HIV panel won't budge on mandatory testing Governor's team still strongly against testing health workers.

December 11, 1991|By Sue Miller | Sue Miller,Evening Sun Staff

Stressing that there has been only one known case of HIV transmission by a health-care worker, the Governor's Task Force on HIV Prevention and Treatment has voted to stand firm on its recommendation against mandatory testing of doctors and dentists.

The Maryland panel, which met last night, referred to a case in Florida involving Dr. David Acer, a dentist who before his death from AIDS infected five of his patients. Four are still alive, but Kimberly Bergalis, 23, died Sunday.

Dr. Don-Neil Brotman, a Baltimore dentist, told the panel that Gov. William Donald Schaefer had pushed for mandatory testing because he thought the figures involving HIV transmission from health-care workers to patients were much higher.

"And, that's what a lot of people out there in the general public think," Brotman said.

"If we spell this out to the governor, it makes our position much more reasonable."

A majority of the task force, including Dr. Richard T. Johnson, the chairman and a Johns Hopkins Medical School neuroscientist, holds the position that mandatory testing is "fiscally irresponsible and scientifically unnecessary."

Dr. Fred A. Gill, a Montgomery County infectious-disease specialist, said, "What impels the governor to propose mandatory testing are the political fears of HIV in the world when, in fact, there has only been one single situation . . . and none other."

It is unclear how the Florida dentist's patients acquired HIV, although lax sterilization of instruments has been cited.

Bergalis shocked the nation in September 1990 when she came forward as the first known U.S. case of a patient who contracted AIDS during a medical procedure. Before her death, she fought for mandatory testing of health-care workers and patients before invasive procedures -- those that are very bloody and in which the risk of exposure is high.

Her stance was opposed by AIDS activists, the American Medical Association and the American Dental Association.

For several months now, Schaefer has made it clear he is for mandatory testing of doctors and dentists and patients before invasive procedures and is counting on the introduction of such a bill in the upcoming session of the General Assembly next month.

As recently as Nov. 13, Schaefer told an Evening Sun reporter, "I am just as strong in my view now as I was. I will push for it." He was not available for comment last night.

Johnson said the panel's position against mandatory testing will be part of a package of recommendations that will be sent to Schaefer by next week.

Johnson also said that he has received a letter from Dr. Janet Horn, who heads the Mayor's AIDS Advisory Council, saying that group also is opposed to mandatory testing.

The package going to the governor will include a modification of an earlier recommendation that called for the mandatory implementation of OSHA guidelines relating to HIV and the protection of employees in the workplace. The guidelines rely heavily on the use of universal precautions -- masks, gloves, face shields, special goggles and non-permeable coats.

Dr. John G. Bartlett, who heads the AIDS service at the Johns Hopkins Health System, said it would cost $53 for the average person to be treated using universal precautions.

"There are times when you need to do these things and there are times when you don't," said Miriam Hawtoff, a nurse and an infection control specialist, who was substituting on the panel for member Sen. Paula C. Hollinger, D-Balto. Co.

"The average person does not have the ability to discriminate, so there's a tendency to do it in a blanket fashion," Hawtoff said.

The panel said it would note its concern "for the utility, cost and lack of established scientific merit" for what it described as "the irrational and irrelevant use" of universal precautions.

Other recommendations include a requirement for:

* Annual continuing education about infectious diseases, including HIV, for all health-care workers.

* The promotion of patients' rights in the health-care setting -- for example, the patient has the right to ask whether a doctor has HIV.

* Policies that clearly delineate the process for handling voluntary disclosures by health-care workers that they are HIV-infected.

And, finally, the panel struggled long and hard but failed to agree on what one member called for: "two or three bold recommendations for the governor" for alternative HIV-prevention strategies.

The stalemate occurred even though an ad hoc committee presented a long list of possibilities, such as:

* Posters featuring Schaefer, who once forbade the state AIDS Administration to release some AIDS-prevention posters, now willingly giving an AIDS message.

* AIDS-prevention billboards in the inner city to target the large group of young people who are otherwise hard to reach.

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