In the midst of perhaps the most complicated AIDS-related problem of his administration, Gov. William Donald Schaefer today vowed to replace members of his Advisory Council on AIDS.
"I'm not so happy with my own AIDS commission," he said of the group of doctors and nurses he set up in 1987 to formulate state policy on dealing with the disease.
Schaefer offered no other details on what changes he plans to make, except that he wants to bring new appointments to the panel.
Schaefer's statement came on the heels of the revelation this week that a former prison dentist who treated thousands of inmates died recently of AIDS.
Spurred by the news, Schaefer this week jumped into the middle of a national debate by calling for widespread testing of the state government's health care providers "before they ever touch anyone."
"I don't know whether I can do that or not," Schaefer quickly added, "But it's what I want."
Schaefer's statement raised several questions. How many employees was he talking about? How often would health-care providers be tested? What would be done with the results? Would providers who test positive be prevented from treating patients?
Ray Feldmann, a spokesman for Schaefer, said answers to those questions would have to wait.
"We're in the very early stages of looking into this whole situation," Feldmann said. "The governor's going to be looking to see if there are any policy decisions that can be made to prevent this from happening. If changes need to be made, we're going to make them. Beyond that, there's not a whole lot more we can say."
Dr. Marcia Angell, executive editor of the widely respected New England Journal of Medicine, wrote in an editorial this week that patients have a right to know if their doctors or dentists have the AIDS virus, even though the threat of transmission from provider to patient is considered remote.
The federal Centers for Disease Control, which tracks AIDS cases, has been able to identify only three specific cases in which a medical provider -- in those cases a Florida dentist -- is believed to have passed the virus to patients.
Under Maryland law, a person must give written informed consent before being tested for AIDS. That law would have to be changed to enact Schaefer's proposal for universal testing of state health-care providers, according to several lawyers familiar with the issue.
The issue goes beyond consent, said several opponents of testing.
If you do test health-care providers, how often do you do it, "if you really want to protect the public?" said Dr. Mervyn F. Silverman, president of the American Foundation for AIDS Research. "Do you test annually, semiannually, monthly, weekly?"
"What you're seeing is the kind of reaction you see many times around testing, which is sadly a simplistic response to a very complex issue," Silverman said.
An AIDS test will not always detect the presence of the AIDS virus, which can take many months to develop inside the body, he said. In those cases, the test results could mislead medical providers and patients.
"I think the first thing any hospital should do is demand that their health care people take safety precautions all the time," said Stuart Comstock-Gay, executive director of the Maryland chapter of the American Civil Liberties Union and an opponent of AIDS testing. "If they don't wear gloves and don't sterilize equipment, disciplinary action should be taken immediately."
The American Dental Association has proposed a policy calling on its members who are infected with AIDS to inform their patients or to stop performing invasive procedures.
"That basically means they would have to stop practicing," said Dr. J. Thomas Soliday, president of the Maryland Dental Association. The association has not adopted the policy, and has instead urged its members to take standard precautions against transmitting the virus.