WASHINGTON -- There is no medical or scientific justification for restricting the practice of AIDS-infected health care professionals, nor should they be forced to tell their patients that they carry the virus, the National Commission on AIDS said yesterday.
The commission also opposed mandatory AIDS testing of health workers, urging instead that any such testing be voluntary.
The best way to prevent transmission of the virus by health care workers was through strict adherence to normal infection control procedures, the commission said, adding that "no effort should be spared" to ensure that all health care professionals are trained in and apply so-called universal precautions.
The proposals were contained in a report intended to help states develop policies to deal with surgeons, dentists and other health care professionals who have AIDS or are infected with the human immunodeficiency virus that causes AIDS. A law passed by Congress last year requires states to develop such policies by Oct. 28 or risk losing federal funds for health programs.
"I think this is a careful, science-based report, and it is my fond hope that states will follow these recommendations as we have outlined them," said Dr. David E. Rogers, vice chairman of the commission.
The law arose from the case of an AIDS-infected Florida dentist, Dr. David Acer, who apparently infected five patients, including Kimberly Bergalis, a young woman who became the symbol of the ultimate AIDS "innocent victim." Until her death from AIDS last December, she crusaded for mandatory testing of health professionals and severe professional restrictions against those who were infected.
Robert Montgomery, who was attorney for Ms. Bergalis, denounced the commission's report as "abominable."
"When a person has a contagious disease that can be contracted by association and refuses to reveal it, it is criminal," Mr. Montgomery said in a telephone interview from his office in West Palm Beach, Fla.
Originally, the federal Centers for Disease Control issued far more restrictive recommendations for AIDS-infected health care workers. Among them was a requirement that health officials draw up a list of surgical procedures believed to carry the greatest risk of transmission, and another that physicians inform patients that they were infected. Later, based on new information, the CDC attempted to ease the proposals.
Among other things, "look-back" studies of more than 15,000 patients of 32 HIV-infected health care workers showed no additional instances of physician-to-patient transmission. The Florida case remains the only such known episode.
But the agency was rebuffed in its attempt to relax the proposals by officials at the Department of Health and Human Services, who said they were concerned that the revised guidelines might have violated the will of Congress. Officially, the more restrictive guidelines remain in force, meaning that states could prohibit AIDS-infected physicians from performing certain procedures and could require them to tell their patients about their HIV status. However, CDC officials have indicated that they will be flexible in reviewing state policies.
The CDC said that it had no comment on the commission's report.
"All decisions in public health have to be made as rationally as possible," said Dr. June Osborn, who chairs the commission. "The initial public response of wanting zero risk was an understandable one, but an irrational one. This is not a world in which zero risk can be achieved by any means."
Furthermore, the commission said that tougher restrictions could result health professionals' refusing to care for AIDS patients.
The 15-member commission is an independent body created by federal statute to advise Congress and the president on AIDS policy.