Emotion, politics seem basis for Schaefer AIDS-test stance Proposal would give Maryland the first mandatory program in nation

August 07, 1991|By Thomas W. Waldron | Thomas W. Waldron,Evening Sun Staff xvB

She was just one of hundreds of women Dr. Rudolph Almaraz treated before he died of AIDS last year. But she could talk to someone few others could: Gov. William Donald Schaefer, one of her husband's oldest friends.

The woman was afraid that Almaraz had passed the AIDS virus to her during treatment of a lump in her breast. The governor was sympathetic.

"There's such a lack of knowledge," Schaefer said in an interview this week. "She had to go through the testing process. There's the fear that's left with people."

The personal appeal from an old friend caught the governor's attention. Then, several months later, when two dentists at the Maryland Penitentiary died of AIDS, Schaefer was galvanized. Within hours of the disclosure of the dentists' deaths, Schaefer was calling for mandatory tests for doctors under contract to the state.

This week, he went further, saying he would like to require tests for all health-care providers and patients involved in procedures with a risk of AIDS transmission.

If enacted, the proposal would give Maryland the first mandatory testing program in the nation.

Critics are eager to pick holes in the idea. How often would doctors be tested? Would a person who was having a cavity filled be required to take an AIDS test first? Who pays for the tests?

Even Dr. Richard T. Johnson, whom Schaefer appointed to head his AIDS advisory council, says testing of doctors is at best a "peripheral" issue. A patient's fear of being contaminated is "irrational," Johnson says.

One Schaefer administration official acknowledges there are "ten thousand problems" with mandatory testing. For the governor, it seems, the decision to pursue testing is based as much on emotion and politics as on pure science.

His own dentist, Schaefer says, looks like a "mummy" when he treats him. "He wears everything from the tip of his toes, the robe, the gloves, mask, something over his hair. All you see is his eyes. I don't know if that's enough or not, but it is for me."

Ironically, some critics of testing suggest that a falsely negative result on an AIDS test might prod a physician or dentist to relax his protective standards, increasing the risks to the patient.

"The public is guys like him -- who know only enough to be scared out of their wits," says one state official familiar with Schaefer's thinking. "It's a very Schaeferian approach to the problem. Whether it's pot holes or AIDS, he's always looking out for the common man."

And administration officials are quick to point out recent polls showing that a huge majority of Americans -- as many as 90 percent, by one poll -- want to know if their physicians and dentists have AIDS.

"Mandatory testing is not a total safeguard. We'd be foolish if we thought it was," says Nelson J. Sabatini, the state health secretary, who has recommended that Schaefer pursue such tests. "But, there's also a public perception I'm concerned about. One of the things that's central to having an effective health-care system is public confidence in the system."

Schaefer seems unperturbed that mandatory testing could well end up putting out of business any doctor who tests positive for the AIDS virus.

"So? I have no problem with that," he says. "If I don't want to be treated by him, that's my choice."

Susan Goering, legal director of the Maryland affiliate of the American Civil Liberties Union, says testing is overkill, since there has been only one health-care provider -- a Florida dentist -- shown to have passed the AIDS virus to patients.

"We're defining public policy on one very murky case in Florida," Goering says.

Meanwhile, a group of doctors representing the state medical society has been meeting this summer with hospital officials and others to come up with a new testing policy for physicians in Maryland.

Schaefer says he hopes they come up with a suitable plan. Otherwise, he may take the issue himself to the state legislature next year.

A draft proposal being considered by the group of health-care officials follows recent guidelines proposed by the federal Centers for Disease Control. These call for voluntary testing of doctors, according to Betsy Newman, the public relations director for Medical and Chirurgical Faculty of Maryland.

Doctors who test positive for the human immunodeficiency virus, which causes AIDS, or for hepatitis-B, would be evaluated by an expert panel before they could perform invasive procedures.

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