In the spring of 1991 Dr. Laurence Spang was cleaning teeth and filling cavities in his seventh-floor office at the Metropolitan Correctional Center, the federal jail of many narrow windows at Van Buren and Clark. Two years earlier, he had tested positive for HIV.
In Florida Kimberly Bergalis was wasting away from AIDS before TV cameras, angrily demanding that health-care workers disclose their HIV status. Infected by her dentist, she would die the following fall.
Spang believed there was little chance he could have transmitted the virus to any of his inmate patients, but he was becoming increasingly worried about his own safety and security at the prison. "It was the hysteria and the hatred," Spang says. "You've got people like Jesse Helms, who wanted to take somebody like myself and put me in prison and fine me $10,000. It didn't last--his bill didn't pass--but here I am dedicating my life to helping underserved people, and this senator wants to put me in jail. I had no idea where it was going."
In a bid to clear his conscience ("I get upset if I get a parking ticket," he says), Spang got on a plane for Washington, D.C. There, on July 22, 1991, he told an assistant surgeon general about his HIV status. His superiors at the U.S. Public Health Service, which provides medical and dental care in federal prisons, immediately put him on administrative leave and kept him there for several days while they huddled with bureaucrats from the Bureau of Prisons to decide what to do.
When Spang got back to Chicago, a research team from the Centers for Disease Control spent two days questioning him in a hotel room. They reviewed his medical and surgical history, asked about his medical procedures, pored over his meticulously kept treatment records, and toured the prison dental facility. In their report they recommended that certain patients be notified and tested: an individual who could have come into contact with blood from a cut on Spang's finger, and the inmates Spang treated during a two-week period when he had a skin rash (which wasn't believed to have been HIV- or AIDS-related). The CDC saw no reason to notify other inmates.
But the Bureau of Prisons disagreed. It prepared to notify and provide testing for each of Spang's 2,800 former and current patients. On August 9 faxes began going out to federal prisons across the country, and a press conference was scheduled for that afternoon at the MCC. "Literally within an hour and a half I was downtown at the ACLU in a suit," Spang says, "and within another hour we were in court trying to stop the press conference." Spang's name was never used by prison officials, but it might as well have been. He was the MCC's sole dentist from 1983 to 1991.
Spang, who's 45, grew up in Philadelphia and got his dental degree from Temple University in 1975. After four years as an Army dentist at Fort Bragg, North Carolina (he reached the rank of captain), he moved to New York City and began working for the National Health Service Corps, a branch of the health service that works in low-income communities. Over four years Spang treated Hispanic teenagers in the south Bronx, Hasidic Jews in the Williamsburg section of Brooklyn, and poor people in a gang- and drug-plagued community on the Lower East Side. By contrast, jail seemed relatively clean and safe, so when Spang was offered the job at the MCC, he moved to Chicago.
When the controversy erupted there, the district court judge refused to intervene. The next day the dailies covered the story with sensational front-page headlines: "Prison dentist sues to hide AIDS," said the Tribune, which was blatantly wrong: Spang was HIV-positive but he had not developed the disease. "Jail dentist here tests positive in AIDS case," said the Sun-Times.
Things got worse. The next week six prisoners awaiting trial asked a judge to transfer them out of the "warehouse of death," complaining that the stress of the situation was preventing them from preparing their defense.
"I was very naive about the process and really should have sought legal help before I started disclosure," says Spang now. "I thought it would be handled very quietly."
Spang spent nine months on paid leave, until May of 1992, when the health service found him a job as director of dentistry with Chicago Health Outreach, a nonprofit subsidiary of Travelers and Immigrants Aid, which provides medical care to homeless and poor people. Because of his HIV status, the health service tried to keep the process confidential. His name was never used, and correspondence was hand-delivered rather than faxed. "It had a slight tinge of espionage about it," he says.
Around the time Spang arrived, CHO received federal funding for dental care and started to move ahead on a new clinic in Uptown for indigent people with HIV, AIDS, and tuberculosis. (Uptown has reported the second highest number of AIDS and TB cases of any community in Chicago.) In addition to dollars from the Department of Health and Human Services, the clinic has received city funding and a rent-free space of a neighborhood health center on Wilson Avenue. Spang, who hasn't gone back to dentistry since he left the MCC, directed everything from designing the clinic's infection-control procedures to the hiring of staff. When it opens in January the clinic, which has been named for Spang, will be the first of its kind in the midwest and possibly in the country.
One dentist and two assistants will provide free routine care, as well as surgery and treatments for oral problems associated with HIV and AIDS, such as Kaposi's sarcoma, herpes, and various carcinomas. For the future, Spang envisions additional clinics in Englewood and on the west side.
Spang himself didn't test positive for HIV until 1989, but doctors have since determined that he probably contracted the virus as early as 1980. "I always assumed that I could be positive," he says. "I was in New York City from '79 to '83. I'm gay, and I was single. To come out of that situation negative would have been very unusual." Although he has never suffered an opportunistic illness associated with the disease, under new guidelines drawn by the CDC, Spang was diagnosed with AIDS earlier this year. "I think I'm very healthy," says Spang. "I don't think I look ill, and I've been positive for 14 years. Still a lot of people think this is an instant death sentence. Obviously it's not."
Once a private person, Spang now speaks openly about his condition and tries to educate other dentists. He advises them to get good disability insurance and consult a lawyer before disclosing their status. He is one of 30 professionals in the HIV Peer Network, a speakers' bureau funded by AZT manufacturer Burroughs Wellcome. He also helped the American Dental Association develop a support program for HIV-positive dentists and those who treat infected patients. This week he's speaking at the Greater New York Dental Association Convention in New York City.
On Tuesday, November 30, the Spang Center for Oral Health, 845 W. Wilson, will hold an open house and dedication ceremony beginning at 10:30 AM. For more information, call 281-4288.
Art accompanying story in printed newspaper (not available in this archive): photo/Yael Routtenberg.