Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
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San Francisco Examiner, Friday, March 12, 1999
Elizabeth Fernandez of the Examiner Staff
In a 10-2 decision, the San Francisco Superior Court jury this week found that Dr. Franklin Hoaglund, a now retired orthopedic surgeon, committed malpractice when he declined to perform shoulder-replacement surgery nearly two years ago.
However the jury, after a nearly two-week trial in San Francisco Superior Court, decided that Hoaglund did not commit discrimination when he suggested a more conservative approach of physical therapy for Steve Iacovino. A former technician at the San Francisco Fine Arts Museum, Iacovino, 47, is on disability and lives in Honolulu. After being turned down by Hoagland, Iacovino had surgery successfully performed on both shoulders in Hawaii.
"I'm real happy with the verdict," he said Thursday. "It's good to have people understand the mechanism of AIDS, and how it really didn't apply to my having surgery.
"There are some very fine doctors at UC. When I was a resident here and was treated at San Francisco General, the care was wonderful. That's why I was so shocked about Dr. Hoaglund."
Diagnosed in 1995 with an irreversible bone degeneration called avascular necrosis, Iacovino said he was in excruciating pain, unable to lift his arm or dress himself, when he first met with Hoaglund in June 1997.
The surgeon, without consulting an AIDS expert, declined to operate on the grounds that Iacovino's T-cell count was too low, putting him at severe risk of infection, Iacovino said.
But according to Iacovino's suit, alleging that he was discriminated against because he is HIV positive, no credible medical evidence shows that the risk is greater for a patient with a low tally of the disease-fighting T-cells. "The whole point of this suit is that you have to look at a number of factors when you are deciding about surgery," said San Francisco attorney Gary Cloutier, who represented Iacovino. "In an HIV-positive person, you can't raise T-cell counts as an absolute barrier. This case demonstrates that HIV status, in and of itself, does not present a risk factor in having significant surgery."
Dr. Michael Giordano, a New York infectious disease specialist who testified on Iacovino's behalf, said in an interview Thursday that HIV, no matter a patient's T-cell count, does not put a patient at increased surgical risk.
"The physician dismissed out of hand that the person was a (surgery) candidate," said Giordano, who runs the AIDS research program at New York Hospital / Cornell Medical Center. "It was a pre judgment. It was completely inappropriate, especially for a facility like UCSF which is known for its AIDS treatment."
San Francisco attorney Michael Lucey, who represented UCSF and Hoaglund, said he was pleased that the jury found no discrimination in the case nor intentional infliction of emotional distress.
"We were disappointed with their finding of malpractice, but I respect their decision," he said. "It's unfortunate that this comes at the end of a distinguished career spanning 30 years. It's a bitter pill, no question about it."
Iacovino, who returns to Hawaii on Saturday, said he is planning to spend the award money on dental work for himself and longtime partner, Mark, as well as buy a car and a computer and make donations to a food bank.
"What amazed me was that even in San Francisco, ignorance about AIDS is still there," he said. "During jury pool interviews, a few people said that those who have AIDS are immoral."
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