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New York Times
Doctor With AIDS Virus Evokes Anger and Pathos
July 29, 1991

In town, people were talking about the letter from the hospital. "Mine came yesterday," was the greeting often heard. "Did you get one?" One woman at the county fair said to another: "I'm not really scared, but I'm not sure what it means. I know I don't have AIDS, but can you be really sure?"

And a man placed a call to the hospital, shouting, "You took away my right to choose! You took away my rights!"

Two days after the local hospital forced one of its doctors to resign because he is infected with the virus that causes AIDS, people here were angry and confused, and they were trying mightily to put aside their fears.

But hysteria was not the ruling emotion. Several former patients of the doctor, Neal Rzepkowski, faulted him for not revealing his condition, but were nonetheless thankful that he has been so candid since the news of his infection broke. His words, they said, had dispelled some of the mystery that typically casts a shadow over the disease.

And Dr. Rzepkowski (pronounced zep-COW-ski) said he understood what anger there was and blamed no one.

"I don't blame the hospital," he said. "I don't blame people for being afraid. And I don't blame myself. I did nothing wrong."

Last week, the administrators at Brooks Memorial Hospital asked Dr. Rzepkowski to leave in reaction to new guidelines from the Centers for Disease Control that recommend that infected health-care workers inform their patients and get their permission before performing invasive procedures like surgery.

And the hospital did one more thing: While stating that there was "no risk" of infection, it sent letters to 4,100 patients who had passed through the emergency room where Dr. Rzepkowski had worked.

By today, 1,000 people had called a special telephone line the hospital had set up, and 270 had arranged to come in for HIV tests.

It was hard to find anyone over the weekend who had not received the letter or did not know someone who had. Now this town of steelworkers and ice-cream-factory employees 45 miles southwest of Buffalo finds itself facing one of the most complex ethical and medical issues confronting the country.

"I feel sorry for the doctor," said Robin Rogers, who was in the emergency room on Saturday with her 3-month-old son, Dale. But then she considered that Dr. Rzepkowski had delivered her baby.

"I'm angry that they would let someone work in that condition," she said. "Now we are all left to deal with it."

The hum of the debate stirred by the hospital's announcement could be felt everywhere on the clear blue summer weekend, in conversations at the lake where people took out their boats and at the Chautauqua County Fair where they took to the carnival rides.

It could be felt a few miles farther south, down two dirt paths, past a wheat field, in a small grassy clearing in some woods. It was there, next to a shining patch where onions, zucchini, and tomatoes flourished, that a visitor found Dr. Rzepkowski. He emerged from a small hut to say, "Welcome, welcome." He had attended the hospital's news conference on Friday, he said, because "I have never hid from anyone about this and I wasn't about to start." But he confessed to needing some time to think quietly.

That is why then, on Saturday night, he gathered as previously planned with 11 people, most of them strangers, to pray and chant in the sweat lodge he had built out of willow branches and blankets in the American Indian tradition on the 14 acres he owns. A Sweat Lodge and a Peace Pipe

Dr. Rzepkowski, a 39-year-old thin blond man whose narrow eyes have a studious look, was beet red when he appeared out of the steam from water poured on heated rocks within. He said he did not want to give anyone the impression that the ritual was a form of escape. As an ordained spritualist minister who lives in nearby Lily Dale, a community of spiritual seekers, he said the sweat lodge represented the opposite, a chance to see things better from everyone's perspective.

He said that he had told many patients about his condition during the 15 months he had worked at Brooks Memorial. He also said that since finding out he was HIV positive in July 1985, he had been open about his condition, as he had been previously about his homosexuality. He said he told his supervisors about his infection and had even gone on a lecture tour to talk about it.

He said he had informed many patients at three other hospitals where he had practiced medicine in the area, as well as at hospitals and clinics where he had worked in Schenectady, N.Y., and in Boston.

But he added that he only told the patients when "I thought they were informed enough about AIDS to handle it." Asked if he understood the anger felt by people who believed he had denied them the chance to make their own choice, he said he did. 'Let's Get Rid of the Confusion'

"But I do not really believe in indulging fears," he said. "Am I sad? Yes. Is my stomach in knots? Yes. But what's happening now is really a wonderful opportunity to educate people. How often would I have the chance to do that?"

"Why can't we all just talk this out together?" he asked. "Let's get rid of the confusion for everyone."

One of the women in the prayer group shared a peace pipe with Dr. Rzepkowski, then said she was amazed at his composure, considering the sudden notoriety.

"I saw him on the news before I ever met him," said Jean Rosthauser. "It occurred to me that in a sweat lodge you should share water, a pipe and sweat. At first I panicked. Then I thought it would be a cruel world that would turn its back on someone who has devoted his life to healing when he now needs healing. I don't think the world is cruel." 'It Doesn't Matter What I Think'

Richard Ketcham, the hospital's president, said it was a combination of the confusion that has surrounded other cases of health-care workers with AIDS and new guidelines from the Centers for Disease Control that had compelled him to ask Dr. Rzepkowski for his resignation, even though he personally agreed with Dr. Rzepkowski's statement on Friday that there was no risk of infection.

"If Dr. Rzepkowski had stayed on, and when he got very sick and died, what would the outcry have been then?" Mr. Ketcham asked. "In my role, I have to look at what the community thinks. It doesn't matter what I think.

"In a perfect world," he said, "where people would listen to facts and act rationally, I would not have had to take this action. But that's not the way reality is. This scares the heck out of people, and in a small community like this, the emergency room would be closed because of the outcry. It would not take a lot of people to wreak havoc."

The Federal guidelines, issued July 12, recommend that doctors refrain from "exposure-prone" procedures, but leave it to individual panels of community experts to arrive at their own lists, inviting varying interpretations. Brooks Memorial chose to define the guidelines for itself, and took a conservative path, refraining infected doctors from doing anything from complicated surgeries to simple stitches.

The fine points of medical treatment were not on the minds of people who spoke at the fair. But moral questions were. Kevin Muldowney, a 26-year-old assistant to a State Senator, said he had received a letter. The doctor had treated him for a broken finger in April, he said.

"I thought he and the hospital had done the right thing," Mr. Muldowney said. "But when I found out that he's known about his condition since 1985, I began to wonder."

Another man, who did not want to give his name, said: "Yeah, he treated my wife and I'm angry. Someone ought to tell him he's not God."

Later that night, Dr. Rzepkowski confronted the questions in chants and prayers inside his sweat lodge.

The moon glowed in the clearing. The doctor paused, and could be heard saying quietly: "Who may climb to the top of the mountain and look down to judge another? With the star of knowledge, we will know that each man must walk his own path."