Multidisciplinary response of San Francisco General Hospital to the AIDS epidemic

Acquired immunodeficiency syndrome (AIDS)-related services offered by San Francisco General Hospital (SFGH); programs to protect employees who are at occupational risk for infection with human immunodeficiency virus (HIV); and the legal, ethical, and economic implications of such infection are discussed. Support from public officials, health-care professionals, and the community has enabled SFGH to develop an extensive program of AIDS-related services. The program consumes 10% of SFGH's budget and was responsible for treating 1693 patients between January 1981 and June 1988. The hospital has two internationally recognized units dedicated to the care of AIDS patients. Many of the medical and support departments at SFGH contribute expertise directly; clinical and basic research are also conducted. Other services sponsored by the hospital include HIV testing and counseling; special training for physicians and nurses; assisting patients with finances, housing, and home care; emotional support; and community education. Expenses per patient are lower at SFGH than nationally because of contributions from the private and public sectors, but costs are not fully recovered. Hospital employees are protected by a body substance precautions program, a comprehensive needle-stick program, mandatory reporting and evaluation of all exposures, and enrollment in a study to document seroconversions. Confidentiality and compensation remain major concerns. San Francisco General Hospital has a model program of caring for patients with AIDS and protecting its workers, but the issue of compensating those employees who do become infected with HIV has not yet been resolved.