Doctors with AIDS would need peer approval to operate under draft guidelines

April 05, 1991|By Lawrence K. Altman | Lawrence K. Altman,New York Times News Service

In a draft of proposed new federal guidelines, the Centers for Disease Control says doctors and dentists infected with the AIDS virus should get permission from local panels of experts before continuing to perform certain operations and invasive procedures.

The draft of a proposal to prevent patients from being infected with the virus is less restrictive than earlier recommendations from the American Medical Association, the American Dental Association and the American Academy of Orthopedic Surgery. They called for infected health professionals to stop performing surgery or to inform patients.

The draft, which has not been made public, says doctors and dentists should accept a professional responsibility to voluntarily undergo tests for the human immunodeficiency virus, which causes acquired immune deficiency syndrome.

The draft calls on medical, surgical and dental groups to identify theoperations and invasive procedures most likely to expose patients to the tiny risk of becoming infected with HIV from an infected professional.

The draft has to be approved by Dr. Louis W. Sullivan, the secretary of health and human services, before it is released for public comment.

Any guidelines that are approved would not be binding. But they could become the basis of a malpractice suit if a patient became infected through a procedure performed by a doctor who did not follow them.

In allowing local flexibility, theCenters for Disease Control in Atlanta seems to be taking into account differences in the rate of AIDS infections throughout the country. The federal agency also seems to be responding to the views expressed at a forum that it called in February.

The meeting in Atlanta was called after an investigation by epidemiologists at the centers found that a Florida dentist had probably transmitted the AIDS virus to three patients. The dentist, Dr. David J. Acer of Stuart, has since died of AIDS. Those are the only known incidents of an apparent transmission from a health care worker to a patient among the more than 170,000 AIDS cases reported since the disease was discovered in 1981.

The new draft does not call for mandatory testing, as many doctors had feared. Instead, it says that health care workers who perform operations and procedures that are most likely to spread the AIDS virus have a professional responsibility to voluntarily undergo tests for that virus as well as for the one that causes hepatitis B, a liver disease.

The draft guidelines call on infected doctors and dentists either to voluntarily stop doing operations and procedures that place patients at risk or to obtain approval from a local committee of experts before continuing to perform them.

Such committees are to include the infected professional's personal doctor; a state or local public health official; an infectious disease specialist with expertise in epidemiology; and a health professional with expertise in the procedures performed by the infected health care worker.

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