Gov. William Donald Schaefer today said he plans to continue his support for mandatory testing of doctors for AIDS, despite the fact that his council on the disease has come out against that approach.
"I am just as strong in my view now as I was," Schaefer said in Annapolis today. "I will push for it."
The Governor's Council on HIV Prevention and Treatment yesterday shot down mandatory testing for AIDS, in spite of the fact that Schaefer chose many of the members of the recently restructured group.
Calling mandatory testing "a fallacy," Dr. Richard T. Johnson, the panel chairman and a Johns Hopkins Medical School neuroscientist, said last night he would explain the council's position in detail in a cover letter that will accompany a set of recommendations to the governor and the General Assembly that still need to be slightly modified.
"There is no scientific basis for mandatory testing and it's very expensive," Johnson said, "So, it's fiscally irresponsible and scientifically unnecessary . . . but, there's a lot of emotion attached to it.
"There has never been a case of direct transmission of HIV from physician to patient, there never has been. . . . There is this one crazy dentist situation that has something very funny about it. So, let's not take all the doorknobs off the battleships."
The dentist Johnson referred to was Dr. David Acer, who before his death from AIDS in Florida infected five of his patients with HIV. It is still unclear how the patients acquired the infection, although the dentist's lax sterilization of instruments has been cited.
In his reference to doorknobs, Johnson was alluding to the theory during World War I that syphilis might be transmitted on doorknobs.
That resulted in the Navy's removing all doorknobs from battleships.
After final approval at the December meeting, the cover letter and the recommendations on AIDS will be sent to the governor and legislators.
In a three-hour meeting last night, the panel also approved in principle a set of recommendations designed to alleviate the public's fears about HIV disease and health care and to "significantly improve" safety in the health care system.
After questioning the effectiveness of school-based AIDS education efforts, the council moved on another front.
It appointed subcommittees to look into controversial non-education prevention programs such as increased distribution of free condoms and a fresh look at a needle exchange for intravenous drug users.
The subcommittees also will evaluate the use of "AIDS theater" as a potential tool for bringing about behavioral changes among sexually active adolescents who know what causes HIV but think they're invincible.
The council recommendations were drawn up by Curtis L. Decker, an attorney, and Dr. Fred Gill, an infectious disease specialist.
Among other things, they seek:
* The best trained health care professionals possible. All health care workers should be required to undergo continuing education in infectious disease control, including HIV infection, on an annual basis.
* Strict adherence to safety standards in health care settings.
* Patient rights, such as the right to know whether universal precautions are being adhered to and the right to question any health care provider of his HIV status in relation to the care he is providing.
* Policies that clearly delineate the process for handling voluntary disclosures by health care workers that they are HIV infected. These should include reasonable accommodations that will be offered these employees, including such benefits as disability and early retirement, alternate work assignments and confidentiality in the workplace.
* The development of programs by the state health department to educate the public on all aspects of HIV disease. "Some people don't even know what we mean by 'transmission' of HIV," one council member said to another last night.
"We're dealing with a complex situation; there is no one easy thing we can do," Decker said after the meeting. "The public wants a simple 'test everybody' and then HIV will go away, but we're saying: 'No, it's a comprehensive plan, nothing goes away.' "
Dr. Jack Zimmerman, a Church Hospital surgeon and council member, called attention to the "limitations" of school-based AIDS education that has no evaluation system.
"We've got to redirect our priorities and resources at other modes of prevention," Zimmerman said. "We need to look at different instructional methods."
Dr. John G. Bartlett, director of the AIDS Service for the Johns Hopkins Health System, said, "We don't know what is being taught in the schools. We need to know what's going on with what ages. We've got to measure something to say it's working or not. We need to have some tangible yardsticks."