Friday, October 22, 2010

* Highly Sensitive Letter to Yale's President





HIGHLY SENSITIVE MATERIAL:
PROFESSIONAL DISCRETION REQUESTED



To:          Mr. A. Bartlett Giamatti, President
                Yale University
                Woodbridge Hall
                New Haven, Connecticut

From:   (Rev.) Paul D. M. Keane

Subject:
                The paralysis of officials over fear that a “Typhoid Mary” walks  New Haven streets in the person of a prostitute and intravenous drug user whose recently born infant is the sole in-patient of Yale-New Haven Hospital’s A.I.D.S. team.

Date:       August 20, 1983

                Rev. Clyde Bowman, Association of Black Clergy, New Haven, Connecticut
                The Hon. Henry Parker, Treasurer, State of Connecticut
                The Hon. Joseph Lieberman, Attorney General, State of Connecticut
                Mr. John Williams, Attorney at Law
               
                Mr. E. William Muehl, Yale Divinity School
                Rev. David Warren, Executive Assistant to the Hon. Biagio DiLieto, Mayor
                Mr. William Farrell, Chief of Police, New Haven, Connecticut
                Mr. William Lee, Director of Welfare, New Haven, Connecticut
                Rev. Owen Sanderson, Hamden, Connecticut
                Rabbi Jacob Mendelson, New Haven, Connecticut

                Rev. Leander Keck, Dean, Yale Divinity School
                Rev. Harry B. Adams, Associate Dean, Yale Divinity School
                Rev. David Kelsey, Yale Divinity School
                Rev. Letty Russell, Yale Divinity School
                Rev. Alice de V. Perry, United Church of Christ on the Green, New Haven, Ct.
                Rev. Hans Frei, Yale Divinity School
                Rev. James Dittes, Yale Divinity School
                Rev. Charles Foreman, Yale Divinity School
                Rev. R.A. Greer, Yale Divinity School

                Father Henri J. M. Nouwen, Harvard Divinity School
                Dean George Rupp, Harvard Divinity School

Sister Margaret Farley
                Rev.Gene Outka          }  Ethics faculty, Yale Divinity School
                Dr. David Duncomb
                Rev. Thomas E. Brown, Yale Divinity School

                Rev. John Vannorsdall, Chaplain, Yale University
                Rev. Edward Dobihol, Chaplain Yale-New Haven Hospital
                Rev. Alan Merman, Chaplain, Yale Medical School
                Rev. Robert Forsberg, Wider City Parish, New Haven, Connecticut

                Mr. G. Harold Welch Jr., President, Yale-New Haven Medical Center
                Mr. C. Thomas Smith, President, Yale-New Haven Hospital


                                                                                                            August 20, 1983
Mr. A. Bartlett Giamatti, President
Yale University
New Haven, Connecticut

Dear President Giamatti,

            I write you both as a graduate of Yale (M.Div.’80) and as a native of New Haven and Mount Carmel. This is the most difficult letter I have ever written and I have thought it over for days. I realize that the parties concerned both at Yale and in the community may be angry that I committed this information to paper. And I am painfully mindful that to do so may come uncomfortably close to violating my professional commitment as a clergyman to maintaining confidentiality. Yet I cannot remain silent, for to do so may literally endanger the lives of people in the community. I have an obligation to a Higher Power to speak. But I will do so with extreme caution out of regard for the rights of all parties involved.

            Let me begin at the beginning. Three months ago a 33-year-old physician interning at Yale New Haven Hospital died of A.I.D.S. (Acquired Immune Deficiency Syndrome). I knew him and we attended some of the same professional gatherings. His last wish included the desire to die at Hospice in Branford. He was denied this request because of the superstitious fear of hospice officials that his presence would contaminate the Hospice community with A.I.D.S. This information was kept from him and he was told instead that Yale-New Haven Hospital  "would make Hospice for him there [at YNHH.”

            In his memory, and out of disgust over Hospice’s unprofessional and heartless behavior, I formed A.I.D.S.  Information Dissemination Service in June, a weekly medical update on A.I.D.S. by local physicians. We have held our meetings at Dwight Hall and thus far four physicians have participated (two in local practice and two from Yale –the University and the Hospital, respectively).
I have firmly resisted suggestions from the gay community that we merge with their group (AIDS/Project New Haven) because I believe the issue of informing the public about A.I.D.S. is larger than sexual politics: It is a health issue first; a moral and ethical issue second; and a political issue last.

            That belief has been confirmed in a sordid and horrible way and it is about that public health problem that I write you today, shepherd of New Haven’s single largest flock, Yale University.

            Currently the only in-patient being treated by the A.I.D.S. team at Yale-New Haven Hospital as a newborn, male infant. (The Centers for Disease Control have not registered the infant as an A.I.D.S. patient because Acquired Immune Deficiency Syndrome must be acquired from another person: The fetus and the mother are

(Cont. from p. 2)
Mr. A. Bartlett Giamatti, President
August 20, 1983

considered the same organism. The infant would best be described as having Congenitally Acquired Immune Deficiency Syndrome). The infant’s mother does not have A.I.D.S.  However, having produced an infant with A.I.D.S., she is almost certainly a carrier of A.I.D.S. She is physically well enough to have returned to her everyday life.

            She lives that life as a prostitute and an intravenous drug user. Medical scientists believe A.I.D.S. is transmitted by body fluids, especially by blood on unsterilized needles passed from person to person. As a prostitute, this woman is literally in the business of exchanging body fluids with other persons. As an intravenous drug user it is highly likely that she shares unsterilized needles with other people.

            Several medical professionals working with this person have been horrified by her cavalier attitude toward her status as a presumed A.I.D.S. carrier. Some of them have spoken to me in confidence and have expressed their anxiety at their ethical dilemma: Namely their professional obligation to protect her anonymity vs. society’s right not to be harmed.

            It is my understanding that pressure has been put on the director of Yale-New Haven Hospital’s A.I.D.S. team to write State Attorney General Lieberman and request that this woman be arrested on a “Typhoid Mary” statute (if such a statute exists). This physician has understandably –and courageously –refused to violate the doctor/patient privilege by revealing her identity. As it was put to me “Why should this woman be singled out?” (from other A.I.D.S. transmitters, I assume).

            My reply to that was that epidemiologically she is already singled out by the fact that she has produced a datum (her infant) of her ability to transmit Immune Deficiency Syndrome. Further, she is in the business of exchanging body fluids (as a prostitute) with other people. To put it bluntly, she is in the business of potentially transmitting Immune Deficiency Syndrome to dozens of people a month. (To say nothing of her activity as an intravenous drug user, in which shared, unsterilized needles are an almost  certain means of transmission.

Note: Since A.I.D.S. has an incubation period of up to three years it may   be that we would not see the potentially lethal results of her activity for quite a while.

            That is, in my opinion, why she should be singled out., but of course not in a way which violates her civil liberties. The urgency of maintaining her anonymity is a bit moot. I understand that her photograph appears on an internal bulletin board of the New Haven Police department with the label “A.I.D.S.” under it. Surely this photo is not being used to promote harassment of the woman but to warn police to protect themselves in a case

(Cont. from p.3)
Mr. A. Bartlett Giamatti, President
August 20, 1983

where they might be required to come in contact with her body fluids in an emergency. I, for one, do not know what I would do if I were called upon to perform cardio-pulmonary resuscitation on her in a crisis, or to bandage her bleeding wound, without proper protection. It is a terrible dilemma.

            In response to this ethical paralysis by officials, I have sponsored two initiatives to protect the community:

            The second of these is my proposal to you in the final paragraphs of this letter. The first is a pamphlet entitled “Needles, Sex and A.I.D.S.” written in street language (It shocks even me somewhat, but such language is essential for communication.), co-authored by a physician on your faculty and myself. The goal of the pamphlet is to get intravenous drug users to stop sharing their needles or at least to boil them for 20 minutes between sharing. I have consulted civil liberties attorney John Williams, and the pamphlet is legal under the precedent of Griswold v. Connecticut. (In other words, your faculty member will not go to jail for abetting the felony of intravenous drug use.) We are scheduled to meet with (and may have done so by the time you read this) police Chief William Farrell to discuss distribution of this pamphlet( I enclose pamphlet here).

            The second initiative is to seek your leadership in a project of “Social Engineering” to protect our community from this woman’s body fluids until a cure for A.I.D.S. is found, or at least until the exact nature of its transmission is identified.

            The current stalemate is this:
                 
                        Do nothing and perhaps foster the illness
                        and death of our citizens.

                                            Vs.

                        Harass the woman with arrests and violate
                        her civil rights, thereby setting a horrible
                        concentration camp precedent for future
                         A.I.D.S. victims.*

* Since 70% of  A.I.D.S.  victims are homosexual and bisexual males, reactionary society is eager for such a witch hunt.


Note: Since the woman is on a methadone rehabilitation regimen, there is some question whether she can be kept in jail at all. If she were kept in

(Cont. from p.4)
Mr. A. Bartlett Giamatti, President
August 20, 1983

jail, it would be only a matter of time before her status (as a presumed A.I.D.S. transmitter) created general panic in the jail.

            Into this stalemate, I propose that we (under your leadership) introduce a
new alternative in the form of a  positive incentive rather than a coercive incentive. Namely, that we raise money (from individuals, institutions and government agencies) to pay this woman to stay off the streets and to boil intravenous needles.

Note: It is my understanding that heads of City agencies are fully aware of     
          this problem and are also in a state of ethical paralysis.

  
               Again, I have consulted with attorney John Williams and such a proposition could be made to the woman through her medical counselors without violating confidentiality, thus preserving her “anonymity”. Verification of her compliance would be a problem. But certainly creative minds ought to be able to solve that.

               “Why are you writing me?” you might be asking at this point President Giamatti. The answer is: We need your moral leadership to break this stalemate. You could call diverse parties (see carbon copy list as a suggestion) together in a meeting to consider the feasibility of raising funds to pay this woman to stay off the streets: parties who normally might otherwise not communicate with each other.  I ask you to do so.
  
               All of us have friends and family in the community. We don’t want them to get sick and die because we failed to act. You are shepherd to a huge institution whose population contains hundreds of persons in the high risk categories for A.I.D.S. You don’t want life-threatening disease to thunder through your campus.

               We must act now.

                                                               Yours very truly,
  
                                                               (Rev.) Paul D. M. Keane
                                                                          (M.Div. ’80)



Enclosure: Pamphlet: “Needles, Sex and A.I.D.S.”