WASHINGTON -- Federal health officials are "leaning strongly" toward a new AIDS policy that would recommend that surgeons and others be routinely tested and that anyone infected be prohibited from surgery or other invasive procedures, according to knowledgeable sources.
Dr. William Roper, director of the federal Centers for Disease Control, said yesterday that he had not made a final decision.
"We're thinking carefully about the process, and we are hearing from a lot of people -- individuals and groups who have strongly held views on the matter," he said.
Sources said that although no final decision had been made, Dr. Roper and his superiors -- including Health and Human Services Secretary Louis W. Sullivan and Assistant Secretary for Health James O. Mason -- were inclined toward favoring the recommendations for new restrictions.
"Dr. Roper has not made up his mind, but from the very beginning his philosophy has been that a physician should 'first, do no harm,' " said one source, who spoke on the condition of anonymity.
"He feels that a physician should not infect a patient. If you accept the fact that transmission can occur, he finds it hard to understand why an infected physician should be allowed to perform invasive procedures."
The CDC, according to sources, defines an invasive procedure as one "in which a health care worker's hand is inside a body cavity where there is also a sharp instrument present." This would include most surgical operations, as well as many dental procedures.
The discussion has become the most controversial AIDS policy debate on the federal level in the last several years and has been the focus of intense discussion since the CDC announced last summer that a Florida dentist with acquired immune deficiency syndrome may have infected one of his patients during a tooth extraction. The dentist, Dr. David Acer, who has since died of the disease, appeared to have inadvertently infected Kimberly Bergalis, now 22. The case is under investigation.
In a more recent case, Johns Hopkins Hospital confirmed last week that Dr. Rudolph Almaraz, a well-known breast surgeon who worked there for several years, had died of AIDS. The hospital began mailing letters to 1,800 former patients offering free counseling and testing.
[A CDC spokesman denied last night that there was any linkage between the Almaraz case and the proposed federal policy change. The change was being discussed as early as August, the spokesman said.]
While the CDC's recommendations are not binding, they traditionally wield influence and are often considered the final word.
Dr. Roper stressed, however, that once proposed guidelines were released, they would be open to a period of public comment and could undergo further changes.
If public health officials propose the new restrictions, they are likely to reopen the national debate over the testing of other groups, particularly surgical patients. The action could also raise sensitive questions of employment discrimination and violation of confidentiality.
While the risk of transmission between health professionals and patients is considered very low, experts believe health care workers are in greater danger of infection from infected patients than vice versa.