who have attended the hearings. So, thank you. We’d like
to take your statement now. I know you are“pressed for time.

I will ask the Commissioners to frame their questions
in their minds for the Mayor. We will focus our questions to him
and then he will be leaving right after we complete. We’1ll start
over here with Mr. Creedon after the Mayor has a chance to make
his opening statement. Mr. Mayor?

MAYOR HUDNUT: Thank you very much, Mr. Chairman and
Members of the Commission. First of all, on behalf of the City
of Indianapolis, it is indeed a privilege and a pleasure to

298
welcome you to our city. We’re grateful for the opportunity we
have to extend to you our hospitality and we’re also grateful for
the work that you’re doing.

I am particularly please to have an opportunity to
share just a few brief thoughts with you. Coming form the
vantage point of being mayor of this city, being a generalist and
not a specialist, I was interested in and find myself supporting
the testimony you’ve just heard from Mr. Stokes. I’m sure that
the other members of the panel that are dealing with the public
sector issues have some very thoughtful presentations to make.
But I thank you for giving me the opportunity now to make mine.

I’d like to introduce to the panel Ms. Kristie Hill,
who is our city attorney, who is with me, who assisted me in the
drafting of the policy I’m going to tell you about, and Mr. Don .
McPherson. They’re both sitting right in back of me. Mr.
McPherson is the Director of our Department of Administration,
where most of the responsibility for implementing our policies
will be lodged. It is conceivable that I might not be able to
answer the questions that you ask me. If not, with your
indulgence --

CHAIRMAN WATKINS: We/’d be pleased to have them join
you. Maybe we could just shift over. We’ll get some chairs and
ask your colleagues to come up with you, Mr. Mayor, and then.
they can be free to answer questions. We’1ll put the names that
you gave us on the record and include them as part of the
witnesses.

MAYOR HUDNUT: We are very grateful for the opportunity
that your Commission has allowed us to share out thoughts as a
public employer about the AIDS epidemic in America and , more
particularly, in Indianapolis.

To date, there have been 120 cases of AIDS reported in
Marion County, which is the county in which Indianapolis is
lodged, with 59 deaths. It is estimated that 50 to 100 times
that number of reported cases exist, but have not been
identified.

The State of Indiana ranks 13th in the nation in the
number of reported AIDS cases. By the end of 1989, statistics
predict that there will be 270,000 AIDS cases in American 179,00
deaths. All of our lives will be touched in some way by the
AIDS virus, whether it be as an employer or co-worker, relative
or friend. I think we must marshall a compassionate and
professional approach to this subject. The City of Indianapolis
is the 9th largest employer in Marion County with 4763 employees.
As the mayor of this city, it is my responsibility to protect the
rights of all of our citizens and all of our city and country
employees.

299
The AIDS epidemic represents a challenge, in respecting
individual rights on the one hand while at the same time
safeguarding public health. The federal and state governments
have worked hard toward developing policies and program on AIDS.
The recently announced federal government guidelines for
employees and recently passed state legislation by the Indiana
General Assembly, with leadership of Senator Patricia Miller from
Indianapolis, places an emphasis on creating an awareness and
understanding of AIDS related issues and employee conduct towards
HIV-infected co-workers.

I also applaud this decision and the efforts of HHS
Secretary, Doctor Otis R. Bowen, whose name I had to work in
since he used to be the government of the great state of Indiana,
and Surgeon General C. Everett Koop in their recently announced
campaign to mail an AIDS informational brochure to every
household in the nation.

It is our responsibility as employers and as elected
representatives of the people in this country to educate the
public about AIDS, how it is transmitted and how transmission can
be prevented. We take this responsibility seriously in our city.
This afternoon, shortly before I came over here, I signed an
executive order stating the city’s policy on AIDS and our
employees. I would like to take just a couple of minutes to
share this policy on AIDS and our employees. I would like to
take just a couple of minutes to share this policy with you and
announce it publicly in the hopes that it might serve as a guide
for other municipalities across the state and nation. I don’t
know how many other cities and states have these policies, but
knowing that you were coming, three weeks ago I asked these
individuals and some others in City Hall to help us work up this
policy statement.

The executive order that I signed this afternoon states
the following. There are ten paragraphs in it.

1) The City of Indianapolis shall not discriminate
against any employee or applicant for employment with respect
hire, tenure, terms, conditions or privileges of employment or
any matter directly or indirectly related to employment because
the employee or applicant is or is suspected of being infected
with the AIDS virus.

2) The City shall allow employees who are infected
with the AIDS virus the same leave allowances and considerations
as are available to an employee with any other type of physical
or mental disability.

3) The Department of Administration, which Mr.
McPherson heads, shall develop an education program about AIDS
and make it available to all levels of City employees.

300
4) The Director of the Department of Administration
shall appoint an AIDS coordinator who shall be responsible for
establishing an education program on AIDS; who shall keep current
on the latest AIDS information and therefore act as an AIDS
clearing house for the City; who shall generally coordinate all
of the CIty’s efforts in dealing with the effect of AIDS on the
City’s work force; who shall be the City’s liaison with other
agencies dealing with the AIDS question; and who shall perform
any other duties as assigned by the Director of the Department of
Administration.

5) The City shall further make available to employees
and the general community ongoing educational opportunities about
AIDS through its program capabilities on Channel 16, our
government access channel.

6) The Department of Administration shall explore the
availability of counseling through its employee assistance
program and wellness programs for City employees who may be
infected with the AIDS virus.

7) The City shall make available to all City
employees free AIDS testing should any City employee desire to be
tested.

8) The City shall maintain the confidentiality of any
information received regarding whether an employee is infected
with the AIDS virus unless the employee explicitly gives written
approval to disseminate such information.

9) All City agencies whose employees come into
contact with blood or bodily fluids on a regular basis shall
provide training and develop safety procedures to be used by
their employees in dealing with such bodily fluids.

10) The City shall comply with all state and federal
laws and regulations regarding AIDS.

On behalf of the policymakers and health officials here
in Indianapolis, I urge the citizens of our community to learn
about AIDS and to take the necessary precautions to prevent
contracting AIDS. I thank you for the opportunity to appear
before this distinguished Presidential Commission.

CHAIRMAN WATKINS: Thank you, Mr. Mayor. We appreciate
very much the effort that you’ve put into the development of that
policy. We/’ll receive that executive order the Commission
records.

MAYOR HUDNUT: I believe that’s been given to your
staff.

301
CHAIRMAN WATKINS: And we’ll start the questioning
with Mr. Creedon for the Mayor.

MR. CREEDON: Well, it sounds like an excellent
statement, Mr. Mayor. One of the things I wondered whether it
covers recommendations that several of our other panelists have
made, and that is to give notification to either the police
officer or the other work if there is an incident involving a
person with AIDS and blood and so forth?

MAYOR HUDNUT: Well, Mr. Creedon, I’m sorry that I
didn’t hear all the testimony that preceded me, but I think that
in a general response to your question, the paragraph in here on
procedures would cover what you are --

MR. CREEDON: Does cover? Fine.

MAYOR HUDNUT: including, although its not explicit.
But it is implicit in the directive that I want to give to your
Director of Public Safety, for example, to develop procedures
that will protect the safety of our public safety employees as
they are working with people who are in some sort of distress.
It seems to me that the notification should be there and that
would be part of the procedures that will implement as a result
of this executive order. I might just add that if there are
others with similar kinds of recommendations, we’d be glad to
hear from you.

MR. CREEDON: The other question -- do I have two Mr.
Chairman, or one?

CHAIRMAN WATKINS: Yes, please.

MR. CREEDON: You indicated that there have been 120
AIDS cases in Marion County and 59 deaths, not an insignificant
number certainly. I wonder, in dealing with these cases, and I
address the question not only to you, Mr. Mayor, but to your
associates, what have been the most difficult issues that you’ve
had to deal with and are there any recommendations that you would
make to us as a Commission in relation to those?

MAYOR HUDNUT: We have a Marion, County Health
Department which you may or may not have had a chance to be
introducea to. They could answer the question much more
helpfully than I could.

Let me just say in a general way that I think as we got
into this over the last two or three years, one of the main
things we had to overcome was attitudes and attitudinal change,
not just here but throughout America with regard to the presence
of this virus and its epidemic proportions. That involved a
learning experience for all of us.

302
You say what was the most difficult thing that we had
to deal with? I suppose just the necessity for people coming to
understand -- if you can put it this way, I guess that you don[’t
treat these people like lepers and put them off somewhere.

You all know about Ryan White and the problems he’s
had. He’s not from Indianapolis, he’s from the road a little
ways. We’re a suburb of Kokomo and he’s from up that way! But
I think the way in which he described his experience to you and
to the American public illustrates the kind of problems that you
have to deal with with regard to understanding what AIDS is all
about, with an acceptance of it, with non-discrimination and with
a professional and compassionate approach to it. Maybe there’s
something more that either of you could add.

CHAIRMAN WATKINS: Thank you. Doctor Lee?

DR. LEE: Along with Mr. Creedon’s questions, I’m
interested in the demographics of the Indianapolis problem. How
many drug abusers do you have, how many women do you have, how
many kids do you have?

MAYOR HUDNUT: I’m sorry, I can’t answer that. We
could get that information for you and make it available to the
record probably before you leave town, but I don’t have that
available to me. Well, may I do after all. Beverly Guidara, I
should have introduced you. My press secretary and executive
assistant. Pediatric cases increased from 11 cases in 1981 to
750 cases i 1987. That’s the national figure, isn’t it? Aren’t
you giving me national figures here?

MS. GUIDARA: Yes.

DR. LEE: Well, we don’t want to push you. I thought
that your administrative aide might have had that. We’ve been
terrifically concerned particularly by the pediatric problems
because they’re going to impact like the dickens on your local
hospital system. I was interested to know what the character of
the problem was here.

MAYOR HUDNUT: I’m sorry I can’t answer that, but I
tell you what, I’11 get you the answer.

CHAIRMAN WATKINS: I think it might be useful for us to
have the demographic breakdown because we’re often accused of
being New York biased, for example, that we’re not that
interested in others. So, I think it would be useful to know
just how it is broken down and perhaps that 200 minus cases that
you’ve already had some of your projections, how they’re
demographically broken out and how you would estimate some of the
projected problems in the city here under your purview.

303
y
MAYOR HUDNUT: It’s just been whispered to me that we
do have somebody here from the Marion County Health Department.
Can they answer?

CHAIRMAN WATKINS: Yes. Please come forward and state
our name. 7

| 7 .
MAYOR HUDNUT: Please come forward quickly.
CHATRMAN WATKINS; ‘ Jast grab the microphone there and
don’t hesitate. i ¢

y 7
‘
4 é

MAYOR HUDNUT: Mary McKeever from the Indianapolis
Public Health Department. ’

MS. MCKEEVER ** Right. Marion County Health Department.
The question originally about the cases and the breakdown, we
have about 83 percent of the cases that involve
homosexual/bisexual* males. Lumped in there are the IV drug using
homosexual/bisexual males. We have about seven percent
intravenous drug users listed as the risk. We have two percent
parent at risk; two percent partner at risk, two percent
transfusion hemophiliac, and the rest is sort of insignificant.

é

But 90 percent of our cases involve some sort of sexual
activity. Then seven percent is the IV drug using. We
guesstimate that in the state there about 7,000 IV drug users.

é We’ve just started a program to have a community health
outreach worker go out into the streets to find the people that
are using drugs that we can’t reach through treatment programs
and to gather some information from those people as well as
educate them.

CHAIRMAN WATKINS: Do you have the general demographic
mix between white, Hispanic, black or other minorities just
generally in the city?

MS. MCKEEVER: Yes.
MAYOR HUDNUT: You mean in the population or in the --

1 yf

CHAIRMAN WATKINS: Yes, just the population in the
city.

MAYOR HUDNUT: Well, we have about 750,000 people in
Indianapolis, may 6,000 Hispanics. Maybe one to two percent
Hispanic. Probably in the whole of Marion County, 20 to 22
percent black and the rest are caucasian.

CHAIRMAN WATKINS: Thank you.

304
DR. LEE: How about the babies? How many babies do you
have in Indianapolis now with AIDS?

MS. MCKEEVER: Three, 0 to 13 pediatric.

DR. LEE: Three, 0 what?

MS. MCKEEVER: Age group 0 to 13, three cases.
DR. LEE: Three cases.

MAYOR HUDNUT: How about from straight blood
transfusions, I thin we have four.

CHAIRMAN WATKINS: Thank you. Doctor Lilly?

DR. LILLY:: Well, I want to congratulate you on your
policy that you’ve promulgated and insist that these gentlemen
have told us how much they need education. I hope you carry out
the policies with respect to educating your employees that you
have told us you’re going to in this proclamation.

I would also say, and perhaps I should save this for
later on, but I’m wondering why these gentlemen who represent
unions aren’t taking on some of that responsibility themselves?

MR. BARAB: We are.

CHAIRMAN WATKINS: Ms. Gebbie? \

MRS. GEBBIE: This is perhaps a different angle on part
of the point that Doctor Lilly was raising. To what extent were
line workers in your various departments consulted or involved in
development the policy or to what extent is there thinking about
their involvement in the methods of carrying it out.or was this a
management policy that some folks went off and wrote? It’s a
good policy. I’m just interested in that interaction because
that seems to be a critical use in many settings?

MAYOR HUDNUT: We designed this order with the hope
that we would establish a well-grounded policy now that is pro-
active rather than simply react after the fact if an AIDS
situation involving a municipal worker should happen to develop.
Kristie, do you have any more of a specific response to her
question?

MS. HILL: I think it’s important for you to know a
Significant amount of the policy has to do with the wellness
program. Our employees were involved in the development of that
program and they will be involved, I think they have to be
involved, in the development of the procedures that are directed
to be developed under this order.

305
MRS. GEBBIE: This is a kind of a very hard question to
answer, I think. In a lot of settings, the people who work in
the public hospital or the public health department have already
been looking at this issue and think it’s important. Perhaps the
public safety personnel is also, but the people who run the road
department say something on the order of, "Why are you bothering
me with this?"

Do you have a feel for that among your managers and
workers whether they’ve been waiting and are excited about this
or whether again you’re so far out front of them with thinking
it’s time for a policy that you’re going to have to do some
catch-up work?

MAYOR HUDNUT: Well, let me begin by saying that I
think there is a very real and legitimate concern among our
public safety personnel, the paramedics, the police officers, the
fire fighters, some of the people that are represented by the
union spokespersons over here on the panel because they’re
dealing with it on a regular basis, as are many of our public
health personnel in the health and hospital corporation here.

Beyond that, I cannot say how much of a concern there
is among our city employee population. But we do have a
generalized commitment to what we call a wellness program and an
employee assistance program. I think that we are sensitive, at
least in terms of management policy, to the fact that when there
are these concerns, they should be dealt with and we’re trying to
make available to our personnel the opportunity to receive
counseling and to have their problem and their concern dealt
with in a constructive manner when it is raised.

MRS. GEBBIE: Thank you.
CHAIRMAN WATKINS: Dr. SerVaas?

DR. SerVAAS: Mayor, the question that Doctor Lee
asked you about, the demographics, I just wanted to menton for
the rest of the panel something very surprising about Indiana.
We have so few cases and no one really understands the teenager
prevalence. But we recently had information 17, 18 and 19 year
olds who wouldn’t have thought they were high risk or they
wouldn’t have applied.

Do you see anything, as a result of those numbers, that
our city should be doing with 17, 18 and 19 year olds? In that
instance, we found that they doubled from 17 to 18 and then it
was three times as much prevalence in the 19 year olds over the
18 year olds. Is that surprising to us in Marion County in that
we think of something we can be doing in the schools with the 17
year olds? How do you see -- we’re talking about AIDS in the
work place and I guess that this may not be as important.

306
 

 

MAYOR HUDNUT: Well, I think that we recognize that
this is a multi-faceted problem and that it requires a multi-
jurisdictional approach to solve. For example, here in Marion
County we have an independent health hospital corporation which
is not under the direct administration of the city or the Mayor’s
office and the public health officials can speak for themselves
and I’11 ask Mary to come up an help in answer to the question in
just a minute.

It seems to me that one of the things we’ve said in
this executive order with regard to establishing and AIDS policy
for city employees rather than the general population is that
we're going to comply with the state law that was adopted under
Senator Pat Miller’s leadership here in the last session of the
General Assembly.

That required that each governing body of a school
corporation establish a 13 member AIDS advisory counsel. One
member must be a representative of the local or state board of
health and must be trained in the area of dangerous communicable
disease. Two student members, two teacher members, two
parent/guardian members, two members representing school
administrator and two representatives of health care professions
and two citizen members.

This council would be required to identify and study
educational materials and resources on AIDS that are available
for use in the schools and their school corporation, determine
which materials and resources are based on sound medical
principals and reflect the attitude of the community, recommend
to the school corporation educational materials and resources on
AIDS that reflect the attitude of the community and it requires
the governing body; the school corporation, to consider the
counsel’s recommendation.

So, this is trying to get at that teenager problem
through school policy, which is hopefully where most of the
teenagers will be at some point in their teenage life. Mary, is
there anything that you want to add?

MS. MCKEEVER: Aside from outreach, with
extracurricular sorts of activities that happen in the count, it
takes a long time to develop curricula. Something that is good
and something that can be comprehensive on different levels from
kindergarten through 12. IPS is involved in that process right
now, developing a curriculum for K through 12 in family life
education.

Another thing is we’re thinking about doing some sort
of pilot program for peer support groups. We’ve had lots of
students tell us that you don’t reach them by adults talking to
the students. So if we can train the students to talk with each

307
other an support themselves in whatever sort of a decision that
they make and educate themselves about AIDS transmission and
support themselves in maintaining safe behavior, that that might
be a way to go. That seems to be something that’s happening in
some of the more progressive programs across the country. So,
we've been involved in all those things.

CHAIRMAN WATKINS: Excellent. Doctor Crenshaw?

DR. CRENSHAW: With regard to the earlier testimony on
fire fighters and policemen, have you seen or do you anticipate
seeing any drop off in your ranks as a result of concern about
this disease?

CHAIRMAN WATKINS: Doctor Crenshaw, I’d like to focus
on the Mayor. He’s going to have to leave in a few minutes.

DR. CRENSHAW: Oh, I’m sorry.

CHAIRMAN WATKINS: Mr. Mayor, in your good executive
order here now, is there a mechanism within say, the National
League of Cities, Conference of Mayors or whatever the title is
of the national level bodies that meet periodically and
coordinates these ideas, a way to share that? is that part of an
ongoing program with your colleagues in the other states to share
these concepts to move the educational process at the most
efficient rate?

MAYOR HUDNUT: I think to be honest with you, sir, I
would have to say that this is a concern among the big city
majors, of which Ed Koch is the chief spokesperson. The smaller
cities and towns, you know there are 33,000 local jurisdictions
around the country and you can’t say they’re all concerned about
this problem. But when I talk to ny colleague Ed Koch, for
example, about the problems that he’s facing in New York, AIDS
is very, very high on his list. The same would be true in the
other big cities. ,

The answer to your question is yes, we can share this
policy and we will send it to both the United States Conference
of Mayors and the National League of Cities. The National League
of Cities is a broader based organization. But between the two
of them -- and the National Association of Counties would be a
third. Between those three organizations, I think that we would
be representative of well over 90 percent of the local government
officials in the country.

We are having a spring leadership conference next week
of our Indiana Association of Cities and Towns which represents
the 116 cities in State in Indiana. I will take our executive
order to them and move it along in that way, not with the
attitude, "Look what a good boy am I," or anything like that, but

308
simply, "This is what we’re trying to do. Do you have a problem?
Can we share our ideas with you? This is what we’ve done. How
do you react to it?"

CHAIRMAN WATKINS: But it comes across to the
Commission as a very concise, clean document that rings well with
us in conjunction with over the 500 witnesses that have come
before us. I think it’s a commendable effort on your part. As
your first item, you went right into discrimination which takes
some backbone. We know that and it’s an important issue as we
move into all these other areas.

Many of the questions that Mr. Stokes -- we have to
answer a lot of questions. When you pull those strings, you find
suspected or anticipated discrimination at the end of the line
with loss of jobs, health insurance, you name it. So, I think
forthrightly addressing that up front and not disguising it down
somewhere in the bottom is a courageous move on your part and I
commend you for it.

MAYOR HUDNUT: Thank you.

CHAIRMAN WATKINS: So, I’m encouraging you to move it.
We like the words that we heard from you.

MAYOR HUDNUT: Thank you very much.

CHAIRMAN WATKINS: Now, if there’s any wish that you
would have that we as the Commission could do to make your life
as the major of a great city in the country easier in this area
of the epidemic, what would you want us to do?

MAYOR HUDNUT: Find a cure or prevention.
CHAIRMAN WATKINS: Okay. How about number two?

MAYOR HUDNUT: Back us up in our non-discriminatory
policy and also in the educational effort that must be made and
help to develop the national consciousness on this subject. We
need to have a war on this just like we’ve got a war going, and I
don’t want to offend anybody, on smoking. There’s a national
mind set that ’s being developed with regard to smoking. We need
that on drug abuse, which you’re not here to discuss. We need a
Marshall Plan on drug abuse, but we also need, I think, to
develop the kind of mentality in America that filters down here
to us at the grassroots, us little old mayors and local officials
and to the people that we serve that cautions them about this
and educates them on what they can do to prevent it and all the
rest of it. "An ounce of prevention is worth a pound of cure,"
to coin a phrase.

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CHAIRMAN WATKINS: Thank you, Mr. Mayor, very much for
coming before us today. We’1ll let you go back to work.

MAYOR HUDNUT: Thank you. We’re very pleased to have
you here and we wish you well.

CHAIRMAN WATKINS: Thank you very much.
MAYOR HUDNUT: Thanks.

CHAIRMAN WATKINS: I’m going to turn the chair over
briefly to Doctor Lee and then let’s proceed back to Mr John
Creedon with questions for the remainder of the panel.

DR. LEE: Mr. Mayor, by the way, we are here to talk
about drug abuse. We’re very, very interested in it as a part of

this problem and we’re going to be heavily concerned with it on
our final report. Thanks for your comments.

Mr. Creedon, you want to start the questioning for the
rest of the panel?

MR. CREEDON: Yes. I’d like really to follow up a
little bit on the brief question that Frank Lilly asked.
Throughout, the testimony of all three, it seems to me there are
a couple of things that are common. One is that there’s a need
for special training on the part of either health workers, fire
fighters or police officers or anybody who’s dealing with blood
or exposed to it. Certainly that is one category of training
that needs to be given. I assume that the unions involved here
are doing some of that currently.

I guess the other part, and it’s part triggered by one
of the comments that Mr. Stokes made, and that is that to some
extent the threat here is a real threat. How do you separate
that in people’s minds? Again, I guess it’s training or
education or whatever. I suppose hereto you people can probably
do it better than anybody else.

MR. BARAB: Yes. Just to repeat, we’ve been doing a
substantial amount of training. We’ve been doing it since 1983
through fact sheets, workshops, through other publications. I
think the other unions represented here and the unions you’1ll be
hearing from tomorrow are doing the same.

Two aspects of that. One is we found that the kind of
training and education that many of our members have been
getting, to the extent they’ve been getting it, especially in the
non-health care settings, has been very poor. They’ve either
been getting very little training, or they’ve been getting
inaccurate training, or they’ve been getting education that has
had contradictory statements. In many cases, we‘ve heard from

310
our members that they don’t know who to believe or if to believe
anyone anymore.

MR. CREEDON: That’s because the municipalities
themselves are not doing the job.

MR. BARAB: Well, it’s not just municipalities. I’m
talking about mental health institution management and that type
of thing.

MR. CREEDON: Yes, right.

MR. BARAB: Right. Part of the problem is they’re not
doing the job. Part of the problem is the way they’re doing the
job. We’ve also been finding that in this case we can divide the
world into two groups, those that know a lot about AIDS and those
that know a lot about what happens in the work place.
Unfortunately, we don’t always get both types giving the
training. We’1ll get someone that knows a lot about AIDS but
knows nothing about what happens in a correctional institution
and a mental health institution, or for example, in a sanitation
work place. Or we’ll get someone who may work in the facility
and knows what goes on there, but doesn’t necessarily know a lot
about AIDS.

We found that the only thing worse than no training is
poor training. If you have an expert in front of you that
supposedly knows what they’re talking about and then you find out
they don’t, then you don’t know who too believe and you don’t
want to believe anyone.

So, again, we’ve been called in on more or less an
emergency basis in a lot of situations and we’ve been told not
only by our members but by management that our materials are much
better in terms of not only the accessibility of the information
but the relevance of the information to the specific work places
and anything they’ve been able to get from the government
agencies.

Again, just in reference to one other statement you
made in terms of the real fear versus the imagined fear, that is
a problem. There is a certain contradiction in that if you
compare AIDS to hepatitis B, OSHA reports that between 200 and
300 health care workers die every year from hepatitis B that they
contract on the job. I don’t think they’re aware of anyone yet
that’s actually died of AIDS that they’ve contracted on the job.
There are other cases of people who have been infected on the job
and now have come down with AIDS. Most of the fear has to do
with AIDS. That has to do with, obviously, various things
associated with AIDS.

311
So, to the extent we’re dealing with the actual risk
in terms of the actual illnesses, I suppose we’re spending an
jnordinate amount of our time training about AIDS. On the other
hand, it has raised our members awareness and concern about
infections diseases in general which is very good, especially
concerning hepatitis B, AIDS, as well as other diseases and
health and safety in general. So, even to the extent that we're
quelling people’s unreal fears, it certainly has not been wasted
time.

MR. CREEDON: Well, there are a lot of fears that are
probably exaggerated and yet there are problems too. It seems to
me you have a difficult challenge here to do both, to get away so
people aren’t imaging fears that aren’t real, and yet at the same
time deal adequately with the real fears.

MR. STOKES: If it’s a perceived problem, then it is
real to the individual who perceives it.

MR. CREEDON: Oh, yes, absolutely.

MR. STOKES: In our job, and I’m speaking just from a
law enforcement perspective, that ‘’s what I know, that’s what I
do. So I’ve got to speak from the law enforcement area and to
what Doctor Lilly said a while ago. Yes, we try to educate and
we have to work with the municipalities. That’s why I said the
first thing they cry about is there’s not enough money to go
around.

These are some of the materials that I received from
around the country. Baltimore, Maryland seems to be, in my
opinion, for a police department, the most advanced in this area.
A police officer that arrives on the scene of a family
disturbance where there has been someone shot or just a physical
confrontation where blood has been spilt doe not have time in an
emergency situation to don a mask, put on goggles and put on his
boots to wade into that situation to quell it before someone is
either permanently maimed or killed in those types of situations.
That’s what we’re dealing with.

Our people have been told, we have read, I’ve been to
several seminars, we send people to seminars to talk about AIDS.
Can you contract AIDS through the tear duct, through the nose,
through the mouth? Is it only through blood? Is it through body
fluid? How long do body fluids live outside the body? How long
does my crime scene search unit have to wait if there’s an AIDS
virus? How long would the virus live in the deceased? How
should they handle that body? What should they do to properly
put on and take off gloves and outfits? We’re now getting to the
point where we educate our people to that, how to put it on, how
to take it off.

312
We understand as police officers in this country that
we're never going to be in a situation of utopia where we’ll have
time to don the eye goggles and the mask before you go in. It’s
just not practical. We accept that as part of a risk. But a
doctor or a nurse in a hospital doesn’t.

What we’re asking for is if we have to take that
initial risk, the same as a fire fighters, then we believe that
after that person is diagnosed as being positive, the courtesy is
to come back for the safety of the officer and his family to tell
him or her that they’ve had that contact. In some cases, two
lives may be in danger.

MR. CREEDON: I agree with you. That’s why I asked the
Mayor that question, so that he would get assurance that at least
in Indianapolis they’re going to do it.

CHAIRMAN WATKINS: Just a quick follow-up, Mr. Stokes.
WOuld you just amplify, how do you keep track of that particular
sequence of events that when the HIV determination is positive
can be fed back and properly employed? In other words, how do
you document when you go into that situation after the fact?
you’ve said, "This is what transpired." Does that get into your
own records?

MR. STOKES: Yes, sir.

CHAIRMAN WATKINS: So you have sufficient tracing then
and you can go back and find anyone who was cut, hurt, exposed?

MR. STOKES: All the hospital would have to do in our
county is call the appropriate agency or contact the police
department. We have AIDS in transport arrests slate sheets, all
that information is made available. When you take someone to the
hospital, you sign that you took that individual. Then the
Department could trace back each and every officer that was at
the scene of that disturbance or that wreck. Yes, sir.

CHAIRMAN WATKINS: Is that fairly common as far as you
know across the country?

MR. STOKES: Oh, yes, sir, very common.

CHAIRMAN WATKINS: That doesn’t add any additional
burden, is what I’m trying to say. That’s already being done and
so there’s no additional burden to set up a system that would

permit you to get to the right people with the right information,
assuming that that HIV status could be given to you?

MR. STOKES: Yes , sir.

313
MR. CREEDON: I know Mr. Duffy, in his comments,
recognized that there is a problem here of confidentiality. I
assume that in the case of the law enforcement officers there
would be the ability to deal with that as well.

MR. STOKES: I guess you get concerned about the
statistics. The statistics that I have here on AIDS from around
the country and the policies, until we say that we finds a cure
or vaccine, then something has to be done. Not too many people
are living that contract the AIDS virus. They are dying from it.

MR. CREEDON: Yes, about half --
MR. STOKES: 120 and 59 dies, that 50 percent almost.
MR. CREEDON: Right.

MR. STOKES: That’s the true statistics throughout the
country. So, confidentiality of the individual becomes a minute
problem in the face of death. I think we’ve got to carry out --

MR. CREEDON: But, Mr. Stokes, one of the issues here
is that there may be a million and a half people out there who
have it and some of them -- now, they could be part of an
incident, for example, involving a law enforcement situation
where they have the virus and they might not come down with AIDS
for 10 years.

MR. STOKES: True.

MR. CREEDON: So, the one issue that we find going
around and hearing people from different walks of life and their
concern is this one of discrimination that the mayor referred to.
In other words, if it gets out that someone has the virus, then
you have a whole raft of discrimination problems that they have
to deal with. So, I understand what you’re saying, but I think
the confidentiality issue is not one that you should overlook at
all.

MR. STOKES: I don’t think you just throw it aside and
overlook it, but I think you have to weigh the confidentiality of
an individual in concern with me as a person who’s out there
working everyday. I don’t go to work with the intentions as
being shot, stabbed or killed or contracting a disease that I can
take home and pass on perhaps to my wife and my children who, in
that case, would be innocent victims. I think there has to be
some compassion and understanding for the public servant that
goes out there and consummates this daily act.

We have contact with three percent of the population on
a daily basis. Three percent of the population, of which the
majority of the citizens of this country could care less about

314

 
and don’t want contact with them. So, I think there has to be an
overt act to protect us. That’s what I’m talking about.

MR. CREEDON: I agree. I think there has to be a
balance. But all I’m suggesting is that the confidentiality
aspect is a factor that needs to be balances.

MR. STOKES: And I think that you can do that with the
hospitals on the contact with the Department and coming back and
saying. "You have had a contact with a person that had tested
positive," without even telling them who that person is. THey
may be able to go back and rationalize and figure it out, but I
think if you say to them, "That’s immaterial who it was, if it
was John or if it was Jim, it doesn’t make any difference who it
was. You had that positive contact. How are you going to deal
with it with you family and how are you going to deal with it as
an individual?" That’s important.

MR. DUFFY: You’ve put sa number of complex issues on
the table and I’d like to respond to them. First of all, in
terms of education, which both of you brought up, our union
likewise is trying to educate our members on this subject. I
have a full-time staff -- professional and support staff -- of
nine people solely devoted to safety and health. The number one
priority of our union this last year, because of obvious concern,
has been contagious diseases. We have produced two videos on it
which have been sent out to every local we have in the country.
We did our guidelines, which were sent out to every local and
will make any quantity available to anyone else that wants then.
We just release posters on contagious diseases that we would hope
hang in every firehouse throughout the country.

Even with all that work, we’re not touching anybody
until the cities, those responsible for their employees -- which
fire fighters are -- start implementing education programs. I’m
glad to see that Indianapolis -- I guess it’s a big coincidence
why it was issued today -- but I’m glad to see them beginning a
program of training their people. Hopefully they will develop a
program first, since there is no standard program for training
emergency response personnel.

Additionally, when we educate our membership, we’re
getting to our member’s leaders. Out of 175,00 people, we don’t
always get to the guy in the street, the rank and file. That’s a
problem with any education procedure coming from a national
level. We can only hope we get there.

The notification issue is much more complex that you’re
presenting right now. We have the major hospital association
groups adamantly against any notification of police and fire and
other public employees and they will fight it to the hilt.
They’re claiming legal problems, anything that they can do to

315
claim why they won’t notify. They’re using legal issues as a
roadblock for this issue.

In addressing the confidentiality issue, which I
certainly strongly believe in, and I don’t want you to
misinterpret our organization’s belief, we are also trying to get
information. I presented examples from small cities in my
testimony because I think its important. These exposures are not
just occurring in New York, San Francisco, Miami, and Washington,
D.c. It’s indeed a national concern, which I’m sure you’re aware
of.

However, I have to go back to one of the major cities.
In San Francisco, our local there requested about three years ago
for locations of the AIDS hospices throughout the city of San
Francisco. They did not want that information -- they wanted
that information provided to the dispatch officers in the
dispatch department and in the fire department.

So if you call 911 in San Francisco and you say you’re
having a problem at one of the AIDS hospices, that dispatcher
will now that and will be able to inform and only inform that
responding vehicle that it’s an AIDS hospice. The city would not
do that. The community was against. our local brought suit
against the state under the Cal OSHA law, under their right-to-
know and they’ve lost that.

The policy that they’ve come out with now in San
Francisco,, which is indeed unfortunate because it hypes up the
fears of everybody -- is that everybody they respond to is
considered to have AIDS and they’re treated appropriately.
That’s their reaction to not getting information. So, there’s a
lot more complexities in addressing this issue and there’s a lot
of groups out there putting up roadblocks to getting that
information out.

When we treat a victim on an emergency scene, we do not
have the opportunity many physicians have to scrub up or clean up
-- which I realize is to protect the patient as well as the
provider. WHen you’re elbow-deep in blood from an individual
who just went through a windshield of a car, that opportunity
doesn’t avail itself when you’re dealing with life. Fire
fighters, paramedics, police officers and other public employees
have to work under these conditions. To tell those people they
can’t get any notification if an individual has a contagious
disease, whether it be AIDS or hepatitis B or any other
contagious disease is criminal. So, it’s much more complex.

MR. CREEDON: I appreciate your clarifying for me the
importance of the municipality or whatever the local
governmental body, the real responsibility for education and so
forth has to rest there and you can stimulate it, but it has to

316
 

be there. I guess the question you raise about the hospital as
being unwilling to give you that information may in part be
influenced by the fact that there have not been any cases so far,
I suppose, and they may have some liability. So, it could be
that it would be necessary to have some legislation authorizing
them to release the information to you. I’m sympathetic to what
you’re saying and certainly if there are any cases showing that
the threat is a real threat and not an imagined threat, which I
guess we haven’t had --

MR. DUFFY: Some of the health care providers such as
the police and fire have been taken out of the health care
provider link. Other people are notified. The emergency room
people find out. In some cases it’s informal. In one case, we
want to lump fire fighters and police in to the health care
provider system, but in terms of notification we want to
specifically exclude then.

MR. CREEDON: Well, all I’m suggesting is you may need
legislation to do what you want. Thank you.

MR. STOKES: It could be a recommendation. We were
hoping, at least I was when we talked about this, hoping that
that may be a recommendation of this Commission to the government
that we have to consider that. We do have confirmed cases of
police officers now who have gotten AIDS in the line of duty,
have now tested pdsitive. I think that’s going to increase over
the next five to ten years.

MR. CREEDON: I think it would be helpful if you
submitted data on that to us and would think that the Commission
should consider what’s being recommend.

CHAIRMAN WATKINS: Well, we did have the presentation
from the Governor of Rhode Island who had proposed to the state
legislature a change to the law that would allow the information
to flow out of the hospital back to the appropriate authority,
protecting confidentiality on the individual, carefully passing
that information back for blood contact cases. In other words,
when the situation occurred, a proper entre into the system would
be made saying, "This did occur under these circumstances. We
are concerned because of the circumstances. We need to have that
information because we have a clear case of blood interchange
with our providers." That was a law -- we don’t know what its
status is, but I’m just telling you there are others that --

MR. DUFFY: I can tell you because I assisted in
writing it. It has passed.

CHAIRMAN WATKINS: Yes.

317
MR. DUFFY: Rhode Island fire fighters and our office
worked on the Rhode Island law.

CHAIRMAN WATKINS: Has is now been passed into law?
MR. DUFFY: Yes, it sure has been.

CHAIRMAN WATKINS: We didn’t know that. That’s good
for the record. We’ll take a look at that and see if there’s
something we should do at the federal level to make
recommendations to --

MR. DUFFY: If you like, I can provide you with other
state laws as well that address similar issues.

CHAIRMAN WATKINS: Where that’s already been done? Are
they almost comparable in other states?

MR. DUFFY: When it comes out of my office, they’re all
the same, same computer. We just change the name of the state.
But yes, there have been some change in it, but they’re typically
all the same. I1’11 send you the ones that we have.

MR. STOKES: Maryland just passed one. It’s on the
governor’s desk. There’s also two pieces of legislation in the
Congress of the United States on AIDS, one submitted by us and
one submitted by the fire fighters dealing with the same subject.

CHAIRMAN WATKINS: There’s been no action on this H.R.
3418 as far as I know at this point in time. But all of you
support that particular piece of legislation that’s sitting up
there? Are you all familiar with it?

MR. BARAB: We’re not familiar with the details of it.

CHAIRMAN WATKINS: Well, this is the one that was
mentioned, I think, by Mr. Duffy.

MR. DUFFY: The Senate AIDS bill does not include it.
It looks like right now the House AIDS bill will include it. In
the conference committee they’re ready or that compromise. It
only addresses police, fire, and not all other public employees.

CHAIRMAN WATKINS: Well, we’ll get access to the bill.
I just wanted to find out whether you supported it. Thank you.
Doctor Lee?

DR. LEE: These guys have worked over all my questions
so hard that I’ve got nothing left except to tell you that I
strongly support putting you people in the loop. I am very sorry
that Mr. Novey isn’t here because these poor guys in Corrections
take a terrific hit on this as well.

318
There’s one thing I guess none of the bills address as
far as I know. We’ve tried to address it as a Commission. That
is, when can we force somebody to have the test done? In the
prison system we can’t, can we?

MR. STOKES: We represent quite a few prison deputy
sheriffs, that watch over prisoners in felony and misdemeanor
cases. Right now you're right, prisoners use this as a line of
defense when they’re incarcerated, as far as feces, spitting or
even cutting themselves intentionally to bleed on guards or
trying to lead them into confrontation. But those individuals,
and I don’t believe it would be a violation of the 4th Amendment
if those individuals are suspected of having a virus being tested
for the protection of the other prisoners and the guards
themselves. But it is, it’s a serious problem within the
prisons.

DR. LEE: But they can’t be forced to do it, can they
now?

MR. STOKES: No. I think there’s going to be some test
cases, just like the one that’s come up out of -- we just had a
state trooper in New Jersey where a prisoner that was under
arrest bit his finger off, the end of his finger. Now, I think
that person has a right to be tested for the protection of the
officer. I’m sure there’s going to be some cases go up to the
Supreme Court or to the Supreme Court of the state. But right
now, I think you should be allowed to test them. I would take it
as a test case if it comes up in our jurisdiction for someone
whom we represent.

MR. BARAB: We represent about 80,000 corrections
officers. In many cases, we have asked to have prisoners tested
and it hasn’t gone through. They just passed a law in the state
of Washington though which originally had a provision where we
could have mandatory testing. I’m not sure if that provision
survived the final cut. That was a few weeks ago, but I can
check that.

DR. LEE: There’s no other state, Ms. Gault? its there
a state, Kris? \

MRS. GEBBIE: Well, under Oregon Public Health Law, I
can ask anyone to be tested if I believe they are exposing
others to any communicable disease. The individual involved has
the right to refuse that test, and if so I have the right to
treat them as if they’re infected. That’s used most commonly
with tuberculosis where the person refuses to be tested and so
on. We can then keep them in isolation as if they had TB until
we can test and proceed.

319
In this case, the issue I think would be whether you
test them or not, whether they’re positive or negative, I’m not
quite sure what difference it does in either their management or
the policeman’s management, but that law in Oregon would apply if
there was a determination that the individual had been put at
risk of the disease and we didn’t have adequate information.
That’s not unusual state law around communicable diseases. It
exists in several jurisdictions.

DR. LEE: Well, how does it apply? We just listened to
this woman here yesterday talked about how her husband got a
blood transfusion and then she got AIDS. Now, these fellows are
in this very sticky environment and sure, they did what they had
to do and what use is it because the thing has been done. But
they should know because they don’t want to infect their wives.

MRS. GEBBIE: And the point is that if you can test, if
you have a test result, you can either say, "Yes, you might, or
no, you might not, "or you’d have to say, "You’re going to have
to wait six months to see whether your antibodies turn positive
anyway." There’s the immediate management of that police officer
or fire fighter is exactly the same regardless of the test
result. You may increase or decrease the anxiety level slightly
by having more information, but it doesn’t make the kind of
management difference that it makes with something like
hepatitis or tuberculosis or many other conditions. That’s an
important difference that’s a part of this perception problem we
all have of sorting out how this disease is and isn’t different
than other conditions.

MR. STOKES: Doctor, I think that’s why it’s important
that we get good information and back to the officers. It’s just
like you said, if you’re tested and you know that he tests
positive and he bit me an draw blood and a week later after I.m
tested I can test positive or negative and six months I’m going
to be tested again.

I think the other thing I tried to address in my
statement was, how do we deal with that officer’s psychological
problems with his family life and his wife in the meantime?
That’s what I was getting at with the counseling. I understand
what you’re saying, but there’s a lot of officers out there and a
lot of the general public that feel that the test is imperative
to prove one way or the other and the initial test is not
conclusive from the education that I’ve gotten on the subject.

MRS. GEBBIE: And I believe you’re right on that.
That’s why we have so much education to do about a whole lot of
the related issues on this epidemic.

MR. DUFFY: The Reagan Administration has gone
gangbusters for urine testing for drug testing. If they were so

320
adamant about looking at drug use in federal work places, maybe
perhaps they can also draw up a policy on testing. It’s a
problematic area. I certainly appreciate the complexities of it,
but I think someone needs to look at it and perhaps the
Commission would want to recommend that the Reagan Administration
develop a policy on such testing and test it. It’s a lot easier
putting an individual with TB away under a state law, but I’d
love to see you be able to do that with AIDS.

MRS. GEBBIE: Again, in most jurisdictions, the exact
same law applies and the same tests of appropriateness would
apply and I think those laws will work.

MR. DUFFY: Theoretically.

MRS. GEBBIE: No, I thin k those laws will work with
HIV the same as they work with the others.

DR. LEE: I understand what she’s saying, but I’m with
you guys. I would want to know and I would want to know now and
I wouldn’t want to have to be hung up by it. If there was the
slightest problem, you have to keep a distance from your
partner. It’s a major, major, major problem. We’re going to be
hearing policemen’s wives and firemen’s wives here two or three
years from now with the same thing.

MR. DUFFY: But we can’t even get the information from
people that have been tested and show -- there’s two levels of
problems here.

DR. LEE: Yes, I understand that and I don’t like it.

MR. DUFFY: Both those that the hospitals know and
won’t give you and then, of course, the problem with testing
people.

DR. LEE: Thank you.
CHAIRMAN WATKINS: Doctor Lilly?

DR. LILLY:: How does one establish that a given case
of HIV infection or of AIDS in your ranks is work related?

MR. BARAB: How does one establish that?

DR. LILLY:: Yes.

MR. BARAB: CDC has a procedure for establishing things
like that. Basically what they do is immediately after a
suspected exposure they’ll do a test, a base line test to see
what your infection status is. If you test negative, they’11 do
periodic tests thereafter and if you test positive after having

321
proved you were negative and having proved that you had an actual
exposure, you will be determined to have been occupationally
exposed.

DR. LILLY:: So, you’re telling me that the people that
are in your union are automatically tested after each exposure?

MR. BARAB: No, no, no, they aren’t generally. But
that’s the way CDC determines.

DR. LILLY:: No but I’m wondering how you determine.

MR. BARAB: Well, we don’t. So far we’ve had a few
cases of people who have called us up and said, "Listen, I just
got stuck by a needle from someone that was tested positive to
AIDS," and we will recommend that they immediately go and get
tested and then get tested periodically thereafter. So far in
our union, we haven’t had anybody, luckily so ar, that has
claimed that they’ve been exposed, or at least have tested
positive due to an occupational exposure.

MR. DUFFY: I appreciate your questions as well. We
have no known HIV conversion from job exposure but we are
investigating one right now. We’ve had a number of people HIV-
positive sand some with AIDS and we’ve had a number of fire
fighter deaths -- none of the deaths as best we know right now
occurred because of job exposure. There were other reasons for
it.

However, in our case, it’s based on assumption and in
some cases presumption if it was an exposure. It’s very well
documented in the fire department and police departments as well.
Any time anything is done in a fire department, and police
departments as well, it’s documented in log books. Every time a
truck is started, every time it pulls in and out, every run it’s
on, what happened on the run. They fill book after book after
book and they end up in big rooms like this somewhere. But that
documentation exists.

_ And an individual -- and we’ve done it in cancer cases
with fire fighters -- is able to go back and to research every
response he’s made during his full career.

Now, without response, is there any way you can equate
that? You can presume it is and you can assume it is, but we
don’t have any real way to do it except, of course, as Jordan
mentioned, some of the CDC guidelines, which haven’t been fully
implemented anywhere to the best of my knowledge.

MR. STOKES: I think, Doctor, if you can go back and
you can show that there was a physical confrontation and there
was blood at the scene or other body fluids excreted at the

322
scene, when you transport someone to the hospital for treatment
or when they’re incarcerated in the jail where they’re already
locked up, those are all documented records. When a person is
transported, treated by the nurse on duty, treated by the on-duty
doctor, all those things are documented. So that’s how we go
back and show the correlation between an opportunity to be
exposed to a disease and then a person testing positive.

DR. LILLY:: Well, an opportunity to be exposed to a
disease in a person who has a documented negative status.

MR. STOKES: Right. If you were to show up positive
five or six months later after release or confrontation, we would
still be able to show that that officer or those officers, either
acting as --

DR. LILLY:: That sort of implies to me that that
person was, in fact, tested immediately after that exposure to
make sure that they weren’t already positive.

MR. STOKES: But I think as one of the gentlemen up
here pointed out awhile ago, you can test positive and not show
up with the illness for five, ten years later, they say.

DR. LILLY:: Sure, but that’s not what I’m talking
about. I’m talking about was it really that incident that
infected the individual as opposed to some other incident or
some other behavioral pattern?

MR. STOKES: We’ve got three departments. One has
definitely said in Newark, New Jersey that the officer contracted
the AIDS as a direct result of that contact and has now died. We
have 15 in one other state that are under suspect of AIDS and
three in one other city that have suspect of AIDS and trying to
go back and show whether it was directly job related contact.

So, those records are going to be maintained. In the future, I
think you’1ll have the basis to respond positively to your
question.

DR. LEE: Actually, in the back of my mind, I’m just
wondering, should fire fighters and policemen be routinely
tested?

MR. STOKES: I think now most of -- at least I’1l speak
from out department. On an annual basis, we are, with out annual
physical.

MR. CREEDON: Are you?
MR. STOKES: Yes. you can request that through our

annual physical when you’re tested. I did last time.

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DR. LILLY:: But it’s voluntary?
MR. STOKES: Yes, sir.

MR. DUFFY: Most fire departments in this country don’t
test, don’t even give people physicals. Too much bucks. We have
fire fighters that pend their whole career in the fire department
and the only physical that they have had is when they entered the
job. And even that was just a cursory medical. It’s sad. You’d
think that from all the injuries and all the deaths of fire
fighters, you’d think they’d have implemented a complete physical
testing and they have not. It hasn’t occurred. I don’t know if
we'd be against doing that, but we certainly are for a full
physical program on an annual basis for fire fighters, for the
basis of establishing a baseline to exposures.

I’11 tell you though, your question is interesting
because we’ve been very successful of documenting hep-B cases
with fire fighters. For example, we had a fire fighter that died
a year or so ago in a small town in Ohio. Through a needlestick
seven years prior to that, he went through debilitating liver and
associated disease with hep-B for seven years and suffered like a
dog from it until he died. That was well documented because it
was a needlestick. Now, needlestick injuries are, I guess, a lot
easier to document than others.

It’s going to be very difficult with AIDS because of
the latency periods and whether they’re going to pick it up or
not. A lost of it will be based, as I said before, on assumption
and presumption.

CHAIRMAN WATKINS: Mrs. Gebbie?

MRS. GEBBIE: Two or three, I guess, observations
before I get to my question.

One to Mr. Duffy. When you mentioned that fact that
because of the lack of information right now, many fire fighters
are treating everybody whom they encounter as if they were
infected, most people involved with this epidemic would applaud
that regardless of whether we ever sort out this reporting issue.
That application of universal precautions in the first aid
setting is exactly consistent with universal precautions in the
in-patient care setting. I doubt we’re going to see us move very
far back from that in anything resembling the new future for a

whole bunch of reasons.

A second observation on the issue of notification that
nobody’s mentioned so far, I believe the Rhode Island law deals
with this, and that’is the reciprocal notification of the patient
who may have been exposed to the blood of the care provider. At
least in hospital settings when that tradeoff is pointed out,

324
people suddenly start looking at it differently. I don’t think
the principal is any different in either case and I hope your
union members, I talk to all of you about this, are thinking of
that as we look at ;who needs to know what about exposures.

Where I really want to go with a question to each of
you or a request for some more observation. I think at the heart
of all of what you’ve said is this whole issue of adequate
communication in designing policies so that the people involved
in both writing and implementing the policies feel that they can
trust each other that they know they’re dealing with facts and
can go forward.

Much of what you’ve described sounds to me like its
been based on some real frustrating experiences in which you’ve
gotten confusing information that feeds misperception rather than
feeds accurate perception. The continuing doubt about work place
exposures for emergency personnel is a concern, when in fact
there have been no documented cases of AIDS that I know of from
that kind of work place exposure.

I wish we had here at the table with you some of the
sheriffs, police chief, fire chiefs, fire boards, police boards,
county commissions for whom your members work or public hospital
boards, Mr. Barab, for whom your employees work, so we could hear
a little more about what is going on in the dynamic that is
making it difficult, apparently, for you to reach a resolution in
a sensible, trusting way, and leaves you looking for a national
solution to some of these things. There may be a need for some
national things, but a let of this is going to be resolved in
each individual worksite. It sounds to me like something is
terribly wrong here from your perception. Can you tell us more
about that process, what’s making it so hard for you?

MR. BARAB: We had a conference a couple of months ago.
It wasn’t really a conference, it was sort of a large meeting,
where we brought out corrections people in and all our mental
health people in and some of our hospital people to talk
specifically about the testing issue. It was very interesting
because what we found was that, first of all, there’s a great
divergence of opinion about whether all correctional inmates
should be tested or mental health residents should be tested,
when, if, what conditions and that type of thing.

Generally, we found those members of ours who had the
most experience with AIDS and have the most people to care for,
in other words those of our members in New York, were the most
opposed tn any kind of testing or segregation. Those who had the
least amount of contact, and correspondingly or coincidentally,
the least amount of training and education were the most in favor
of testing. It was obvious why that is, I suppose.

325
Especially when you look at our situation in New York
several years ago, they were all very much in favor of testing
everyone and segregating everyone that might be HIV-positive.
And over the time, they have received very good training and
they’ve grown accustomed to guarding or caring for people with
AIDS and that fear has gone down. Some of the other people in
other parts of the country had just seen their first AIDS cases,
had received either no training, very poor training and in some
cases had wild people running around biting them on purpose and
that type of thing. They were the ones that were probably most
in favor of that kind of testing.

Now, in terms of your statement concerning the
universal precautions, we’ve more or less given up -- well, we
haven’t given up but in terms of the testing, we realize that
you’re never going to test everybody. You couldn’t test
everybody and even if you did it wouldn’t be accurate. So, we’ve
got to have universal precautions. You have to assume that
everybody you come into contact with is infected. The only time
we have a strong consensus in favor of testing is post-exposure
when this source person’s status is already known. But again, it
is an issue that we’re all over the board at as far as our
members are concerned.

MRS. GEBBIE: Yes. What about this issue of how you
bring people together to work this out sensibly at the local
level? I get the sense that there’s nobody there listening to
you when you ask the question or that they’re giving you a
runaround or that your local health departments are useless in
providing you sensible advice, although they say that’s one of
their jobs. What’s the dynamic that makes this such a difficult
issue?

MR. BARAB: Some health departments are very good and
some are very bad. The day wee had this conference, somebody
handed me a newspaper story saying that some nurse had given
training to some police officers in Harrisburg saying that AIDS
is spread not only through blood and semen but also through
saliva and tears. This was in the newspaper. I don’t know if
they misquoted her or she actually said that or what, but that’s
an example of the kind of training people get. The kind of
fears, when the real fears get to false fears, go to paranoia,
seems to me directly related to the type of training.

As I mentioned earlier, that training deals with not
only how knowledgeable people are about AIDS, but also how
knowledgeable people are about what goes on in the work place.
You’1l be hearing more about this tomorrow. But in discussions
with CDC, the policymakers at CDC and OSHA, you find that a lot
of those policymakers tend to be administrative types who may
know a lot about AIDS and their institutions in general, but very
little about what actually goes on in the work place, on the

326
floor itself and what kind of exposures people actually have and
how frequent those exposures are. That’s a problem too. You
really need people that are familiar with the work places.

MRS. GEBBIE: Well, could we be helpful to you? I
guess I’d like to hear from Mr. Duffy and Mr. Stokes too. But
could we be helpful to you by some recommendation that would push
policymaking that involves line workers in that process? I’m
looking for what we could say that would make a difference.

MR. BARAB: Definitely, and for all training, not just
infectious diseases or AIDS. But we strongly encourage the
employers to do the training. Also, if they’re going to do the
training, to have us involved in the planning and in the actual
training. If they’re not going to do it, we end up going in and
doing it ourselves. We don’t have enough time, obviously, to
train a million members. So we try to get the employers to do it
and to do it well and to use the resources that they have
available. But we will do everything we can in order to
actually help them do it.

MR. DUFFY: The answer is real easy. I can be short.
It’s money. It’s the obvious. I don’t know how much the fire
chiefs will say, because they’re political animals and their
comments are a function of the political entity that they work
for. However, it costs a lot of money to train people on health
issues. You can even look at the comments from the mayor of
Indianapolis and all respect for the major, it’s not that
expensive a program. They’re going to develop a training
program. They’re going to have in a non-discriminating clause,
which we would object against because I think in emergency cases
there should be discrimination against people. I don’t want
that out of context. I don’t think fire fighters that have AIDS
or any other blood-borne contagious disease should be fighting
fires and providing emergency medical care until they don’t have
it anymore or they should be found other fire department jobs
such as those in support services. So, I think the
discrimination clause has to be looked at.

Their sick leave allowances, you have that now. If
you’re sick, you can go out and you can use your sick leave up.
So, at least for the fire department here and around the country,
it’s not an expensive program. But when you get into expenses is
when you have to put an ambu bag on every truck, when you have to
provide a fire fighter with a gown and gloves that he’s going to
throw away after using once, when you have to provide pocket
masks for every fire fighter and resuscitators in every truck and
not just on a handful of them. That’s where -- and you look at
it and it doesn’t seem very expensive and to me it doesn’t seem
very expensive but you’re dealing with cities that have finite

budget and other priorities instead of putting masks and

327
disposable gloves on a fire fighter. That unfortunate, but
that’s the reality of what’s out there.

So, it’s purely bottom line. It’s not that they don’t
want to do it, it’s the cost of doing such a program. We’ve
worked now for two years with a full program on hepatitis-B,
spent almost a half a million dollars. We developed videos on
hepatitis-B. We’ve increased the hepatitis-B vaccination of fire
fighters rom six percent a year ago up to almost over 25 percent
of all fire fighters. A good accomplishment, the most successful
occupational program that’s ever been done in getting people
vaccinated.

Other departments just won’t do it. The bottom line is
not that they don’t want people to get hepatitis-B vaccines it’s
money. It’s $100 to $300 for the series of shots and they don’t
have that money. When you take that to New York City which has
13,000 fire fighters times $100.00, its a lot of bucks. If you
get Mayor Koch, who is the head of the Mayor’s program on AIDS,
and ask him why he doesn’t spend $1.3 million on vaccinating fire
fighters for hepatitis-B. he’1l just say the money’s not there.
We just closed fire stations down in New York City. That’s our
priority, to give fire protection and not inoculate people for
that. AIDS is the same way. So, it’s a money problem. And
education programs are expensive.

MRS. GEBBIE: So, you think that the money for that
education should come from outside the employment setting and be
poured in or do you think we ought to say something about the
money setting priorities within the existing system?

MR. DUFFY: Well, we’re dealing with public employees,
so it’s going to come for a tax base somewhere. So, there has to
be tax base money, whether it’s local level or federal level.

MRS. GEBBIE: But which -- I’m pushing you. WHich
ought it to come from?

MR. DUFFY: I could personally care less.
MRS. GEBBIE: But we’re looking for recommendations.

MR. BARAB: I don’t think in terms of the training --
that it’s that much of an additional expense. The OSHA Hazard
Communication Standard requires all employers to train their
employees anyway about what chemicals they’re exposed to. So I
don’t think it would necessarily be that much additional expense
to train them concerning the infectious diseases they are exposed
to. Now, when you get into the cost of protective materials and
equipment, that may be a different story. But in terms of
training, it shouldn’t be that much of an additional expense.

328
MR. DUFFY: H.R. 3418 provides $25 million of federal
funding to begin to develop a curriculum. It would be nice to
have, a federal curriculum developed so we don’t have every city
developing their own, number one. Number two, the pilot programs
that will be initiated on that, there is $25 million. Obviously
not enough money, but if there is some recommendation the
Committee could make would be to support those efforts to get a
national curriculum and to have the federal tax base support
training these people. That’s the only way it will be done
effectively beaus then you don’t have to go through the
individual tax bases.

MR. STOKES: Let me respond to your question with a
request that the Mayor did awhile ago. Let me bring the
president of the local lodge of the FOP up and let him address
your question as to how well that’s functioned here in
Indianapolis.

CHAIRMAN WATKINS: Just announce your name here so we
can record it.

MR. BLACKWELL: My name is Leo Blackwell. I’m the
President of FOP in Indianapolis. I wish that the mayor or some
of his entourage were still here because I would like to respond
to his well-intended press release that he had today and his
proclamation.

Approximately 18 months ago, when I first took office,
I went to the Chief of Police here in Indianapolis with a case of
hypodermic stick of a police woman who was searching the purse of
an arrested subject and inadvertently stuck her finger with a
hypodermic needle. The arrested subject said she was, in fact, a
positive AIDS carrier. The police officer followed procedure,
documented the case, sent the hypodermic needle in for testing
and for results. She waited three to four days with no
guidelines, no contacts. She determined then that inadvertently
that needle had been destroyed with other narcotics
paraphernalia. There was no way to go back and double check
other than to go find the arrested subject who had since been
released from jail and have that person tested.

I documented that case, sent it to the Chief of Police,
asked for some guidelines, sent along with it information on
Fraternal Order of Police seminars and other seminars around the
country on the problem with IDS and suggested that we develop
policies within our department that would address the needs of
law enforcement officers. To this day,, I have not heard any
response of a positive nature until the Mayor comes here today
and makes a very eloquent.

However, the people who are charged by him with
developing those policies are not in this room listening to what

329

 

 
they should bee listening to. They need to get to the line
officers, to the fire fighters, to the police officers, to the
ambulance drivers, medical technicians and say, "What do you
need? How can we help you?" They aren’t here. They made a nice
show and they’re gone. And I wish that Doctor SerVaas was here
because I know that would get back to Mayor Hudnut because I know
they’re very close. I’m sure it will anyway.

These people need it and we’ve been trying to get it
done. And to answer your question, ma’am we can’t get it done on
a local level. We need some prodding by the federal government,
whether that be proclamations, whether it be help at the
legislative level or whether it be funding. Something needs to
be done and all of the rhetoric and all of the proclamations
throughout the country are not going to help to get the situation
resolved.

We have police officers, police women, fire fighters
out there who are exposed to situations and weeks go by before
they have nay response from the hospital.

I have another incident. AA hospital that is a stone’s
throw from here, from this building, an arrested subject was sent
in after a bad fight and a gunshot. The police officers
administered first aid, as did the fire fighters. The subject
was sent in. On the way to the hospital he says, "Oh, I have
AIDS," and it was a boyfriend situation, homosexual situation.
They send the guy in and it took six days for the hospital to get
a response back to those persons involved at the scene who were
exposed to the blood, six days to finally determine that this man
was not a positive Arps carrier. In the meantime, these people
were pulling their hair out. "Do I go home? Do I talk to my
children? Should I be with my wife? Should we drink from the
same glasses? How should we cleanse?"

There are no answers. We don’t have those answers.
And apparently, my prompting at the local level is not getting
the job done. It took this Commission coming to Indianapolis to
get the Mayor to nays a proclamation. To me, that’s not enough.

CHAIRMAN/ WATKINS: Well, may I just follow up? What
avenue do you have there? This is a very important accusation
you're making. We’re not an arbiter in that in any way, but
you’ve made it now publicly. What is your normal avenue of
appeal here? It seems to me that with this proclamation there is
a new opportunity to do something better perhaps than in the
past. Your colleagues who are municipal employees, if they found
the same response to their appeals for similar kinds of
situations from the mayor would be ablésto band together and say,
"We've gotten the proclamation. Here are the issues we have
facing us. Here are the ones that have not been responded to."
You certainly have avenues, if the normal system can’t stand it,

330
to use other means of getting the information through. It’s a
very important issue.

So, I’m not sure what this Commission does with that.
That’s a local issue, but if we can help at the Commission level,
and we probably will make some statements along these lines, then
we can do that. But we’re not going to be able to solve a local
governmental problem at this session. And yet you’re raising it.
So, I feel compelled to follow up on it to a certain extent, to
the extent we have any authority.

Is this something that is shared by other agencies,
municipal employee agencies here in this county?

MR. BLACKWELL: I would suspect that it is, but I can’t
speak for them. All I know is it’s my particular problem with
law enforcement. To answer your question, what are the channels,
what are the ways of --

CHAIRMAN WATKINS: What’s the normal way that you would
make this approach now to --

MR. BLACKWELL: Being an Admiral in the Navy, I’m sure
you’re familiar with the chain of command.

CHATRMAN WATKINS: It’s easy in the military. I’ve
found it’s very difficult in the private sector. I used to give
the right full rudder order and everybody went to the right. I
now give the right full rudder order and everyone says, "Who the
hell’s this guy?" I understand the problem, but there must be a
mechanism to move up the line here by some technique in
Indianapolis like the television is not here now and would
normally have picked this up and been on the evening show.

MR. BLACKWELL: I think that with the Mayor’s
proclamation, and I’m sure that it’s made in all sincerity, there
will be a mechanism put in place. But I just know for the past
18 months I’ve been looking for just such a vehicle.

CHAIRMAN WATKINS: But the whole country is in this
situation. I really recommend that you move aggressively now
with the Mayor’s proclamation. Assume that it was given in good
faith. It sounded to me as those though it was given in good
faith and I think all the nation needs to pick itself up and move
much more aggressively now. So, this is not a unique experience
that you’re facing here. I’m sympathetic with it. I would just
encourage you to press on and through our contacts here, we will
make it known that some people think there’s not much teeth in
the rhetoric in the past and I hope this is a new opportunity for
them to be heard.

331
MR. BLACKWELL: I asked to be recognized so that I
could respond to Mrs. Gebbie’s suggestion that we have some front
line people involved. This is the same message that I delivered
to Kristie Hill, the Mayor’s legal advisor, as they left. I
said, "Kristie, this is great. Let’s get together on it." She
said, "Yes, we must." I’ve made a note to that effect-and I will
see that she does.

My point is that there are front line people who have
things to offer who can tell these administrators throughout the
nation of the problem first-hand and then they can look for a
solution.

MRS. GEBBIE: Well, you’ve helped lay out what I was
trying to push for. There’s been a lot of rhetoric about every
employer, and in my mind I include public employers in that
rhetoric, ought to be doing something. You speak for some folks
who feel that, A, very little has happened, as near as I can
tell, and B, when it’s happened, appropriate front line people
haven’t been involved.

It’s still not entirely clear to me what we as a
Commission can do. I doubt we’re going to recommend passing a
law that orders every public employer to create a forum to design
an AIDS policy because by the time you passed a law, we’ve wasted
another year.

Somehow I think we need to be helpful in saying, "It’s
past time to get on with it. Sit down and do the dang thing."
The facts are there. You know the work site, the scientific
people know the issues. How we say that in a way that’s positive
and helpful is what I’m still grappling or. Your comments have
been helpful in seeing a little more light in that fog of how we
could do it. I appreciate your coming forward.

MR. STOKES: What I said in the initial statement was a
coordination of all this information where it’s funneled down and
it’s factual and there’s some way to update it. I went to a
seminar in Philadelphia, spent three days there, only to have
people from Atlanta and local doctors and some people stand up
and ultimately wind up in a dispute in front of 125 police
officers about what we should or should not be doing and how or
how we cannot prevent the spread of AIDS. It became very evident
that we were in a very turbulent time for information, factual
information.

I guess what I’m saying to you now as a Commission, try
and get us the factual information that fed back to us that we’re
not feeding outdated information or information that is not a
fact. Can you contract AIDS by shaking hands? No. That’s
pretty evident. Now they’re saying, can you contract AIDS
through body fluid, blood, in the mouth, eyes, tear duct, nose?

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Can you or can’t you? Yes or no? And on what percentage? If it
occurs, does it occur every time?

MRS. GEBBIE: See, from the point --

MR. STOKES: The front line people that we represent --
I’m a police officer. I’m not a chief of police. You get to
the chief of police position and you’re far removed from what a
street officer is doing down here. That’s what I’m saying to
this Commission. That’s why I cam to you today with questions,
not answers, because I don’t have the answers.

MRS. GEBBIE: Let me just point out to you before I
finish up, because I have taken too long here. At least some
people listening to your presentations, others from folks like
you, would say that union representatives are, in fact, making
more of the confusion that need be, are emphasizing the lacks and
gaps in the system, not for what it will do about this particular
infection, but because of what other gains or moves or maneuvers
you can make as a bargaining unit.

I’m not saying what truth there is in that or to what
extent anybody really buys into it. I’ve heard that said.
Certainly when you reemphasize those confusions, when in fact the
vast preponderance of people speaking speak on a very common
basis of how you can and can’t transmit the disease, it can lead
credence to those who want to discredit your role as opposed to
helping you further what I think is a legitimate mission in
protecting your employees.

I just shared that with you as something that is
sometimes heard by folks outside wondering what you’re yammering
about when you’re raising this issue.

MR. STOKES: Our mission as the Fraternal Order of
Police is to represent professional full-time law enforcement
officers and our first line is to offer them that protection,
whether it be on AIDS, guns, bulletproof vests, security in the
jail, whatever it is. The other people out there can say what
they want. I’m not a high paid union official. I belong to a
professional organization. I make $27,000 a year, that’s it.
So, my endeavor here is as a representative. Most of the people
in mu organization are volunteers.

Getting back to what Doctor Lilly said awhile ago,
give us the grants and the aids that are passed out to other
people and I’11 put together a staff of people, as Duffy said a
minute ago, of nine, ten people and come up with a front line
police officer’s solution to your problen.

Whether you get it implemented or not throughout the
country, I don’t know. I don’t know whether Mayor Hudnut or

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Mayor Reinhart from my city, or Mayor Koch or the mayors from all
the other major cities would implement the program, but we do
have a vehicle available to us to do that through a National Law
Enforcement Steering Committee and we’d be interested in doing
that.

I don’t care what the other people, I guess, are
saying. I know what out interests are and what our concerns are
and AIDS is a major issue right now. When we put on an AIDS
seminar, it’s a packed house. But I’m just saying to you, to
pack the house, I want to make sure we’re giving them current
factual information. That’s what I’m really reaching out to you
for. Tell them to get us current factual information and a point
of dissemination.

MRS. GEBBIE: Thank you.
CHAIRMAN WATKINS: Doctor Crenshaw?

DR. CRENSHAW: I completely support your concern about
some notification of emergency workers in the police and fire
department to exposure to an infected person. I would like to
also point out that it isn’t correct that even though you may go
through the same motions, regardless of whether you know or not,
you don’t go through the same emotions at all.

In the number of police officer families that I treated
in therapy, I would say easily I had to do 50 percent less
therapy with the policy officers whose subjects voluntarily were
willing to let them know that they were antibody positive or were
willing to subject themselves to a test. And the ones who
weren’t, 50 percent of that therapy went toward dealing with
their anger toward the system and it was much, much more
difficult for them to cope with the whole experience. They went
through cruel and unusual punishment. So, I think that’s
something important and something that’s very rarely brought to
light.

Secondly, I have some concern about a double standard
that we tend to set as we put two guys on the spot over a concern
about your health issues related to AIDS. That is, you’re
charged with protecting the public safety, our safety. What I
hear over and over again is that when society doesn’t do
everything reasonable within their power to protect your safety,
morale problems develop. That’s why I asked the question
originally. Are you experiencing or do you anticipate a loss of
personnel based on any of the problems that you are seeing within
your communities?

MR. STOKES: I think, Doctor, as the virus situation
becomes more prevalent and I think as candidates for police and
fire sense that this is a real danger to them, that may impede us

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from recruiting those qualified individuals that are out there.
As I said earlier, we don’t have that opportunity to take those
precautions that are provided inside the hospital emergency room
or even in some cases with fire fighters. You’re involved in
situation before you know that it’s a negative situation, that
it’s an HIV situation. I don’t know whether that answers your
question.

MR. DUFFY: I don’t know why anybody in this world
would ever want to be a fire fighter. I’m a fire fighter union’s
health professional, but I don’t know if I have answer if it’s
lessening the amount of people because we’re dealing in an
economic sense. Because of the unions out there, it’s a well
paying job perhaps.

But on the other hand, we’re dealing with a population
that has a mortality ratio far above the general population and
we’re dealing with healthy workers because it’s a medically
selective job to begin with because you have to go through
medical training and agility testing, et cetera, before you can
get on the job. And then you see the same set of people with a
mean age of death at 59, 60 years old compared to the general
population. That’s more than significant. All the mortality
work that’s been done so far has shown mortality in almost all
cases either identical or greatly above the general population.
So, even if you’re identical to the population, you’re still far
exceeding it because your dealing with a healthy population
group.

Do people consider that in a job when they can leave
high school at 18 years old and start up at $24,000 $25,000 a
year? I doubt it. But it sure comes to play four years, five
years later. We are though seeing the fire fighters wearing
protective equipment. In the fire environment, they’re wearing
their breathing apparatus and their clothing more. And now in
the health care providing environment, if there’s such a word, we
are seeing fire fighters demanding to wear gloves and demanding
to fully implement a protocol which I agree everybody should
abide by.

DR. CRENSHAW: Thank you. I think you’re just making
my point stronger. That is that all of you are not asking for a
risk-free environment and enter knowing that. And the morale
impact, feeling abandoned by policies and frustrated by not being
able to take all the limited precautions available could have
significant impact in the long terms. Thanks.

MR. DUFFY: But I think the employer -has the

responsibility still of making that unsafe job as safe as they
possibly can make it.

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MR. STOKES: Doctor, that what I was saying in the
opening statement. When we take the job, I understand there’s a
risk involved. But I would be negligent if I didn’t have my vest
when I went to work or if I went into raid a crack house today
and didn’t take and place the SWAT unit in the most cautious
manner to insure the safety of myself and the other officers to
do that search warrant.

It’s taking that precaution, going the extra step.
That’s what we’re saying here. If it’s the rubber gloves, if its
the wearing of the mask, if it’s a psychological follow-up that
necessary after an HIV-positive, then that’s the precaution and
the training that our departments should be doing with the police
officer.

I understand those risks and I know tomorrow I may
catch it and there’s not anything I can do about it. But what I
am saying is, train me so I can prevent it if it’s preventable.
Train me or give the department the initiative to train, to give
the psychological training to my wife and to my children. I
don’t want to go home and spread it to my children or to my
grandchildren in some cases.

DR. CRENSHAW: Thank you. I think you’ve made your
points really clearly. I hope everybody listens.

CHAIRMAN WATKINS: Let me close out with just one
question for you, Mr. Barab. We’ve had people come before the
Commission that have looked in from outside into the OSHA
responsibility, mission statements and so forth, and feel that
somehow the ball is being dribbled around between a variety of
agencies on responsibilities for other than health care workers.

As you look into the OSHA mission statement and
responsibilities, does it need to be expanded and clarified as to
who is in charge of safety in the work place for federal, state,
local, county employees?

MR. BARAB: Well, I think it’s clear that OSHA’s really
the only agency we have now that’s responsible for work place
health and safety.

CHAIRMAN WATKINS: But I mean for AIDS now. I’m
talking for HIV-infected individuals, for AIDS.

MR. BARAB: I don’t think it matters. Their mandate is
work place safety, whether that be chemicals, ladders,
scaffolding or infectious diseases. I think to a certain extent
mainly due to our pressure and the pressure of the unions and
workers, they’ve picked up the ball: not adequately but toa
certain extent, with health care workers. But they still have a
long way to go with other --

336
CHAIRMAN WATKINS: But is that a matter of mission
statement change? Should the Commission be recommending --
after all, that’s something we can impact on heavily.

MR. BARAB: I think definitely the COmmission should
do that in terms of health care workers, in terms of other
employees who are exposed to blood and body fluids and most
importantly in terms of education and training. OSHA has a
mandate to require that all employee be trained about chemicals,
so they certainly could do the same time for infectious diseases.

CHAIRMAN WATKINS: But informal connections say that
that’s a fuzzy mission responsibility as some of them view it.
Now, we haven’t pulled that string and that’s why I’m asking you
as kind of a user looking into the system and you’ve obviously
answered yes, more can be done there.

MR. BARAB: Yes.

CHAIRMAN WATKINS: More aggressive leadership there and
taking charge of that situation. Do you agree with that?

MR. BARAB: Yes, definitely. In terms of their right to
know, there are already two states that are dong that, that are
requiring training for infectious diseases.

CHAIRMAN WATKINS: Well, I want to thank all of you.
It’s refreshing on the one hand to have your candor and it’s
sobering on the other to know what you people face is the real
world everyday. We’ve seen it in our travel around and we
respect what you’re doing.

Why would anyone want to be a fire fighter? If you’ll
read the latest edition of The Saturday Evening Post, Mr. Duffy,
you’1l see a picture in there of me at eight years old wearing my
fire department uniform. For many, many years before I thought I
would do into the Navy because we were fighting WOrld War II, I
was going to be a fire department person because I think it’s a
great draw still in this country. There are a lot of people that
want to serve. It’s up to us to make that environment safe.

It’s up to us to build the incentives when people want to go into
that profession and stay in it. It’s important to the nation as
is the police department. We know that.

So, I would never sell the American people short.
They’ll be there to volunteer. We’ve got to be fair with the
fire fighters of the nation and give them a chance, the same with
the police department, to do their jobs. We have hamstrung them
over the years. There does tend to be a migration because of our
constitutional setup to be more interested in the accused and we
always have to be fighting to find the right balance in there.

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So, we appreciate what you’ve done and your candid
testimony before us. It’s useful to hear from you all and I
think it’s been a valuable presentation. Thank you very much.
We’ll adjourn until tomorrow morning at 9:00.

(Whereupon, at 5:30 p.m., the above-entitled matter was
adjourned to reconvene tomorrow morning at 9:00a.n.)

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