University of California Berkeley Regional Oral History Office University of California The Bancroft Library Berkeley, California The San Francisco AIDS Oral History Series THE AIDS EPIDEMIC IN SAN FRANCISCO: THE RESPONSE OF THE NURSING PROFESSION, 1981-1984 Volume IV Gayling Gee, R.N. , M.S. HEAD NURSE AT THE AIDS CLINIC, SAN FRANCISCO GENERAL HOSPITAL Grace I. Lusby, R.N., M.S, INFECTION CONTROL PRACTITIONER, SAN FRANCISCO GENERAL HOSPITAL Diane Miller, M.P.H. AIDS POLICY AND ADMINISTRATION AT SAN FRANCISCO GENERAL HOSPITAL With an Introduction by Helen M. Miramontes, R.N., M.S., F.A.A.N. Interviews Conducted by Sally Smith Hughes, Ph.D. in 1995 and 1996 Copyright 1999 by The Regents of the University of California Since 1954 the Regional Oral History Office has been interviewing leading participants in or well-placed witnesses to major events in the development of Northern California, the West, and the Nation. Oral history is a method of collecting historical information through tape-recorded interviews between a narrator with firsthand knowledge of historically significant events and a well- informed interviewer, with the goal of preserving substantive additions to the historical record. The tape recording is transcribed, lightly edited for continuity and clarity, and reviewed by the interviewee. The corrected manuscript is indexed, bound with photographs and illustrative materials, and placed in The Bancroft Library at the University of California, Berkeley, and in other research collections for scholarly use. Because it is primary material, oral history is not intended to present the final, verified, or complete narrative of events. It is a spoken account, offered by the interviewee in response to questioning, and as such it is reflective, partisan, deeply involved, and irreplaceable. ************************************ This manuscript is made available for research purposes. All literary rights in the manuscript, including the right to publish, are reserved to The Bancroft Library of the University of California, Berkeley. No part of the manuscript may be quoted for publication without the written permission of the Director of The Bancroft Library of the University of California, Berkeley. Requests for permission to quote for publication should be addressed to the Regional Oral History Office, 486 Library, University of California, Berkeley 94720, and should include identification of the specific passages to be quoted, anticipated use of the passages, and identification of the user. It is recommended that this oral history be cited as follows: To cite the volume: The AIDS Epidemic in San Francisco: The Response of the Nursing Profession, 1981-1984, Volume IV, an oral history conducted in 1995 and 1996, Regional Oral History Office, The Bancroft Library, University of California, Berkeley, 1999. To cite an individual interview: [ex.] Gayling Gee, "Head Nurse at the AIDS Clinic, San Francisco General Hospital" an oral history conducted in 1995 and 1996 by Sally Smith Hughes in The AIDS Epidemic in San Francisco: The Response of the Nursing Profession, 1981-1984, Volume IV, Regional Oral History Office, The Bancroft Library, University of California, Berkeley, 1999. Copy no. Cataloging information THE AIDS EPIDEMIC IN SAN FRANCISCO: THE RESPONSE OF THE NURSING PROFESSION, 1981-1984, Volume IV, 1999, xv, 285 pp. Gayling Gee, head nurse, San Francisco General [SFGH] AIDS Clinic: oncology background; association with Paul Volberding, M.D. ; SFGH oncology clinic (AIDS Clinic predecessor) ; recognition and definition of AIDS; AIDS Clinic creation, staffing, organization, patient care, nurse- MD partnership, relations with SFGH AIDS ward, psychological support, visitors; gay issues. Grace Lusby, (b. 1935) infection control practitioner at SFGH: infection control before AIDS crisis; infection control during AIDS epidemic: establishing guidelines, hospital and community instruction, role of Centers for Disease Control, tension between SFGH and University of California, San Francisco infection control committees, patient rights, hepatitis B precautions; women and AIDS; personal impact of AIDS. Diane Miller, (b. 1944) SFGH hospital administrator with responsibility for AIDS services: institutional history of SFGH; SFGH relations with UCSF and San Francisco Health Department; administrative oversight of SFGH AIDS activities: creation of AIDS clinic and ward, funding, expansion, patient referral patterns; San Francisco Health Department directors role in AIDS, 1977-1993; AIDS impact on SFGH. Introduction by Helen M. Miramontes, R.N., M.S., F.A.A.N., Associate Clinical Professor, Community Health Systems Department, School of Nursing, University of California, San Francisco. Interviewed 1995-1996 by Sally Smith Hughes, Ph.D., for the San Francisco AIDS Oral History Series. Regional Oral History Office, The Bancroft Library, University of California, Berkeley. TABLE OF CONTENTS- -The AIDS Epidemic in San Francisco: The Response of the Nursing Profession, 1981-1984, Volume IV SERIES INTRODUCTION i SERIES HISTORY iv INTERVIEW WITH GAYLING GEE xi TABLE OF CONTENTS xii INTERVIEW HISTORY xiv I FAMILY BACKGROUND, EDUCATION AND EARLY CAREER 1 Early Life 1 Early Career 1 II THE AIDS EPIDEMIC 3 The Oncology Clinic on Ward 5B at San Francisco General Hospital 3 Sharing with Housestaff 4 Furnishing the Unit 4 First Patient 4 Staff Relations with the Kaposi s Sarcoma Clinic, UCSF 7 Patient Histories 8 PCP Patients Seen at the Oncology Clinic on Ward 5B 9 The AIDS Clinic, Building 80 10 The AIDS Nurse Screening Clinic 10 Recognizing the New Disease as a Syndrome 13 Fear of Infection 15 Defining AIDS 17 The Clinic as a Streamlining Process 18 The Nurse-Physician Partnership 19 Setting Personal Boundaries 20 Paul Volberding 23 Additional Clinic Physicians 24 Nurse Practitioners 24 Keeping Up-to-Date 25 Comparison with New York City 26 The Response of Other San Francisco Medical Institutions 27 Setting Up the AIDS Clinic 29 Opening Day 31 Administrative Isolation 32 Environmental Improvements 33 The Surgeon General s Visit 33 The AIDS Inpatient Unit 35 Staffing 35 Rivalry with the AIDS Clinic 37 The Division of AIDS Activities 38 More on the AIDS Clinic 39 Advantages of Central Record Keeping 39 The Early AIDS Team 41 Furnishing the Clinic 42 Dysfunctional Aspects 43 Staff Psychological Support 44 Hiring Staff 45 Abrams Lymphadenopathy Patients 47 Neuropathy 49 Living Longer with AIDS 49 Community Physicians 50 Insurance Coverage 51 Therapy 52 Clinic Physicians 54 The Triage Desk 55 The Clinic as a Response to a Community Crisis 56 UCSF Acknowledges the Clinic 57 Staffing and Space Problems 59 Visitors 59 Social and Community Services 60 The Shanti Project 61 More on the AIDS Inpatient Unit 62 Creation 62 Inpatient-Outpatient Unit Interactions 63 The Gay Pride Parade 65 Mervyn Silverman s Participation 65 Pressure to Participate 66 Gee s Experience with the Gay Community 67 The Epidemic s Impact on the Nursing Profession 68 INTERVIEW WITH GRACE I. LUSBY 72 TABLE OF CONTENTS 73 INTERVIEW HISTORY 74 BIOGRAPHICAL INFORMATION 76 I EDUCATION AND EARLY CAREER 77 Education 77 II INFECTION CONTROL PRACTITIONER, SAN FRANCISCO GENERAL HOSPITAL, 1969-1992 78 Arrival as the First Infection Control Practitioner 78 The CDC Course in Infection Control: Hospital Infection Surveillance, Control and Prevention 79 Early Activities 80 III The AIDS Epidemic 82 Recognizing a New Disease 82 Two Cases of Pneumocystis Pneumonia 82 as a Perception "Gay" Disease 84 Formulating Guidelines for Infection Control 86 The First CDC Guidelines 86 Selma Dritz s Role 87 AIDS Task Forces in San Francisco 88 Teaching Infection Control for AIDS 89 Infection Control Committees, San Francisco General Hospital and UCSF 90 Debating the Guidelines 92 Resuscitation 92 Cases of Transfusion AIDS 94 The Hepatitis B Model 95 Debating Foundation of an AIDS Inpatient Unit 97 Difference in Infection Control Policies at SFGH and UCSF 98 Infection Control and Patients Rights 100 Workmen s Compensation 102 Protecting the Patient 102 Fear 104 Power Struggles 105 Interactions with the CDC 106 Extending the Hepatitis B Precautions Model 107 Lusby s Epidemiology 110 Comparing New York s and San Francisco s Responses to AIDS 111 Identifying Infectious Agents 112 The Kaposi s Sarcoma Study Group, UCSF 114 AIDS Advisory Committees at the San Francisco Department of Public Health 115 UCSF AIDS Task Force 117 Definitions of AIDS 120 Establishing Universal Precautions in Infection Control 122 Forerunners 122 Body Substance Precautions 123 Developing Body Substance Precautions at SFGH 124 AIDS Transmission 125 Infection Control at UCSF 127 Concern About AIDS Transmission 128 Immunocompromised Patients 128 The Flap about Casual Transmission 130 Early Infection Control Guidelines for AIDS at SFGH 131 Countering Overly Stringent AIDS Precautions 133 Giving Advice on Infection Control for AIDS 135 The CDC and UCSF AIDS Task Force Guidelines 136 Comparisons 136 Hepatitis B Guidelines 138 Teaching Infection Control % 138 Debating Aspects of Infection Control Procedures 141 To Glove or Not to Glove 141 The Location of "Sharps" Disposal Box 142 Relations Between Physicians and Infection Control Personnel 143 Potential Tensions 143 Differing Policies among Medical Services 144 Learning about Gay Culture 145 California State Task Force on AIDS 147 Early AIDS Education Efforts in the Community 148 Mechanisms 148 Emotional Toll 150 Second National AIDS Forum, Denver, June 1983 152 Infection