2014 Health Care Heroes: Elaine Cox, M.D.

Winner – Physician

Elaine Cox, M.D., Medical Director of Infection Prevention & Riley Safety Officer, Riley Hospital for Children at IU Health

 Dr. Elaine Cox can list many upsides to being a pediatrician. “It’s fun being around kids. They make you laugh. And you’re set up for success,” she said, “because little people are healthy” and can often fight off what ails them.

But they shouldn’t have to start their lives fighting a virus, HIV, that can be avoided if their mothers are tested during pregnancy. Making sure pregnant mothers are tested has been Cox’s passion the last three years.

“When you diagnose a young baby with HIV, you’re really diagnosing two or three people. You tell the mother she has it, and you know if she had known ahead of time you could have intervened on the baby’s behalf. There’s no way to stand by and let that happen,” said Cox, a pediatric infectious disease specialist and director of infection prevention at Indiana University Health’s Riley Hospital for Children.

Elaine Cox, M.D. (IBJ Photo/Eric Learned)

Cox took action, and for her advocacy around the issue and her dedication to her young patients, she is the winner of the Health Care Heroes Award in the Physician category.

The medical community has known for 20 years that an unborn baby’s risk of getting HIV can be lowered from 30 percent to about 2 percent with proper intervention. So when Cox saw a 400-percent increase from 2008 to 2010 in the number of babies in Indiana born with HIV, she knew something was up.

What she discovered was a flaw in a state law passed in 2007 to increase testing. Technically speaking, the law didn’t require patient consent. But it required expectant mothers to sign off on 10 pages of educational material before they could be tested. That amounted to consent, and it was preventing widespread testing from happening.

“The original law laid a foundation, but it was never going to work,” said Cox, who became vocal about the need for a change and lined up a coalition to help push for it in the Legislature. The Indiana Minority Health Coalition, the Indiana State Department of Health and the legal staff at IU Health were among the groups that played a role.

Meanwhile, Cox and a nurse at the Riley HIV clinic launched a campaign, “One Test, Two Lives,” to educate caregivers around the state about the need for testing. Even her kids got in on the action. They assembled 2,200 packets of educational materials that were distributed to every pediatrician and obstetrician in the state.

“If you were a kid in Zionsville and your name was Cox, you were making those packets,” she said.

In the packet is a laminated card Cox created that tells doctors how to test, when to test, and what to do with the results. “There are a lot of doctors in Indiana who’ve delivered lots of babies and have never had an HIV-positive mom,” Cox said.

Cox believes it’s the grass-roots campaign that was responsible for legislators in 2012 approving universal HIV testing for expectant mothers. She wasn’t involved the first time the issue came before lawmakers, when there was considerable controversy surrounding the issue. The second time, Cox said, legislators really seemed to want to understand the problem and do something about it.

Now, more mothers are tested and more doctors know what to do when the news is bad. Mothers who test positive immediately go on a cocktail of medications, and babies get AZT at birth and have frequent checkups. To some people, the 25-percent to 30-percent chance of a mother passing HIV to her baby doesn’t seem alarming, Cox said.

“But if you had those odds in the lottery, you’d buy a Powerball ticket.”

For all of Cox’s advocacy efforts, it’s her dedication to her young patients that stands out among her colleagues.

She makes herself available 365 days a year to counsel colleagues when questions arise, and she’ll go to extraordinary lengths to help a patient. When one young HIV-positive patient suffered bullying at school, Cox showed up at the school to meet with school administrators.

“This is a pattern with Elaine,” said Dr. Paul Haut, chief medical officer at Riley.

The bullied child is in college now and has written a book about what it’s like to grow up with HIV. Another of her patients is in law school.

“The hardest thing is remembering that these are kids,” she said. “They’re not a disease. If you come to my office and you’re getting bad grades in school, that’s what we’re going to talk about. Being HIV-positive shouldn’t exclude you from normal kid-evolution things,” she said.•