Dear Vikram
I can understand issues that come up while admitting a person in the hospital. This may not happen just in cases of HIV positive individuals but also in crisis cases where the person being admitted is unconscious. This has happened in a couple of cases of suicide attempts that Vivek and I have attended to , wherein individuals who have actually intervened are not entertained by the doctors. Doctors need someone who can take medical decisions for the person in case of complications that arise during such procedures. This also happens in case of HIV positive individuals who are not open to their families and sometimes need a supportive individual to accompany them. We have noted that while doctors are not willing to allow individuals, they have agreed to go ahead with the necessary procedures when we have used our organizational status. Hence Vivek and I as The Humsafar Trust can intervene and help since we speak about the Organisation and its focus of work. Specifically in suicide cases we even need to handle the police since the reporting doctor is obliged to report the case to authorities. Apart from the Humsafar Trust , Sanjeevani which is a registered PLHIV support group regularly goes through the process of admitting individuals in public hospitals where issues similar to yours come into play. Sanjeevani has a health worker system that knows hospital staff , and thereby facilitate the process for the PLHIV individuals. The long and short of it is that registered organizations , NGOs or CBOs can negotiate with hospital authorities on these issues. Hospitals on the other hand need a legal entity/body that can take responsibility for the admitted patient. Please note that in the future in case such an intervention is ever needed we will be more than happy to step in and help out in organizational capacity. Regards Pallav From: lgbt-in...@yahoogroups.com [mailto:lgbt-in...@yahoogroups.com] On Behalf Of Vikram D Sent: Tuesday, October 09, 2012 4:00 PM To: gaybom...@yahoogroups.com Cc: gay_bombay@yahoogroups.com; movenp...@yahoogroups.com; lgbt-in...@yahoogroups.com Subject: [lgbt-india] informing non-relatives for operations A friend of mine recently had to have a minor surgical procedure done for which he had gone to a surgeon in one of Mumbai's leading hospitals. My friend is HIV+ which, of course, was known to the specialist who had no problem doing the procedure. This surgeon said the procedure would require general anesthesia, but it could be done in the morning and my friend would be able to leave by evening. This was important for my friend because he lives with his parents who do not know about his HIV status and he is very clear he does not want them to find out. The condition he needed help with is not necessarily HIV linked, but he was worried that if he tells them about the operation and they go with him they could get to learn from the staff, or from medical reports that would be issued for him since his HIV status is something the staff would have to know, and it would probably be highlighted on his reports. So it was important for him to have this small operation done without his parents knowing. My friend followed the usual procedure to prepare for general anesthesia, taking some medication the night before and not eating in the morning. When he went to the hospital he was given a form where he had to fill in the people to be notified in case of problems. This is standard, and we had agreed that he would give my name and contact details. But when the surgeon saw this he said that the person to be contacted had to be a family member and, ideally, someone from the family should actually be there during the operation. He completely refused to accept that a non-relative, like me, could be the person to contact, even if I was actually sitting there right through the operation and recovery time. The surgeon said the operation couldn't proceed and gave the operating theatre to someone else and told my friend to reschedule when he could come with a family member. My friend was not prepared to take the risk of telling a family member, and was prepared to give up having the operation at all at this hospital, but was then told by the administrative staff that the money he had paid could not be refunded. I checked with Vijay Hiremath, who advises us on legal matters, and he said the rules in this case were unclear. Hospitals can, and do, operate on people in emergencies when there is not time to find out who the person to notify is, but this was not an emergency procedure and the hospital could refuse to do it without a family member. Vijay said that sometimes hospitals would accept a notarised affidavit giving a non-relative responsibility for the patient, and if there was no time for this sometimes even just a letter from the patient stating that such an affidavit could be given when possible would do. My friend and I went back to meet the surgeon to see if he would accept this, but he wouldn't. It was perhaps my friend's bad luck that this surgeon was also the hospital's legal and ethical adviser, for which he had legal training and he pointed out that the affidavit would not stop the patient's parents from suing the hospital in case something went wrong and they realised they had not been notified, as was their right. The surgeon agreed that other doctors might be less scrupulous on this, but he was not willing to be. He wasn't unsympathetic to my friend's issue, and he said that there was no reason why his parents were likely to find out about his HIV status. But he admitted that he couldn't give an absolute guarantee about this, and this was a risk my friend was not willing to take. We pointed out that this requirement for a family member should have been pointed out from the start, so my friend could have been clear what his options were, and could have been prevented the problems of preparing for the operation and having to deal with it not happening. Among other things, he had taken leave from a job he had just got. And of course, he was extremely upset at all this happening at the last minute. The surgeon acknowledged this, but said that having a family member was really so routine that it was not mentioned and they could not be expected to think of all possible cases when taking in a patient. Since the surgeon was clearly not going to change his mind and my friend's condition didn't have to be treated with extreme urgency, he decided to put it off. We also knew there was another specialist in Mumbai who would probably operate on my friend without requiring relatives to be told, so he did have the option of going to him. (He didn't do this from the start since this other doctor practices very far from where my friend stays and the large hospital was much more convenient and didn't seem to pose any problems until the last moment). So my friend decided to forget having the operation there and I will say this of the surgeon that he said he would ensure that a full refund would be made, and accompanied us to the administration office and told the staff to make sure it was done. And I'm not recounting all this because I want to attack the surgeon or the hospital. I do wish they could have been more flexible, or at least made the family requirement clear from the start, but they would have had no issues operating on my friend because he's HIV+ (his being gay didn't come up at all). And its true that legal action is a constant threat for hospitals and they need to be careful about protecting themselves. I guess the reason I'm putting all this down is because this was a learning for us about the problems that people face when dealing with medical issues like this where they don't want family members, but people who not blood relatives to be placed in position of responsibility over them. This is something we can see coming up quite a lot with lgbt people, and its something we need to find ways of tackling in different ways, like listing doctors who are willing to be flexible about this issue, or trying to find a legal format that would satisfy most hospitals, or just in raising the issue from the start when they go to discuss surgery. Any suggestions, views, comments or stories of similar incidents would be welcome. I'm particularly interested in comments from the many doctors (real medical ones!) who are on these lists, Vikram [Non-text portions of this message have been removed]
