The Schaefer administration is poised to seek mandatory AIDS tests for both health-care providers and patients involved in procedures that risk transmission of the deadly virus.
Gov. William Donald Schaefer said yesterday he strongly supports such tests and is considering pursuing the issue in the legislature next year.
Maryland would be the first state in the country to require mandatory testing and would make the state's requirements more stringent than those recently established by the federal Centers for Disease Control.
But the head of the governor's new AIDS advisory council, Dr. Richard T. Johnson, was lukewarm to the idea of mandatory testing, saying that more people get AIDS from unsafe sex or sharing needles than from a physician.
Schaefer, who has previously advocated testing some doctors and dentists working for the state, said yesterday he wants to test health-care providers and patients involved in such procedures throughout the state, both in private and public hospitals.
Schaefer acknowledged that the CDC has estimated a patient's risk of contracting the virus that causes acquired immune deficiency syndrome from a doctor or dentist at no greater than 1 in 41,000.
"Do you want to be the one?" Schaefer said. "No, you don't. My job is to prevent that one."
State Health Secretary Nelson J. Sabatini said he has urged the governor to pursue mandatory testing, in part as a way of reassuring citizens that their doctors and dentists are free of the human immunodeficiency virus.
"If you're a patient, you have a right to know all of the risks you will be facing," Sabatini said.
The CDC last month issued guidelines calling for voluntary testing of doctors and other health-care providers who perform so-called "exposure prone" procedures -- virtually everything from having a tooth pulled to heart surgery. Doctors who test positive for the AIDS virus would be obliged to tell their patients before such procedures, under the CDC proposal. A review panelwould make recommendations on what kind of procedures the doctor could then provide.
Sabatini's proposal calls for making the testing mandatory and expands it to include patients.
Last month in Washington, the Senate passed a measure that would make it a crime for physicians or dentists who knew they were HIV-positive to keep that fact from patients on whom they perform invasive procedures.
Schaefer said his concern for patients has grown in the past year amid disclosures of the AIDS deaths of a Johns Hopkins Hospital surgeon and two dentists at the Maryland Penitentiary.
He added that it is only fair for doctors and nurses to know if their patients are carrying the virus.
The Schaefer administration is already planning to require testing of some doctors and dentists who are hired as contractual employees in the state prison system. It does not require legislative approval to do that.
The General Assembly would have to approve a change in the law to require testing of patients or private health-care providers.
Schaefer said he will refer the issue to his AIDS advisory commission before deciding whether to make the issue part of his legislative agenda in Annapolis next January.
Schaefer has yet to name new commission members after dissolving his old commission, which he said focused too much on civil liberties for AIDS patients and not enough on prevention.
Johnson, appointed by Schaefer to head the new AIDS panel, called testing of medical providers "a peripheral issue."
"When people say let's spend all our time worrying about the possibility that over the next year there may be a case of a patient getting it from a physician, it's frustrating," said Johnson, chairman of the neurology department at Johns Hopkins Hospital. "We know hundreds of people will get it from unsafe sex or sharing needles."
Sabatini and others in the administration cited a recent national poll that found that almost nine out of 10 people would like to know if their doctor is carrying the AIDS virus.
"The general public feels they're not being told the whole story," Sabatini said.
Civil libertarians have called mandatory tests impractical and misleading.
"How often will you test the doctor?" said Susan Goering, legal director for the Maryland American Civil Liberties Union.
State Sen. Paula C. Hollinger, an influential legislator on AIDS issues, said she can support some mandatory testing.
"It's becoming more and more apparent. Everybody wants everybody else tested," Hollinger said, referring to both patients and doctors. She said the legislature must be careful to deal fairly with doctors who test positive for AIDS and face the end of their medical practice.
Schaefer said he is aware that a doctor who tests positive for the AIDS virus could go out of business.