WILi'lAM E. DANNEMEYER 39TH DISTRICT. CAUFDRNIA COMMITTEES: ENERGY AND COMMERCE JUDICIARY 1 Congress of the %lnited States WASHINGTON OFFICE 1214 LONGWORTH HOUSE OFFICE BLDG WASHINGTON, DC 205 15 (202) 225-4 111 DISTRICT OFFICE. 1235 NORTHHARBOR9OULEVARD SUITE 100 FULLERTON. CA 92632 (714)992al41 %onse of Representa~es October 28, 1986 l%e Honorable EdwinMeese U.S. Attorney General ChairmanProTeqore President's mstic Council U.S. Dapartmnt of Justice Washington, D.C. 20530 As Chairman of the President's Istic Council, yau have the authority to bring the AIDS crisis and the crisis of the inaction of public health officials to the attention of the President. At present, the U.S. is experiencing a health catastrophe of historic proportions and a mral crisis of equal magnitude and yet inaction is the unfortunate course chosen by the Public Health Service. I urgeyalto consider ny recamnendations before this epidemic expands beyond the grasp of public health control. At present 24,085 persons have been diagnosed with Acquired Imune Deficiency Synm (AIDS). Of that number, 13,442 are already dead and the remaining number are expected to die within five years. A recent report by the Centers for Disease Control (CDC) projects that by 1991 the emulative nuxber of AID6 cases will total more than 270,000 and the number of deaths will exceed 179,000. In addition, it is estimated that between l,OOO,OOO and 1,500,OOO persons are infected with the AID6 virus and are capable of transmitting the disease. Until recently it was hoped that only 25-30% of those infected would beome victims of full-blown AIDS. However, recent evidence indicates that mre than l/3 of those exposed will progress to the fatal stages of the disease and all of those exposed will experience sane substantial impainrrent of their immme system. If this scenario fails to illustrate the severity of the health crisis at hand, there is mre. Perhaps the mst disturbing aspect of this bleak projection is that individuals who suspect they may be infectious and those who know they are infectious continue to engage in high-risk activities proven to spread this disease, although there have been improvemnts. Despite the authority of public health officials to halt this type of The Honorable Edwin Meese October 28, 1986 Page 2 intervene saying that isolation orders or restrictions on sexual activities infringe on the civil rights of AIDS victims. The issue at hand is not the civil rights of any victim nor of any potential victims, it is finding a way of stopping any and all activities that may spread this 100% fatal disease. The AIDS virusdoes not have rights, and the rights of individuals who persist in engaging in certain activities are outweighed by the rights of those unsuspecting persons whose lives are placed at risk. It is a blatantly selfish action for an individual to reject or'ignore knowledge which would assist him in preventing the death of another. Yet we are faced with the unfortunate facts that many victims of AID6 refuse to acknowledge that any transfer of body fluids could result in the death of another. Persons who suspect they may have been exposed are refusing to get tested because they are afraid of losing their jobs, their friends and the support of their families. While denial and disbelief are understandable reactions, AIL6 victims nust be forced to acknowledge the severity of their illness and take responsibility for the consequences of their actions and inactions. The U.S. Public Health Service is the entity which should be setting and inplementing these vital standards. I have met with Assistant Secretary Windan on this matter as well as his predecessors and remain unsatisfied that this Administration is conmitted to taking responsible action in responding to the AIIX epidemic. For this reason I have introduced a number of legislative efforts aimed at curtailing the spread of AIS. In,the waning days of the 99th Congress I introduced two bills which I believe are the lynchpin for altering the devastating course of this disease. The first bill will make it a crime for federal enployees,members of the armed services and those in federal buildings who knew they have AIDS or who kncm they carry the virus to kncrwingly transfer body fluids. The penalty for engaging in this prohibited conduct will be enforced isolation for a period of five years under the supervision of a public health officer or until a cure is found. It is anticipated that this legislation will be difficult to enforce and will be used only in those rare circumstances where transmission of the virus is purposeful, knowing or where the actor evidences extreme recklessness. pursuant to this legislation, In atterrpting to prosecute an offense it would be necessarytoprovethata particular person was the source of contagion and that the individual possessed the requisite degree of intent necessary to prove culpability. Although criminal prosecution for transmission of the AIDS virus could be accoqlished in most jurisdictions under theories of homicide, manslaughter , attempted rturder and criminal assault, this legislation is designed to spell out a federal policy of deterrence The Honorable Edwin Meese October 28, 1986 Page 3 and to put the federal government on record in opposition to any high- risk conduct known to transmit AIDG. In my judgemnt, it is good public policy for the federal governrrrent to state outright that such behavior is unacceptable to society. Several jurisdictions currently address venereal diseases specifically and recognize a violation of public health orders as a misdemeanor. 'Ihe California Health and Safety Code Section 3198 makes it a misdemeanor to "expose any person to, or infect any person with any venereal disease" and to "marry or have sexual intercourse" if the individual is infected with venereal disease and knws of such condition. In addition, Section 3354 of the California Health and Safety Code makes it a misdemeanor to violate any public health order dealing with curmunicable disease and assesses a fine of $25-$500, irrprisonment for not nxxe than 90 days, or both. The purpose of this bill is to deter future high-risk conduct and to encourage recognition that high-risk activities knwn to spread AIB are criminal under current law and should be treated as such. No civil rights claim can overcome the fact that knwingly passing on a fatal disease is ethically wrong. Society cannot and rmst not condone different standards of conduct for AIDS victims because they are fatally ill. We mst shw caqassion while taking the preventive steps necessary to control proliferation of this terrifying disease. In w judgement this bill will encourage such action. _ The: second legislative effort I introduced at the close of the 99th Congress is a resolution expressing the sense of Congress that States should enact the follwing laws in an attempt to deal with the AIDS problem: - legislation which would require that the blood testing req.&xl before a couple may be married include a negative test result fran a test for AIDS or a test to determine if an individual is a carrier of the virus; -legislation that would require that tracing of individuals with venereal disease include individuals with AIDS, or those determined to be carriers of the virus, and that upon notification of the pcsitive result of such test, the individualat risk be counseled respecting the potential for spreading the disease: -legislation that would encourage desigtlated hospitals to offer blood transfusions which are made directly between the blocd donor and the person receiving the transfusion: -legislation that would require individuals seeking a license to practice medicine, nursing, or any other health care profession to have a negative test result from a test for AIDS, or a test to determine if an individual is a carrier of the virus; and -legislation that would outlaw sodomy. The Honorable Edwin Meese October 28, 1986 Page 4 I introduced this bill with the hope that States will enact this legislation and will take these and other prudent steps to curtail the spread of AIDG. Sane claim that the states are the only ones with jurisdiction over the health threat of AIIX. While I concur with the assesmnt that the States should retain jurisidiction, I do not agree with the assessment of those that indicate that States are solely responsible. An overwhelming federal interest has been created in this issue based on the magnitude of the burden created by the health care costs of the present victints of AIL6 and the potential burden of the 270,000 victims estimated to have the disease by 1991. 'Ihe disabling effects of this debilitating disease dictate that AIDS victiats cannot care for thmelves in the final stages of illness. In-t instances the states and the federal govermnt are the only entities able to shoulder the cost burden of adequate medical care. In this instance the realities of the massive burden iqosed on the federal government raises what is generally considered a state issue to the level of mandated federal involvement. , Earlier in the 99th Congress I introduced a series of five bills in response to the inaction of the Public Health Service on issues which were brought to my attention by constituents in my home state of California or by guidelines prmlgated by the Centers for Disease Control. The first in this series of bills expresses the sense of Congress that children with AID6 be educated outside the public classman and be provided alternative forms of education. This bill was introduced in response to the August 30, 1985 guidelines prmlgated b CIX. These guidelines failed to provide any rational recarmendations to school districts actually faced with this problem. They advocated that each child be dealt with on a case-by-case basis and that confidentiality be accorded the highest priority. In my judgement it is appalling that a child with a disease which is 100% fatal and decried as a mystery to the akadical camunity be not only encouraged to attend school but to do so a- sly so that other children are precluded fran taking appropriate precautions. Most recently, UP1 reported the first apparent case of AIDS virus transmission between children. InWestGermany,ayoungbay~receivedAIDGfmnablood transfusion reportedly infected his older brother by biting him on the arm. Similar cases of biting have been reported, lx& until this case, subsequent infection had not been shown. Based on increasing medical information which indicates that persons with AIDS often suffer brain involvement, referred to as dementia, the only prudent means of dealing with children with AIDS is to educate them in a setting renroved fran others where high-risk behavior cannot occur. The second bill would irqlement a recamendation from several nurses that health care workers with AIDS be prohibited from working The Honorable Edwin Meese October 28, 1986 Page 5 in close contact with patients. CDC guidelines released on Nove&er 15, 1985 were in opposition to this legislation and remnded that health care workers not undergo any seriologic testing for AIIX based on the rationale that the disease was fragile and posed no risk to co- workers or patients. These re-ndations appeared to me to be patently irresponsible in light of available scientific evidence which indicated that the AID6 virus can live up to 10 days outside by the body in ltoom tqrature. Although I do not believe that AID6 is casually transmitted, I do feel that all medical evidence should be considered when making a decision of this magnitude. The guidelines also contradicted the request of nurses that all patients exhibiting synptams of AIL6 be tested so that nurses could determine the appropriate precautions to be taken. A third bill would permit health care workers to wear protective garments when treating AIRS patients at their discretion. This legislation was introduced in response to canplaints by California nurses that they were being denied the use of standard precautionary masures based on hospital policy that the sensitivities of the AIDS patients be a priority. While I believe that we rmst do everything possible to inprove the spirits of fatally ill patients, I believe the health and am-ale of our health care workers rmst be given priority. In respondingtothe AIDS crisis, PHSoverlooked themostobvious means of attempting to curtail the spread of AIDG. It failed to re-nd that public health authorities shut down public bathhouses. This blatant omission was notable and.even Congress felt carpelled to respond. OnOctober 2, the House passed an mnenchnentby a voteof 417 to 8which gave the SurgeonGeneralthe mrto close public bathhouses. When I introduced legislation on October 30, 1985 on this issue Dr. Mason, then Assistant Secretary for Health, told me that such action was unnecessary and would only serve to alientate the hcxosexual cautunity. On March 14, 1986 CIX finally issued guidelines recarmending closure of these AIDS factories. Despite this recannendation a few bathhouses remain open in California. The fifth bill in my original package dealt with making it a crime for persons with AIDG, or for 'those who carry the AID6 virus, to knowingly donate blood. Evidence that the Public Health Service is not pursuing policies based solely on the concern for the public health but on political considerations can be seen in PHS's inappropriate handling of our blood supply. Virtually all hmhiliacs in the U.S. and elsewhere who have received clotting factor concentrates derived fran blood collected in the U.S. prior to 1985 have beaxne infected with the AIOS virus. Nine thousand herrrqhiliacs and twenty thousand transfusion recipients are MW permanently infected with the AIDS virus. These statistics serve to illustrate the magnitude of this truly historic tragedy which has been visited upon innocent The Honorable Edwin Meese October 28, 1986 Page 6 individuals, through no actions of their mm. The mst regrettable part of this reality is that the contamination of our nation's blood supply could largely have been avoided if the Public Health Service had appropriately restricted all high risk groups, specifically male homsexuals, from donating blood at the outset of the AILS epidemic. AIDG was recognized as a blood-transmitted disease as early as 1982 and as a disease peculiar to hamsexuals, intravenous drug users and.Haitians at approximately the same time? Despite this evidence, PHS recamrended in 1985 that intravenous drug users, which carprise 13% of the identified cases, be prohibited fran donating blood, while suggesting that polygamus male hamsexuals, who caqrised 73% of the knm cases, refrain fm donating blood. These initial guidelines servecjtoencouragemale hamsexualswho considered themelves xmogamus, to donate blood. Atthetime these guidelines were issued, PHS knew that the incubation period for AIDS may be as long as eight years and that a recent Kinsey report indicated that the longest relationship between hamsexuals averaged one to three years, and yet the recmmndation only requested male hmosexuals who had been polygamous in the past six years to refrain fran donating. Follwing the releaseof these guidelines, PI-IS admitted thattheywere aproduct of onqmxnise between thehamsexual ccrmunity and public health authorities. On August 8, 1985 I wrote to PHS suggesting that all hamsexuals be placed in the sam category as intravenous users, namely, that they be prohibited fran donating blood. On September 6, 1985 my recammdation was partially implemented and the new recamnendations requested 'all males who have had sex with another male since 1977 to refrain from donating." In October 1985 the Red Cross began affixing a sticker to its blood donation literature which stated "males who have. had sex with another male since 1977 nust not donate blood." 'Ihe official guidelines issued by PHS have never been changed. Ihe- result of the PHs's failure to recognize the risks inmlved in encouraging male hamsexuals to donate blood and in relying exclusively on the FLISA test is the almst certain death of two Colorado residents who recieved AIDS through transfused blood. According to the June 20, 1986 issue of Morbidity and Mortality Wkly, a 31year-old-donor who shwed a negative reading in a test for the AILS antibody in April 1985 and August 1985 donated contaminated blood in August 1985. Two recipients of the August transfusion are nw infected with the virus and test anti- positive although neither currently exhibits symptans of AIDS. The donor of this contaminated blood admitted that he had participated in a hanasexual encounter earlier that year. In light of the 4% false negative rate of the ELISA test, self-exclusion of high-risk donors is the only cmpletely reliable method of excluding contaminated blood. The Honorable Edwin Meese October 28, 1986 Page 7 It is urgent that we shift from complacency to action in preventing future cases of AIDS. In my judgemnt, the best way to accomplish this is to discard the naive assumptions and simplistic solutions which have hampered our progress to date. We have avoided these and other options out of fear of being labeled discriminatory. It is tima to explore any and all options which may lessen the burdens of this frightening disease. It is mst properly the jurisdiction of the Public Health Service to take these vitally needed actions but in the absence of prudentmanagemntof PHS I urge you, as Chairmanof the President's Dmestic Council, to mbilize the necessary resources in this Administration. The sobering reality is that AIDS is an epidemic and all reasonable measures aimed at slwing its spread mst be considered-& just those politically expedient ones. The AX6 epidemic will result in a profound loss of life. In the next five years the number of deaths attributable to AIDS will exceed the number of U.S. military deaths which resulted fran World War II. It is a tragedy for any nation to lose so many productive citizens in the.prim of life and to bear the societal cost of such a devastating disease. The Centers for Disease Control estimte that the average medical cost for a victim of AID6 in the next five years will approach $46,000, resulting in a total of $69 billion in health care costs. This cost will be borne largely by state and federal governmnts and, to a lesser degree, by mr health insurance institutions. While I do not,advocate prioritizing the cost of health care at the expense of saving lives or improving the guality of life for victim3 of AI=, I do believe that cost restraints nust be considered in determining which solutions present acceptable options. I would appreciate a detailed response to my wndations.. In addition, I hope to met with you to discuss this matter further in the first months of the next session of Congress. I look forward to yourproqtresponse. Sincerely, /c--l ,4 LiaiQ . . bmemyer Meqber of Congress cc: Members of the President's Rmestic Council