‘For Going Against God’s Will’ Catholic Hospital Denies Gay Man HIV Meds

[Ian David]

‘For Going Against God’s Will’ Catholic Hospital Denies Gay Man HIV Meds

A Catholic hospital in New Jersey is accused of denying a gay and HIV-positive man his HIV medications, as one doctor on staff reportedly stated, “for going against God’s will.”

“Joao Simoes sued Trinitas Regional Medical Center in Union County Superior Court,” the Courthouse News Service reports. “He says that the hospital admitted him in August 2011, but that requests for his lifesaving medication were not honored, and his sister was denied visitation rights.”

Susan V. Borga, M.D., from the Department of Behavioral Health and Psychiatry, allegedly approached Simoes while he was confined to the hospital’s mental health wing. Borga is not named as a defendant.

Simoes says Borga was unfazed when another patient told her that he had just gotten out of prison, where he served time for murder. But her reaction was allegedly different when Simoes said that he did not work because he planned to go back to school and because of his HIV status.

Borga then allegedly asked Simoes how he got HIV, to which he responded, “I got it from unprotected sex.”

The complaint then says that “Dr. Borga closed the plaintiff’s file, put it down and looked at plaintiff with disgust on her face and asked, coldly, “Is that from sex with men?”
...
“Dr. Borga responded to plaintiff’s doctor by stating, ‘This is what he gets for going against God’s will,’ and hung up the phone on plaintiff’s doctor.”

<snip>

The University of California at San Francisco AIDS Research Institute notes:

Treatment failure may occur rapidly with poor adherence. Some studies suggest that drug resistance can develop after one week of missed medication or irregular use, or after missing as little as one dose in five. When resistance to a drug develops, it loses its effectiveness forever; in some cases, cross-resistance to other drugs occurs, further limiting treatment options.

More:
http://thenewcivilrightsmovement.com/1-for-going-against-gods-will-catholic-hospital-denies-gay-man-hiv-meds/legal-issues/2012/06/03/40477?utm_source=dlvr.it&utm_medium=facebook

[skepticscott]

1. Has this been reported and substantiated anywhere else?

The whole account sounds a bit fishy to me, starting with the convenient inclusion of a convicted murderer (how Simoes knew that is unexplained) that was supposedly treated better than him. And how does drug resistance develop in the absence (as opposed to the presence) of a drug! And in a few days? Also very convenient.

[Bluenorthwest]

2. Really? Is sounds 'a bit fishy'? Why? Be specific, please...

http://www.courthousenews.com/2012/06/01/47019.htm
I urge great care be taken when defending haters of the sick. Nothing about HIV is 'convenient'.

[rug]

3. There are two obvious questions.

Why is a psychiatrist prescribing or withholding HIV medicine?

Why has she not been named as a defendant?

[Bluenorthwest]

4. I take your questions as seriously as those of the other poster...

Who is stunned to learn about drug resistance...."And how does drug resistance develop in the absence (as opposed to the presence) of a drug! And in a few days? Also very convenient."
Here's for that bit of ignorance:
The University of California at San Francisco AIDS Research Institute notes:

Treatment failure may occur rapidly with poor adherence. Some studies suggest that drug resistance can develop after one week of missed medication or irregular use, or after missing as little as one dose in five. When resistance to a drug develops, it loses its effectiveness forever; in some cases, cross-resistance to other drugs occurs, further limiting treatment options.
http://ari.ucsf.edu/science/s2c/adherence.pdf

It is not possible to discuss reality with those who are deeply ignorant of basic facts.

[rug]

5. That's informative but it answers neither question.

[Bluenorthwest]

8. I'm doing unto others. The OP did not so much as address the facts presented

Instead we have you wanting to change the subject. You are arguing as proxy for a person who is so incorrect on the basic facts of HIV treatment that the post is a testament to the very ignorance that allows for such abuses.
So if you want to offer any facts, please do. I posted some facts to counter the conjecture in the other poster's words. Conjecture which was needless as all that information is a google away. The poster 'asked' and I offered facts. And links. None of which were so much as acknowledged by either of you, instead you insist upon discussing more conjecture based on nothing. Aside from the rudeness of it, those who are asking questions who are not interested in the answers seem to be asking the questions for some other reason.

[rug]

10. The fact is she is a psychiatrist.

The fact is she has not been named as a defendant.

If this happened I don't condone it.

But I do value healthy skepticism as opposed to knee jerk rhetoric.

[Bluenorthwest]

14. Well the knee jerk rhetoric was in the fist post I responded to

And I corrected that with actual facts about drug resistance, which are thus far not acknowledged by the skeptic crowd which introduced their qualms about the facts of the matter.
So I am the only person in this discussion who has offered facts, I'm sorry if I am addressing that which I know as opposed to that which I don't know. The question foisted with editorial comment was 'And how does drug resistance develop in the absence (as opposed to the presence) of a drug! And in a few days? Also very convenient.'
I offered a link and a bit of advice. Which was to inform one's self and take the path of great care toward the sick and perhaps grossly mistreated. If one is going to suggest that drug resistance facts are not as they are and use this falsehood to paint the victim as telling a 'convenient' story of his HIV treatment one might, , wish to check out the damn facts rather than use conjecture and arch implications against a sick man.
This man has his own physician as a witness, and I'm certain his lawyers have answers for your questions, as the court will ask them all and hospitals have lawyers like stray dogs have fleas, so no worries there, nothing will get past them. They do not need protection from anyone which they can not provide for themselves. So you can sleep tight knowing the hospital is well represented.....

[skepticscott]

18. No you're not

You offered no "facts" beyond parroting what had already been quoted, a statement that is somewhat at odds with experience, and which you have been unable to substantiate from any other source.

You also failed to provide even marginally plausible explanations for the other aspects of the account which were of dubious credibility, despite having them pointed out more than once, so get off your high horse. I'll remain skeptical of this story without evidence above and beyond a personal account.

[Bluenorthwest]

20. The first post of yours I responded to questioned the drug resistance information

and asked for the source of the story. I offered you the source and followed up with a great link from the University of CA at SF regarding drug resistance which comes from non adherence to the course of medications.
The fact that you started your 'skepticism' by doubting that which is medically accepted fact and in addition using that to cast doubt on the sick man by noting that this is 'convenient' is what I addressed.
The only information of dubious credibility was your own made up view of drug resistance issues. I don't see what is 'dubious' unless one is working from preconceptions, such as those you hold regarding drug resistance and adherence to the course of treatment.
I offered you a link which could fully inform you, lead you to any more information you might want. It's convenient, for all of this knowledge is important for all people to have. Take it or leave it. Your first post in this thread was filled with falsehood and editorial presumptions. The rest of the thread is an attempt to avoid speaking to that fact. Others can read, and they can see what is important.
There is no excuse for pushing false information regarding a serious health issue. None.

[skepticscott]

12. I was specific

Did you even read my post? It seems you have a preloaded bias, but here it is again:

The inclusion in the account of a convicted murderer who just happened to be on the same ward that was supposedly treated better than him makes the story sound a little too fictional...as I said, it lends impact in a bit too convenient a manner.

How did Simoes know that this other patient was a convicted murderer in the first place? And how did he known the doctor was "unfazed"? This assumes that the doctor either disclosed confidential information about another patient to him, or held a confidential discussion with one patient within earshot of another. Not very likely or credible.

And thank you, I read the quote about drug resistance the first time, and I'm well aware of the phenomenon. The question is whether delaying one phase of treatment for only a few days can lead to irreversible drug resistance in a patient. That is not the usual mechanism for HIV drug resistance (which typically develops over years of use in a population), but it again lends impact to the story in a way that is a bit too convenient. Can you cite any of these "studies" or similar information transmitted by another organization, like WHO?

Any one of these would be one thing, but when a personal account contains several elements that seem less than credible on their face, it requires more substantiation.

[Bluenorthwest]

21. I already offered you a link to UC SF's HIV Institue which will offer you all

the information you need, and which will lead you to any and all legitimate studies regrading this issue. The current thinking, like it or not, is that missing a few days can lead to resistance and even to the medication simply ceasing to work at all. If you were to read the linked article, as many others will, you could see that there are many reasons why this has implications for the wider population as well. Do you claim that UCSF's HIV Institute creates "studies" rather than conducting exhaustive research and compilation of other's research? On what grounds do you doubt their work and reject it in favor of your own assumptions that this is 'convenient'?
I'm not going to go citation hunting for you, I gave you an authoritative source of the sort that WHO comes to for their own policy decisions. Read up and learn what you clearly don't know.
Knowledge = Life
Get some.

[skepticscott]

23. Wow, you went on at great length

in not one, but two posts, and completely dodged two of the substantive points I raised, and said nothing to substantiate you "refutation" of the third beyond "it was posted on the Intertubes, and it's a study, therefore it must be true."

Tell us how Simoes would have known that another patient was a convicted murderer, and that his doctor was "unfazed" by that. I doubt you can, since you've ducked that issue four times now, as everyone has noticed.

[Ian David]

27. I'm confused about just what kinds of things SkepticScott is actually skeptical ABOUT.

I get the feeling that they might not be the same things Skeptic Magazine or Skeptical Inquirer is skeptical about.

[skepticscott]

33. Well, feel free to be confused

I'll continue to be skeptical about anything that seems of questionable credibility, until better evidence comes along. Like how this person knew Borga had been also treating a convicted murderer (You as yet have no evidence of that, other that your unsupported assertion that they identified themself; I assume if you had even one link, you would have provided it). Nor have you provided evidence that Borga was "unfazed" by this, despite that point having now been raised 5 times.

[Ian David]

37. Those are actually two good points. n/t

[Ian David]

26. The convicted murderer identified himself as such. And as for the drug resistance...

The patient was already on a drug regimen for HIV prior to being hospitalized. The hospital refused to allow him to continue receiving those meds for five days. This five day gap in treatment allows the virus a chance to rebound and become resistant.

It works the same way as when you stop taking antibiotics too early when you have an infection.

This is basic, BASIC stuff.

[skepticscott]

32. As I said, I'm aware of how drug resistance evolves

but it doesn't happen within the course of a single interrupted regimen of treatment in a single patient. It just doesn't. That's even more basic. In all of the cases of drug-resistant microbial strains evolving, it has taken years of use within a broad population. A virus or bacteria in a single person doesn't become any more resistant after treatment is withdrawn than it already was at the point they stopped getting the drug.

[Ian David]

36. Yes, it does. That is basic, BASIC knowledge.

If you stop taking your antibiotcs or your antiviral medicine too soon, then the bacteria or virus living in your body can become resistant to that medicine, and will no longer respond to treatment with it when you start taking it again.

This is really pedestrian stuff.

Do you really need to go google that?

[skepticscott]

39. No, I don't

because you clearly don't have a good grasp of the mechanism for the emergence of drug resistance. I don't see any point in wasting further time trying to explain it to you.

[Ian David]

41. Call your doctor's office & ask to speak to a nurse. Unless it is your INTENTION to remain ignorant.

[intaglio]

6. Cross posted from my response to the thread in GD

The whole report about the consulting doctor is dubious. If it is a Dr Borja (see below) then I find it unlikely that either a Child Psychiatrist or an Ob/Gyn would have any role to play in the treatment of an HIV/Aids patient. Because the Doctor concerned has not been indicted as an individual indictment I suspect that there may be an imposter at work, which might account for the misspelling.

About Dr Borga. There is no Dr Borga listed in NJ on You Compare. There are however 2 Dr Borja's listed. One is an Ob/Gyn associated with Christ Hospital, Jersey City; Dr Manuel Borja and the other is a Child Psychiatrist associated with Trinitas Hospital, Elizabeth; Dr Susan Borja. Both had their primary training in the Phillipines at University of Santo Tomas but I do not know if they are in some way related; another job for other researchers

Further information

Trinitas is a Catholic foundation and has had patient treatment problems before - sorry but the link is to Wiki (with all the problems) If others could research more deeply feel free. http://en.wikipedia.org/wiki/Betancourt_v._Trinitas

Ruben Betancourt of Elizabeth, N.J. was a 73-year-old retired machinist who suffered from anoxic encephalopathy, a form of brain damage, following successful thoracic surgery for a thymus gland tumor at Trinitas Regional Medical Center in 2008.[2] His doctors determined that he was in a persistent vegetative state, removed his dialysis port, and sought to impose a do not resuscitate order on him. In response to this decision, Betancourt's daughter went to court and sought legal guardianship of her father.[3] The hospital, which is affiliated with the Catholic Church, opposed her petition.[4] In court papers, Trinitas argued that "Mr. Betancourt is dying...and that dying is being prolonged by the treatment rendered." A trial court ruled in favor of Betancourt's daughter, finding that she was unquestionably a loving, appropriate guardian, and was also the unanimous choice of her family.[5] The hospital appealed the court's decision.[6] In contrast, Betancourt's daughter does not accept this diagnosis. "My father would turn his head," she told an interviewer. "One time I was joking, my father started laughing. How can you tell me a person like that is nonresponsive?".[7] When asked if Betancourt was suffering pain, a Trinitas doctor answered, "I know it. I've seen it." This calls the diagnosis into question, as pain is not consistent with the diagnosis of persistent vegetative state.[8]

I understand this denial of treatment is acceptable under certain interpretations of Catholic dogma.

Original Thread

[rug]

7. This denial of treatment is acceptable under no dogma and under no sense of humanity.

[ret5hd]

13. well, i don't know about that. research mother theresa.

[rug]

15. Research moral theology.

[ret5hd]

22. So you are claiming that mother theresa was acting contrary to either/both dogma..

and humanity?

If so, then we agree and no further discussion is necessary.

[rug]

28. Actually you claim the opposite but the OP is about a hospital in Elizabeth NJ.

Stay focused or no further discussion is indeed necessary.

[intaglio]

16. You might want to check the doctrine of "Due Proportion" before you make such statements

Vatican teaching does not support euthanasia - a treatment to end life - but can support the withdrawal of treatment if it would be "morally disproportionate" to continue treatment.

The Church does not explicitly address the morality of a "do-not-resuscitate order," but it still uses the distinction between "ordinary" or "proportionate" (=morally obligatory) and "extraordinary" or "disproportionate" (=morally not obligatory) treatments. Moreover the Church clearly teaches that it is morally wrong to impose on anyone the obligation to accept treatments that impose undue burdens on him, his family, and the wider community or to accept treatments that do not offer reasonable benefits or are useless or futile. This is the teaching found both in the Congregation for the Doctrine of the Faith's May, 1980 Vatican Declaration on Euthanasia ("Iura et Bona&quot , Part IV on "Due Proportion in the Use of Remedies," and in the United States Conference of Catholic Bishops' Ethical and Religious Directives for Catholic Health Care

From Zenit - the world seen from Rome the opinion being that of William E. May. Professor Emeritus. Michael J. McGivney Professor of Moral Theology. B.A., M.A., Philosophy, The Catholic University of America. Ph.D. (retired) and Senior Fellow at the Culture of Life Foundation

[rug]

17. Treatment of HIV at this stage is far from that.

I am personally familiar with the morality of extraordinary measures to preserve life and hospital ethics committees.

The secnario presented here, if true, does not implicate either.

[intaglio]

19. You haven't actually read my post, have you?

The comment about dogma was about the DNR that Trinitas put on another patient. In my post title I said I did not think the HIV decision was about religion and that remains the case.

But if you want to go there it would be theologically possible to argue that HIV/Aids treatments are morally disproportionate. It would be despicable to so argue but theologians are paid to seek reasons for such actions.

[rug]

29. I did. Nevertheless, the situation remains far outside the realm of extraordinary treatment.

[intaglio]

30. Essentially you have conceded that Catholic teaching permits such actions,

Actions that you denied were permitted under Catholic teaching, and which you now say can happen "Far outside the realm of ordinary treatment". Those words mean such cases are not impossible, just rare.

[rug]

31. What are you smoking?

Do you comprehend the difference between extraordinary care and ordinary care? Are you actually equating refusing prescribed medication to maintain an immune system from removing a g-tube and a ventilator?

You can try to put words in my mouth all you want but at least try to put some thought into them as well.

[intaglio]

34. Oh, I do comprehend what you are saying

But at what point did I or Dr May mention ordinary an extraordinary care? A dialysis line is perfectly ordinary care in most circumstances but it was withdrawn at the behest of the hospital in the case to which I referred. There was also considerable doubt as to the extent of neurological activity of the patient concerned.

The reference related to was the dichotomy between morally proportionate and disproportionate treatment. I view this as a false dichotomy. Given this sort of reasoning how many classes of morality would it be possible to set up? How many pin dancing angels would decide how great the "disproportion" is? and whether that disproportion is great enough to act upon?

Withdrawal of treatment and DNR without the express consent of the patient or their responsible representative can happen under the rules described. Such withdrawal is in my mind unethical and an appeal to morality based upon mediaeval theology is hair splitting.

As for putting words into your mouth, I quote from your post 7

This denial of treatment is acceptable under no dogma and under no sense of humanity

[rug]

35. The OP is about HIV medicine, not dialysis or DNR.

And the quote is about treatment, not extraordinary treatment.

Next, you'll be talking about euthanasia, an interesting, but extraneous, topic.

[intaglio]

38. I refer you to my post 19 and my post 6

You intemperately responded to post 6 without bothering to comprehend it, just as you foolishly reponded to my post 16 without actually taking issue with the points I raised. You proceeded (post 29) to concede, despite earlier denials, that decisions such as the one I highlighted were taken but attempted to derail any discussion by stating that such occasions were "Far outside the realm of ordinary treatment".

In respect of euthanasia I specifically excluded that from the discussion of moral values in this question. The subject under discussion is the moral justification of failure to treat, specifically in the case of Betancourt vs Trinitas and how it might relate to the refusal to treat an HIV patient. DNR requests are an issue related to this but not referred to in the items quoted.

If you wish to continue arguing stop doing so in headlines and actually address the issues. You will have plenty of time for I am away to bed.

[lunasun]

9. I stay away from any Catholic institutions

due to 2 incidents I know are true because one was me and another a friends mother
They mix religion and medicine at their hospitals and that is not a lie
My spouse/family knows....do not take me to a Catholic hospital if anything happens where I can not say it myself

[Ian David]

11. The dude was being held in the psych ward. I don't think he got to choose his hospital. n/t

[backscatter712]

24. That also explains why a psychiatrist was doing this.

Since he was in the psych ward, the front-line doctor is going to be the shrink.

BAD SHRINK! NO PROZAC!

[cbayer]

25. If true, this is despicable, but there are a lot of questionable areas of this story.

JCAHO requires that a patient have a screening physical exam. In a psych ward these are generally done by someone other than the psychiatrist, who then addresses physical problems.

And why isn't the patient suing the doctor he claims withheld his meds?

There is just a lot about this that doesn't make sense. As there is basically just one article on this, and the one linked doesn't even spell the doctor's name right, I am going to withhold judgement until more information is available.

[dimbear]

40. Agree 100%. Explosive accusations need to be accurate and documented.

Otherwise it gives explosive accusations a bad name. This particular story as presented doesn't ring right at all.

[meow2u3]

42. Borga needs to realize God didn't die and leave her in charge

“Dr. Borga responded to plaintiff’s doctor by stating, ‘This is what he gets for going against God’s will,’ and hung up the phone on plaintiff’s doctor.”

Nor is it God's will to deny someone medical treatment just because their behavior may be immoral. Let God do the judging, Dr. Borga. It doesn't matter if he's gay and got HIV from unprotected sex. Just treat the guy.