Talking with Dr. William Scott
What made you decide to become a doctor?
My mom was a nurse, so I’d been around hospitals. Then when I was 16, I sprained my ankle and was on crutches. I was still in pain when we went to a church service, and I felt this gnawing at my heart to make a commitment to do something with my life. After the service, I prayed with my pastor.
That night, my ankle swelled more. I noticed little dots all over my body, my gums started bleeding. My mom took me to a local urgent care center. They drew blood and discovered my platelet level was too low to count. We spent the next several days in a children’s hospital having tests, doctors coming in with residents and medical students. It felt odd that the very night I committed my life to helping people, I ended up in the hospital. I decided to pay attention and follow along with the doctors. It was fascinating—like a Sherlock Holmes mystery being solved.
We discovered I had idiopathic thrombocytopenia purpura, which basically means my body was eating up all my platelets. I had to get a series of transfusions, in 1985, when people were afraid of contracting HIV that way.
Ryan White was in the news—the Indiana teenager who was diagnosed with AIDS in 1984 after getting HIV from a transfusion. His school banned him. There was so much fear and ignorance.
Yes. I was born the same year as Ryan, so I was really aware of that. I didn’t contract HIV, the blood supply was safe, but watching what Ryan went through made me want to fight fear and discrimination.
Why did you open your practice in Austin?
After my family medicine residency in 2004, I looked for a community where I could make the most difference. Austin hadn’t had a doctor since the last one retired in 1978. An entire generation grew up without local access to health care. It was the poorest community in the state; there was a high burden of disease, disability, and death.
Where did that burden originate?
It goes way back. After the Great Depression, people migrated out of Appalachia looking for opportunities. Morgan Foods, one of the largest food distributors in the world, needed workers in Austin. There was that factory town mentality you see in Appalachia with coal mining. People had temporary housing, dirt floors, no running water or electricity, but they got by because Morgan took care of them.
In the ‘70s, there was an economic downturn. Morgan wasn’t doing well, so Austin wasn’t doing well. In the ‘80s, unemployment was over 20%. You had people growing up in poverty, without basic needs being met, not feeling safe. There was toxic stress, and one way to cope with that is by taking opioids.
Tell me how that became a crisis.
The community started experiencing more injection opioid use. Typically, people crushed and snorted the medications. The formulation was changed to prevent that, so people figured out how to melt and inject it. This was an unintended consequence of efforts to decrease drug use. Clean syringes were illegal here, so people reused and shared them. They started spreading hepatitis C. We knew something devastating was happening—any community with hepatitis C will see HIV unless there’s intervention.
The first two HIV cases were diagnosed in December 2014. With contact tracing, another eight people were identified. Before this, we hadn’t seen a new HIV diagnosis for over ten years. In 2015, this town of 4,300 people had 200 HIV cases. It was the worst drug-related HIV outbreak in U.S. history, and the first rural outbreak.
We met with the state Department of Health, and I offered to open my office to anyone at risk or who’d contracted HIV. Governor Pence signed an emergency order exempting us from state law so we could run a syringe program. We brought in infectious disease doctors to help me learn about HIV care. We connected with behavioral health centers. We became a hub of care.
What did you learn about your patients as you built this care system?
They were injecting drugs. They were living with stress, trauma, and instability. The general consensus was that these people wouldn’t be willing to take care of themselves.
We met each person with respect and dignity, and provided an opportunity to feel safe and cared for, often for the first time in their lives. We found that people responded by taking care of their health—and the health of their community.
Needle sharing went from every person to 22% of users. It’s even better now. Over three quarters of our HIV patients suppressed their viral loads by taking medication. They’re willing to meet with me, and often, they allow me to help them get into recovery.
Your faith helped determine your profession. How does it influence you now?
I grew up in a fire-and-brimstone church. It was about making sure you’re right before God. Other people needed to get their lives right, too. If they lived righteous lifestyles, they wouldn't experience harmful consequences.
When I went to Austin, I saw a whole community that had experienced structural violence. These people weren’t harmed because of personal choices they made, they were harmed by social sins. Society can sin against people by restricting how much access they have to life.
Now, there’s not just a relationship I need to have with God. There’s a responsibility I have to others.
Why did you get involved with Hoosier Action?
Bill Schafer reached out to me. He explained that Hoosier Action is working to get everyone access to healthcare, to keep people safe in the workplace. Part of what I’ve done as a doctor is to try to give a voice to people whose voices aren’t being heard. Hoosier Action does that on a larger scale throughout Indiana. Everyone needs a doctor. Investing in that isn’t Republican or Democratic, it’s just compassionate. It’s human.