Stirred by the death of a prominent Baltimore surgeon who had AIDS, a group representing some of the city's leading surgeons has called for laws to require the routine testing of all health-care workers and patients for antibodies to the AIDS virus.
Routine testing would give doctors and patients the information they need to protect themselves, the Baltimore Academy of Surgeons' executive council said in a position adopted two weeks ago but just made public. The organization represents about 150 surgeons, including the chief surgeons at all of Baltimore's hospitals.
The council said health-care workers treating infected patients could take extraordinary and sometimes burdensome measures to protect themselves and others -- such as wearing two sets of gloves and impermeable gowns, and removing interns and residents from the operating room.
Meanwhile, patients alerted to a physician's positive test result could decide whether to go elsewhere for treatment.
Dr. Thomas R. Godacz, chief of surgery at the Baltimore Veterans Administration Hospital, said yesterday he realized that testing physicians and making patients privy to their test results could ruin the reputations and, thus, the practices of doctors who tested positive for the virus that causes acquired immune deficiency syndrome.
"One could say it's not necessary because the risks are so low," said Dr. Godacz, a member of the surgeons' council. "For me, as the potential patient, I would really want to know, if I was going to have a major operation, the HIV [human immunodeficiency virus] status of my physician."
Dr. Godacz said infected doctors could confine themselves to procedures that did not involve the use of sharp instruments -- or devote themselves to treating patients who also carried the virus.
The concept of testing patients and doctors without their consent remains intensely controversial. Testing doctors "sends the message: Don't take care of people who are HIV-positive, because if you get infected, it will take away your livelihood," Dr. David E. Rogers, vice chairman of the National AIDS Commission, said recently.
Last summer, the federal Centers for Disease Control reported that a Florida dentist had apparently transmitted the AIDS virus to a young woman during a tooth extraction. That remains the only case in which transmission from a health-care worker to a patient appears likely, although the facts of that case are hotly disputed.
On the other hand, the CDC knows of 40 cases in which health-care workers have contracted the virus from patients. Most experts agree that the risk to health-care workers is far greater.
The Baltimore Academy of Surgeons proposed routine testing of patients two years ago but, according to Dr. Godacz, received a chilly reception from the Governor's Advisory Council on AIDS. The group expanded its recommendation to include the testing of doctors in light of concerns that emerged after the Nov. 16 death of Dr. Rudolph Almaraz, a cancer surgeon at Johns Hopkins Hospital who had AIDS.
"It would be very difficult to support or endorse the testing of patients without patients' having the advantage of knowing" the doctor's status, Dr. Godacz said.
The executive council includes top surgeons at Sinai, Union Memorial, University, St. Joseph and St. Agnes hospitals, as well as the VA. The group has not proposed any specific legislation.
The Centers for Disease Control, however, is expected to release guidelines on this topic in several weeks.