Unhappy with the direction his special AIDS task force is taking, Gov. William Donald Schaefer said today that he "absolutely" will push for passage of a bill that would require mandatory testing of state health-care workers for the deadly virus.
The Governor's Task Force on HIV Prevention and Treatment, stressing that there has been only one known case of HIV transmission by a health-care worker, voted last night to stand firm on its recommendation against mandatory testing of doctors and dentists.
The Maryland panel 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 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."
But today in Annapolis, Schaefer rejected the task force's position and said he was unhappy because the panel did not warn him it was going to vote on the issue again.
"I think they owe me a little bit of duty to tell me what they're doing," said Schaefer, who dismissed the state's previous AIDS task force and hand-picked the members of this one.
The governor said his staff will draft a bill requiring AIDS testing for state health personnel and introduce it when the General Assembly meets in January. He also said he may personally attend the next task force meeting to argue his case.
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.
Johnson said the stand on 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 modified version of an earlier recommendation calling for implementation of OSHA guidelines for HIV protection in the workplace. They rely heavily on 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 to treat the average patient using those precautions.
Other recommendations include requirements for:
* Annual continuing education about infectious diseases, including HIV, for all health-care workers.
* The promotion of patients' rights -- 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.