WASHINGTON -- The American Medical Association and the American Dental Association urged their AIDS-infected members yesterday to refrain voluntarily from performing surgery or other invasive procedures on their patients or disclose to their patients that they are infected.
"The health of patients must always be the paramount concern of physicians," said a statement issued by the AMA, which represents about 300,000 physicians in the United States. The ADA represents about an estimated 150,000 dentists and dental students.
The recommendation came as health officials released the results of their study of Dr. David Acer, a Florida dentist who died of acquired immune deficiency syndrome, concluding that three of his patients probably were infected in his office. They based their conclusions on studies of the human immunodeficiency virus that found the strains of virus in all three patients were extremely similar to that of the dentist, but different from viral samples obtained elsewhere in the community.
The recommendations were immediately criticized by AIDS advocacy groups and others.
Officials from the federal Centers for Disease Control in Atlanta said they could not determine exactly how the Florida cases occurred. They theorized that the dentist could have hurt himself while operating on his patients, mingling his blood with theirs, or that he contaminated his equipment, or that a combination of factors was involved.
Overall, CDC officials and others emphasized that the risk of such transmission was still extremely low. In fact, the Florida case is the first known instance in which a health care worker-to-patient transmission is believed to have occurred.
In December, reports that a breast surgeon in Baltimore had died of AIDS the month before roused a storm of fear and outrage.
Dr. Rudolph Almaraz, who operated at Johns Hopkins Hospital, sold his practice as of March 1 but apparently did not tell his patients or his hospital colleagues about his illness.
Hopkins offered HIV counseling and blood tests to everyone Dr. Almaraz had treated since joining the staff in 1984. Hospital spokeswoman Carol Pearson said about 400 women called the hospital, many of them requesting the test. As of the end of December, none of those tested had shown evidence of HIV.
The CDC is debating whether to recommend that hospitals and other facilities impose new restrictions on infected health-care professionals who perform invasive procedures. They are expected to release new guidelines some time after March 1.
The AMA and the ADA insisted that their new stance was based on ethical concerns and that the scientific evidence of such transmission was still unresolved. "Until the science is clear, you have to opt on the side of patient protection," said Dr. M. Roy Schwarz, the AMA's senior vice president for medical education and science.
Others argued that the recommendations were unfair.
"They are not yet scientifically justified," said Alvin Novick, a professor of biology at Yale University who chairs the ethics committee of the American Association of Physicians for Human Rights. "I believe it may be wise for some HIV-positive health providers to refrain from certain seriously invasive procedures. But the tone of this advice will almost surely lead to much more severe rules on the part of hospitals, requiring or proposing mandatory testing . . . seeking to identify persons who might be positive."