Physician at hospital’s AIDS clinic charged head of infectious diseases department with religious bigotry; problems continue for Amelia Court
A Dallas County jury found UT Southwestern guilty of discrimination on Tuesday, May 25, and the following day awarded former Amelia Court physician Naiel Nassar $3.6 million.
Nassar had charged UT Southwestern with religious bigotry and said Dr. Beth Levine, head of infectious disease medicine, drove him to quit.
UT Southwestern said it would appeal the verdict.
Last week, UT Southwestern chose not to renew the contract of Michael Limerick who works at Amelia Court. Limerick is an assistant professor at UT Southwestern with R.N. and Ph.D. degrees in nursing. His duties are split between patient care at Amelia Court and clinical trials.
Limerick declined to comment. Although not a physician, he had experience in caring for patients with HIV.
When UT Southwestern was unable to find a doctor for the Amelia Court position, Limerick was hired to fill the void.
One doctor said they hired him when it was convenient because they were unable to find a physician with his experience in HIV care and getting rid of him is typical of the way doctors at Amelia Court are treated.
Amelia Court is the Parkland Hospital HIV/AIDS clinic. While it is part of Dallas County-owned UT Southwestern hospital, the medical school that is part of the University of Texas system hires the physicians.
The two remain separate organizations with different missions. While the relationship may work in other areas, patients and doctors complain that they clash in the operation of Amelia Court.
Spokesmen for both Parkland Hospital and UT Southwestern disagree.
"I think the mission of the two integrate well," said Josh Floren, senior vice president of medicine services. "They are all about clinical care in a teaching environment. We both support research. They have clinical trials available to our patients. We’re very complimentary."
UT Southwestern spokesman John Walls said, "It’s kind of like a family. There may be moments when we disagree, but Parkland wouldn’t be what it is for the community without UT Southwestern. UT Southwestern wouldn’t be what we are without Parkland."
Doctors who have worked at Amelia Court and some patients say the clinic is where the two systems clash.
One said that the reason Limerick’s contract is not being renewed is because he was not bringing in revenue for patient care. Although he is seeing patients, Parkland is not processing his patients for billing because he is not a medical doctor.
On paper, he appears to have no billings although he actually sees a large portion of the patients coming through Amelia Court.
Another reason cited for Limerick’s dismissal was failure to bring in enough clinical trials. He is, however, involved in clinical trials. One Amelia Court patient said he was part of an ongoing study on lipodystrophy. He said Limerick is his principle contact for the study.
Lipodystrophy involves either wasting syndrome caused by HIV or fatty deposits that have been linked to taking protease inhibitors and more lately linked to reverse transcriptase inhibitors.
Limerick is listed as the principal investigator for the study on the National Institute of Health website.
Another doctor still listed as sub-investigator in the lipodystrophy study is Dr. Gary Sinclair. He was the former medical director of Amelia Court.
Sinclair, who left UT Southwestern in April, contacted Dallas Voice from Pretoria, South Africa, where is now training nurse practitioners to administer HIV medications under the President’s Emergency Plan for AIDS Relief (PEPFAR) that is better known as the Bush AIDS Initiative.
He said that since Levine was put in charge of hiring for Amelia Court, about 23 doctors have come and gone. He said some were fired, some did not have contracts renewed, and others "quit under duress."
Sinclair said he left after hiring attorneys in a successful effort defend himself against personal charges made by Levine.
"The ongoing struggle between UT and Parkland is their differing missions. Patient care for HIV is caught in the middle," Sinclair said.
While Parkland is charged with caring for Dallas County’s indigent and uninsured population, UT Southwestern is more concerned with clinical research and training physicians, he said.
And some doctors practicing at the clinic have said they feel there is a disregard for patient care by UT Southwestern, at least when it come to patients at Amelia Court.
Meanwhile, Parkland has received quite a bit of Ryan White funding but has not used most of that funding for Amelia Court. Most of the money has been invested in their Community Oriented Primary Care facilities located around the county.
Dr. Ampro Bernal, formerly an Amelia Court physician, is now a Parkland employee working at the Irving COPC.
UT Southwestern only staffs Amelia Court. Physicians at the community clinics are Parkland employees.
Nassar and another physician wanted to transfer their employment from UT Southwestern to Parkland but remain at Amelia Court. Instead, they were offered positions at community clinics by Parkland. But to remain at Amelia Court, they would need to remain with UT Southwestern under Levine.
Sinclair said that most of the doctors at the COPCs do not have the experience to treat people with HIV effectively. He said that even those with some HIV experience didn’t have the facilities to treat those in need of higher levels of care.
He said that the COPCs do not provide the infusion services that Amelia Court has and have no emergency services.
Floren agreed that Amelia Court provides a higher level of critical care than the COPCs.
"If we have patients who are higher risk, there’s a larger support structure around you — labs, infusion, dental services," he said.
But for a large number of people with HIV, it has become a manageable chronic disease that can be handled effectively in a community clinic setting, Floren said.
He said three of Parkland’s 11 COPCs have HIV practices. One is Bluitt-Flowers Health Center on Overton Road off south I-35. Two are at Southeast Dallas Health Center on Elam Road in Pleasant Grove. One of those clinics specializes in HIV care for women.
This article appeared in the Dallas Voice print edition May 28, 2010.
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