Medical groups resist call for AIDS guidelines

August 30, 1991|By Lawrence K. Altman | Lawrence K. Altman,New York Times News Service `

Saying that the risk of transmitting the AIDS virus from health care workers to patients is insignificant, dozens of medical groups have refused to cooperate with the government in setting guidelines for infected workers, health officials said yesterday.

The action throws into confusion the government's effort, which calls on professional groups to devise lists of high-risk procedures that AIDS-infected doctors and other health care workers should avoid.

Most of the 40 medical, nursing and other health care groups invited to a meeting Wednesday in Chicago declined to help develop these lists.

They contended that new data showed there was no significant risk of infecting patients, said Dr. M. Roy Schwarz, a vice president of the American Medical Association, which convened the meeting at its headquarters.

"The prevailing attitude was that compiling a list implies there is a significant risk, and thus would mislead the public and capitulate to public fears," Dr. Schwarz said in an interview. "Most of the representatives felt there was no scientific basis to do that."

Dr. Schwarz said that there was no way the AMA could now meet the deadline of Nov. 15 that Dr. William Roper, director of the national Centers for Disease Control in Atlanta, set earlier this month for health care groups to develop the lists.

In the next several weeks, AMA officials will discuss whether the organization should develop a list on its own, Dr. Schwarz said.

Dr. Gary Noble, an AIDS expert and official of the CDC, said that the prospect of no list "makes life more difficult" for his agency but that it intended to proceed by writing directly to professional organizations.

In July, the CDC issued general guidelines saying that health care workers should voluntarily test themselves for the viruses that cause AIDS and hepatitis B and that those infected should stop doing certain "exposure-prone procedures" unless they got permission from a panel of experts and informed their patients.

The CDC left it up to the professional groups to define the procedures posing the highest risks.

The American Dental Association has said it expects to issue its list of high-risk procedures next month. The American Academy of Orthopaedic Surgeons has said that many procedures its members perform do pose risk of transmission.

Many health care experts are deeply concerned about the chaos that could result if each hospital interprets the federal guidelines differently.

The new general guidelines were issued after months of debate among federal health officials and revision of dozens of drafts. The guidelines came after an investigation by epidemiologists from the CDC and the Florida Health Department found that Kimberly Bergalis, who is now dying of the disease, and four other patients of a dentist, Dr. David J. Acer of Stuart, Fla., had become infected in his office.

But the cluster in Dr. Acer's practice is the only known transmissionof the virus from a health care worker to patients among the more than 180,000 AIDS cases reported to the CDC. Health officials have not been able to determine how the virus was transmitted.

In recent weeks, health officials have stepped up the number of investigations of possible AIDS infections among patients of infected health care workers. Dr. Michael Osterholm, chief epidemiologist at the Minnesota State Health Department, has compiled a list of 30 such investigations, often called "look-back studies," said Dr. Schwarz.

He said he has found an additional 13, for a total of 43. The studies involved varying degrees of intensity, and all but six are unpublished. They involve 21 dentists and dental workers, 19 doctors and 3 nurses.

None of the 3,500 patients of the infected health care workers has been found to be infected with the virus, Dr. Schwarz said.

Most groups at the AMA meeting found the data strong enough to saythat the risk of transmission from health care worker to patient was so low that compiling lists of high-risk procedures was worthless, Dr. Schwarz said.

The groups concluded that "the Acer case is bizarre," Dr. Schwarz said at a news conference called yesterday by the AMA in Washington.

One aim was to help stop what the AMA called public hysteria over the risk of contracting the AIDS virus from an infected health care worker.

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