AVN interviewed Dr. Mark Henrickson of the Northeast Valley Health Corporation several times last week in connection with the Marc Wallice ELISA test papers dated 3/30/99. On those papers Wallice is listed as being 49 years old and a female.
Mark Kernes, on March 18, asked Dr. Henrickson why this happened. "Well, you're asking me specific questions about a specific client record at this point," said Dr. Henrickson. "I'm afraid that I legally can't answer those questions. What I will say is that I stand by the work of my staff, and any other questions, you'd need to raise directly with the individual involved."
Kernes asked Dr. Henrickson who the logical person would be to sort this out. "The DA," said Dr. Henrickson. "That's the only legal recourse here, to get that - to get the issue into the courts, if that seems to be the issue. At this point, the client record that we have is absolutely confidential," Henrickson went on to say. "Any other supporting documentation or comments that I could make are completely governed by California law, which you know the HIV community worked very hard to put in place. And I'm bound by that."
When Kernes suggested that his answers sounded like a stonewall, Henrickson replied, "Well, in some ways, that's exactly what it is, and it's intended to do that, to protect clients."
"Even though a case is already in controversy, and he produced the test?" Kernes asked. "Well, I gave it only to the client [Wallice]," said Henrickson. "Who he shows it to is entirely up to him. At this point, I can't say anymore because I'd be breaking the law. And I hope that it does get - I - almost more than anyone, I would like this resolved, but it needs to be done in the appropriate ways. Otherwise -"
"The client you produced the test for was a male and the test says female," Kernes observed. "Is there any way you can comment on that part of it?" Henrickson, no, he couldn't. "Because you're asking me about a specific part of the record. I would certainly pose that question to the client. I'm sorry I can't go any further with this at this point," Henrickson said.
AVN's managing editor Mark Logan did a follow-up interview with Dr. Henrickson. Henrickson said he was prohibited by law from commenting on any specific file or any specific patient's records. Henrickson was asked, in a general sense, how it was possible that someone could come into Henrickson's clinic and that Henrickson's records would show, after the fact, that both age and gender was wrong, and how that could happen.
"I'd have to say that I'd rely on our clinic records as accurate," Dr. Henrickson said. "I'm measuring my words here. We believe that our records are accurate. That's what I'm going to have to say."
Logan offered a hypothetical situation. "If Bob Smith produces a record from your clinic, and on Bob Smith's sheet from your clinic, it says at the top, 'Bob Smith,' as his name, and it has that Bob Smith is a female who's 97 years old, what happened in that situation?" Logan asked. Henrickson laughed
Logan: "You understand, these are questions - that are glaring."
Henrickson: "I absolutely understand."
Logan: "And, you know, I think it behooves you to clarify this because you have to admit that this -
Henrickson: "No, it doesn't."
Logan: "Well, but don't you think that this throws the veracity of the tests produced from your clinic into some -"
Henrickson: "No, I don't believe that it does."
Logan: "Okay. So you don't feel that this demonstrates the possibility that somehow, records have gotten mismatched?"
Henrickson: "No, I don't. Well, wait a minute. Without commenting on any specific test -"
Logan: "Exactly."
Henrickson: "I believe that we have a system which is very - which - in which we are very careful about all of that."
Logan: "Okay. Is there any reason why -"
Henrickson: "I believe that there are reasons."
Logan: "Okay. Is there any reason why someone would intentionally misidentify the gender of a patient?"
Henrickson: "One of my staff? Absolutely not."
Logan: "Absolutely not? Then, my question would be, would you personally certify a test that you knew to have been altered after the fact?"
Henrickson: "I'm not sure what you're asking there."
Logan: "In other words, would you ever personally verify the accuracy of a test that had been altered?"
Henrickson: "By whom?"
Logan: "By anyone. In other words, if someone comes to me with - this same Bob Smith, a 97-year-old female who's obviously a 50-year-old male Bob Smith - comes to me and he has a test, and that test has been signed by you verifying its authenticity, would you do that? I mean, knowing that there's - obviously, there's something wrong with this test. Obviously, somewhere along the way -"
Henrickson: "The only thing that I would attest to is that the copy of the test that I furnished the client is an exact copy of the test that we have on file in our records here.That's the only thing to which I will attest."
Logan: "Well, that leads me back, then, to the original question: How would something that is on file in your records have such a huge discrepancy as gender? How would that happen? I mean, what could -"
Henrickson: "I can think of several ways it could conceivably happen - It's really hard for me to give you examples without taking you into the - talking about a specific test."
Logan: "Well, don't name any names; don't give me dates, you know -"
Henrickson: "Naming names -"
Logan: "Right. Just give me - and you're not even saying that these things have happened; I'm not even going to print that you're saying that these things have happened."
Henrickson: "No."
Logan: "Give me an idea of what could happen that could produce these effects. Obviously, somebody could -"
Henrickson: "Let's say that someone comes in with identification that is not their own."
Logan: "I understand. You're not required by law to verify that they are the person who they're presenting ID to say that they are."
Henrickson: "No, I mean, we can only go so far. And we can't - I mean, you can only - you can't do a whole background search on everybody that walks in."
Logan: "No, no, no, no, obviously not. So, in a situation that arises like this, would someone looking at this test - should they be looking at the statistics or should they be looking at the name? Obviously, the phlebotomist who's drawing the blood, or the nurse, or the doctor, is obviously going to be able to tell this is a man; within a ballpark range, should be able to tell age, you know; very general things. So if we assume those are right, then we should then assume that possibly the ID is incorrect?"
Henrickson: "Beyond this, I am on such thin ground that I'm going - I'm not going to comment on that part."
Logan: "Okay. But it's not possible, then, that it would have been a simple clerical error; someone typing up the form entered the wrong code for female -"
Henrickson: "No, I mean, it's not inconceivable that the laboratory could confuse that, but I have not ever seen that happen."
Logan: "I understand... I'm trying to find a way to ask you these questions so that you can answer them without endangering yourself legally, because I do understand - that's a consideration."
Henrickson: "It seems to me that - I - the question becomes for me, what is the correct forum or what is the appropriate forum to resolve this - these kinds of problems, and part of my concern here is that the - I mean, the adult entertainment industry is relying on the kind of 'contain-and-control' measure, the sort of aggressive testing measures, which are really not terribly useful in the long run in attempting to contain HIV. Because those results are invalid in the amount of time it takes somebody to go out the door and shoot up or have sex with somebody. Could be ten minutes. That's - that's my chief concern here."
Logan: "Right. As opposed to focusing on behavioral modification -"
Henrickson: "You're bothered about one test result, and I think it just happens to be one particular individual or test result, when I think the problem is much larger than that. And it seems to me that the way - and I've read things in your publication which advocate for those - which raise this issue, and I certainly support that as the direction for this conversation to go in. It seems to me a much, much larger issue is - is the very essence of what you're asking these tests to do. You're asking them to do things that they can't. Won't, ever."
Logan: "Yeah. I absolutely agree with that. It's a slow process. We obviously do support the idea of people being responsible in their personal lives, but you can never enforce that."
Henrickson: "Or - or for producers and directors being responsible on the sets. That is the direction - that is the inevitable direction that we're headed here. And that's - I mean, it's gotta happen."
AVN's Mark Kernes interviewed Dr. Tom Horowitz (DO), an epidemiologist last week. Dr. Horowitz was asked whether it was possible for a person to test with an extremely high viral count [as did Marc Wallice] after testing negative in an ELISA only several weeks previous.
Horowitz: "When you're infected, the first thing the body does is basically make antigen, then antibody. Until you have antibodies, you have nothing to fight it with, so you get a surge of infection; what we call an acute viral syndrome or acute infectious syndrome; and during that time, you'll get a pretty significant viral load. Your body then makes antibodies and the load goes down some. You need to remember that the antibodies we make aren't totally useless; they're just not as useful as it takes to end an infection, as it is with many other infections. So what's going to happen is you'll get a surge of a viral load. If you recheck that a month later, it will actually have gone down a fair amount, because your body's now made antibodies. And that's when your ELISA test will come back and tell you that you've been infected. That's the window of opportunity we have with the PCR technique.
Q: "Assume HIV+ was possibly involved in the transmission of HIV in Nov. of the previous year (5 months before negative ELISA and 6 months before positive DNA test); does that scenario make sense?"
Horowitz: "There are some people who never make antibodies, and that's why the PCR becomes important. Now, the question is, did the ELISA test ever become positive? Because there are people who we call 'non-converters,' where the virus is there but they just never make antibodies. So if there's an infection tied to it, then you'd have to wonder whether that test wasn't practical or wasn't useful."
Q: "Would the state of the person's health have to do with the high viral load?"
Horowitz: "Sure, any challenge to your immune system - a person who's a heavy drinker isn't going to make antibodies as well. Most substance abuse will affect your immune system. Other infections, what we call 'co-infections' - a person who's dealing with hepatitis, who's dealing with any other chronic infection that's not letting your immune system really get cooking can muck up the test, which is why the newer techniques are more practical; or more expensive, more practical screening tools."
