Mandatory Testing

The Schaefer administration is poised to seek mandatory AIDS tests for both health-care providers and patients involved in procedures that risk transmission of the deadly virus.Gov. William Donald Schaefer said yesterday he strongly supports such tests and is considering pursuing the issue in the legislature next year.Maryland would be the first state in the country to require mandatory testing and would make the state's requirements more stringent than those recently established by the federal Centers for Disease Control.

She was just one of hundreds of women Dr. Rudolph Almaraz treated before he died of AIDS last year. But she could talk to someone few others could: Gov. William Donald Schaefer, one of her husband's oldest friends.The woman was afraid that Almaraz had passed the AIDS virus to her during treatment of a lump in her breast. The governor was sympathetic."There's such a lack of knowledge," Schaefer said in an interview this week. "She had to go through the testing process. There's the fear that's left with people."

ANNAPOLIS -- A state health department bill requiring certain doctors and patients to be tested for the virus that causes AIDS may be sinking under the weight of its own cost.An official at the Johns Hopkins University School of Medicine in Baltimore said the legislation is a "financial disaster" that could cost Maryland's health care system $74 million a year."These costs would obviously be borne by the consumer, meaning higher health care costs," according to Dr. John G. Bartlett, infectious diseases division chief at Hopkins.

Growing national sentiment for protecting patients from health care workers who carry the AIDS virus has gained momentum in recent weeks amid speculation that it will lead to mandatory testing of patients and care givers.From New Jersey to Oregon, the debate is being waged in state legislatures, courtrooms, hospital boardrooms and within professional organizations.In Florida, where an infected dentist apparently transmitted AIDS to three patients, some dentists and hygienists even have begun posting their AIDS test results on their office walls in an attempt to reassure skittish patients.

Three months after disbanding his AIDS Advisory Council and promising to appoint a new one that's more attuned to his way of thinking, Gov. William Donald Schaefer has created a new council composed mostly of old names.He searched the field for talent, but apparently found that he couldn't do without the expertise of more than half of the people who sat on the old council, a group he once said had disappointed him by not doing enough to address public fears about the disease.All told, 13 people whom Governor Schaefer named to his new 22-member council last week are veterans of the old panel.

The newly structured Governor's Council on HIV Prevention and Treatment appears to have moved away from supporting mandatory or voluntary AIDS testing in favor of mandatory education for all health care workers, students and the public.The council took no formal vote last night after nearly a three-hour debate on the complex and evolving testing issues, mandatory education, universal precautions and empowering patients to ask surgeons who may be operating on them to disclose their HIV status.

Forty percent of the heavy diesel trucks tested so far in Maryland's new voluntary emissions-control program flunked, spewing smoke dirtier than an industry-recommended standard.But state Department of the Environment officials greeted the news cheerfully yesterday.That failure rate is very close to what they expected when the program for heavy-duty rigs began seven weeks ago, officials said at a press conference in West Friendship, held at a truck weigh station on Interstate 70.The 18-month, penalty-free "pilot program," they said, is supposed to encourage the owners of soot-belching vehicles to tune up their engines and clean up the air. The $160,000 effort is also intended to help the state decide in 1995 whether a mandatory testing program for heavy-duty trucks, defined as those weighing more than 8,500 pounds, is needed.

FRESH from Yale Law School in 1978, Lori Andrews took the bar exam the same day that Louise Brown, the first test-tube baby, was born.Since then, Ms. Andrews' legal career has been intertwined with the stormy development of reproductive and genetic technologies.Her expertise, tempered by compassion and wit, has made her a respected voice of reason in clamorous disputes -- about genetic testing, surrogate arrangements, the disposition of frozen embryos, cloning -- that were never forecast by the pioneering scientists who made them possible.

A bill that would make a blood-alcohol test mandatory after a vehicular accident results in "life-threatening injury" was approved yesterday by the Senate Judicial Proceedings Committee.SB-315 is designed to close a loophole in current law, which requires a test in fatal crashes only if the death occurs immediately.With shock trauma systems and other modern medical techniques, fatally injured victims often live for days, allowing suspected drunken drivers to escape the mandatory test."We're encouraged," said Susan Edkins, the mother of a 12-year-old girl killed last Oct. 29 in a crash involving an alleged drunken driver.

PEDIATRICIANS share a common reaction to the Food and Drug Administration's decision to require pharmaceutical companies to test the effects of new drugs on children: It's about time.Only 20 percent of the prescription drugs on the market today have been voluntarily tested for safety and effectiveness on children. That means pediatricians too frequently are forced to guess when making critical decisions about the drugs and dosages they prescribe for their youngest patients.And unfortunately, even a doctor's educated guesses can be deadly.