Subject: U. S. Seeks Self-Policing by Doctors Instead of Mandatory AIDS Tests
Date: Published: 7/16/91 (92 lines)
Source: Wall Street Journal. Copyright Dow Jones & Co. Inc.

    Technology & Medicine:
    U. S. Seeks Self-Policing by Doctors
    Instead of Mandatory AIDS Tests
    ---
    HHS's Sullivan Does Urge
    Some to Undergo Tests
    To Help Protect Patients
    ----
    By Glenn Ruffenach
    Staff Reporter of The Wall Street Journal

    Health and Human Services Secretary Louis W. Sullivan said
 that self-policing by physicians and dentists -- and not
 mandatory AIDS testing -- is the best way to protect patients
 from health-care workers who might be infected with the AIDS
 virus.
    The recommendation is the government's long-awaited
 response to increasing public concerns that health-care
 workers may be transmitting the human immune deficiency virus
 to patients.
    The Centers for Disease Control last July reported the
 first instance of a health professional, a Florida dentist,
 infecting a patient.  In the intervening months, reports of
 four more infected patients of the dentist, along with news
 stories in a half-dozen states about physicians and dentists
 with AIDS who continued to practice their craft, have sparked
 demands for new practice guidelines for medical providers.
    The guidelines, drafted by the Atlanta-based CDC, urge all
 health-care workers who perform exposure-prone procedures --
 those in which workers might be cut and have their blood come
 in contact with a patient -- to undergo AIDS testing.  If the
 health-care worker tests positive, the guidelines recommend
 that he or she stop performing those procedures, unless
 permission is received from both a medical review committee
 and the patient.
    Dr. Sullivan stopped short of calling for mandatory AIDS
 testing, noting that "in the overwhelming number of medical
 encounters, we simply don't need to be worried about AIDS
 transmission."  Indeed, the Florida cases remain the only
 reported instances of an infected medical provider
 transmitting the HIV virus to a patient.  And of the more than
 150,000 people diagnosed with acquired immune deficiency
 syndrome in the U. S. since 1981, only about 4%, or about
 5,800 people, have been health-care workers.
    While the CDC's recommendations aren't binding on the
 medical community, its guidelines often carry considerable
 weight with federal and state regulators.
    The medical community, which has strongly opposed
 mandatory testing, generally applauded the CDC's
 recommendations yesterday.  William Schaffner, chairman of the
 department of preventive medicine at Vanderbilt University in
 Nashville, Tenn., called the guidelines "exceedingly sound,"
 adding that they should "go a long way toward reassuring the
 public."
    The American Medical Association, in a statement, said it
 was "pleased" that the guidelines had been issued and said it
 would work "vigorously" to implement them.  In January, the
 AMA urged physicians who are already infected by the AIDS
 virus to abandon surgery, unless they have patient consent.
 The AMA also urged physicians "who are at risk of acquiring
 HIV infection" to undergo testing, but it didn't go so far as
 to call for voluntary testing of all physicians who are
 involved in "exposure-prone" procedures.
    The new guidelines, however, met with some criticism at
 both ends of the spectrum.  Rep. William Dannemeyer of
 California, the ranking Republican on the House Energy and
 Commerce Health Subcommittee, dismissed the recommendations
 as not going far enough.  Mr. Dannemeyer, who has introduced
 legislation calling for mandatory AIDS testing of physicians,
 said the guidelines "continue a failed policy of
 volunteerism."  Citing the plight of the five patients in
 Florida who contracted the AIDS virus from their dentist, he
 asked:  "Why do the civil rights of the infected take
 precedence over the civil rights of the uninfected?  "
    By contrast, Benjamin Schatz, who directs a program for
 infected health-care workers sponsored by the American
 Association of Physicians for Human Rights in San Francisco,
 said the guidelines go too far.  "It's nonsense to pretend
 that, once physicians notify patients of their HIV status,
 they can continue to practice," he said.  The recommendations,
 he added, actually give health-care workers a "greater
 incentive not to know their HIV status.  If they find out it's
 positive, they're under an ethical obligation to quit."

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