Miami Herald (MH) - Sunday, July 14, 1991
Dan Keating; Herald Staff Writer

"I look like someone put bubble gum and clear plastic tape over my nose," said Jim Horn, a 46-year-old chef.

But a doctor at the Veteran's Administration Medical Center in Miami said Horn's HIV infection has nothing to do with the decision not to operate: His nose simply can't be repaired.

The VA doctors knew Horn was infected with human immunodefiency virus (HIV) when they cut off the cancer-tipped end of his nose last fall. Now, Horn says, plastic surgeons refuse to fix his face because he has the virus. It's transmitted by an exchange of body fluids or through dirty needles or infected blood transfusions.

"I have been treated callously, inhumanely by 'care-givers,' " he said. "Nobody will touch me because of my disease. The trauma of being HIV is one thing. Being constantly stressed is something I don't need."

Dr. Barry Materson, who reviews patient complaints at the VA hospital in Miami, said Horn's nose has already been fixed.

Horn had two operations in November. In both operations, general surgeons worked to remove the cancer. In the second surgery, plastic surgeons did a skin graft.

"The plastic surgeons looked at it and said they have done as much as can be done," Materson said. "It was much more likely that any attempt at further surgery would harm him more than help him."

Of Horn's appearance, Materson said, "It's not so bad."

About three-quarters of an inch is missing from the end of Horn's nose. It cuts sharply toward his lip, rather than having a rounded end. There's also an extra hole -- about the size of a freckle -- above the left nostril.

The end of Horn's nose is yellowed. The grafted skin was taken from under his right arm, where the skin is paler. "I'm sure something better cosmetically could have been done," Horn insisted.

"He runs the risk of winding up with worse," Materson said. "He's never going to get a perfect match . . . "

Materson said Horn's HIV infection is irrelevant. "He had the cancer removed and revised and graft put in place when the surgeons knew he was HIV positive," the doctor said.

But Materson said he sympathized with concerned doctors: "I wouldn't blame any doctor for not doing purely elective surgery on an HIV patient. . . . Obviously, they risk their lives every time they go into the operating room with someone who's HIV positive."

Horn said, however, that Dr. John Devine told him that elective surgery on an HIV patient would not be done. Materson said Devine, the hospital's chief of plastic surgery, would not comment.

"Dr. Devine told me point blank: 'There will be no operation under any circumstances unless it is a life-threatening situation,' " Horn said.

According to the Centers for Disease Control, 40 U.S. health-care workers have been infected with HIV through their work -- a tiny fraction of the one million cases in the country.

Horn, who cooked on a Navy ship during the Vietnam War, argued he should not have been promised plastic surgery.

"They did a good job for what they were doing. They got the cancer," he said. "I understand their concerns. . . . From the beginning, they said they would take some part of my face off and do a skin graft, and after that healed, I would have reconstructive surgery. Now they leave me dangling like a puppet."
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