With the hotly contested issue of mandatory AIDS testing looming, Gov. William Donald Schaefer has decided to disband his AIDS Advisory Council and create a new panel.
The decision to scrap the council, whose members often differed philosophically with the governor, goes hand in hand with the administration's aggressive pursuit of a new mandatory AIDS testing policy that could go so far as to include all state health-care workers.
The council has consistently opposed any mandatory testing.
If such a policy were implemented, it would be the first of its type in the nation and probably would be challenged in the courts. State officials have sought an opinion from the attorney general's office, which is expected to allow testing under certain circumstances, based on whether the worker poses a "significant risk" to patients.
"The governor has expressed an interest in requiring mandatory testing for certain health-care providers, and that's something that's being evaluated," said Paul E. Schurick, the governor's former press secretary, now his top aide on health matters. As for how far the testing could reach, Mr. Schurick said, "The governor will look to his health department and his new council on HIV to make a recommendation."
But administration officials say privately that a testing proposal is inevitable and that it could include all health care workers who work for the state. At the least, it would require that medical contractors working for the state certify that their employees had tested negative for the AIDS virus, the officials said.
"Once again, he ignored our recommendations and went off emotionally on this issue," said Curt Decker, a lawyer who served on the commission for several years. "It's no surprise that he wants people who will tell him what he wants to hear. This is a governor who doesn't want anyone to bring him bad news."
The U.S. Centers for Disease Control is working on new guidelines for infected health care professionals, but a preliminary draft seemed to reject any mandatory testing, favoring voluntary testing.
Mr. Schaefer said he wanted to pursue mandatory testing in a May 24 news conference where he registered his displeasure with the AIDS Advisory Council in the wake of revelations that two dentists who had treated inmates at the Maryland Penitentiary had died of acquired immune deficiency syndrome. The dentists were employed by the prison system's medical contractor.
"I'm very unhappy, not as happy as I should be with my own AIDS commission, and I expect to reappoint another commission," he said. "I'm going start over again. I'm going to appoint some, reappoint others.
"I want to protect the rights of people," Mr. Schaefer said. "I'm very concerned over the general public. Treatment. What are we doing about treatment? What's the cost? Are we doing enough about education?
"They don't think it's a serious problem. Maybe the educational program is not serious enough. I'm just not satisfied with what we're doing.
"My dentist wears gloves and a mask. I walk in, and he looks like a mummy. I feel very secure. But if he starts grabbing my gums and pulling them aside with his bare hands, I'd be very nervous," he said.
Although the governor is on a trade mission in the Far East, his office sent letters on Tuesday notifying the 4-year-old AIDS council's 22 members that he was eliminating it. And yesterday, the administration announced that Dr. Richard T. Johnson, chief of neurology at Johns Hopkins University School of Medicine, would head the new panel, to be called the Governor's Council on HIV Prevention and Treatment. Human immunodeficiency virus (HIV) is the virus that causes AIDS.
Dr. Johnson is out of the country and could not be reached for comment.
Mr. Schurick said Dr. Johnson wanted a hand in naming members of the new council and that it could include some from the old panel.
Mr. Schaefer appointed some of the state's acknowledged AIDS experts to the original council but frequently rejected their advice. The governor and his advisers often seemed split by philosophical differences -- the council most interested in better services for AIDS sufferers, the governor most intent on protecting the uninfected. The governor rejected the group's proposals to spend more on services for AIDS patients and to introduce laws protecting the confidentiality of people who test positive for the AIDS virus.
Yesterday, some members said they saw the handwriting on the wall a few weeks ago when Mr. Schaefer told reporters that he wanted AIDS-antibody testing for health care professionals working under contract for the state.
"We have consistently, for years, tried to debunk the myth that testing is answer to everything," Mr. Decker said. "People like the governor want to believe that's the easy way out."
At the same time, he said, the governor has shown little interest in reports about AIDS sufferers who lack services or crowded clinics.
"Unfortunately, this is a governor who doesn't like the disease, who doesn't want to deal with it and wants it to go away," Mr. Decker said. "While I don't like it, there's a reality question here. And it's an expensive disease, and it is going to continue to be, and that doesn't fit into the governor's budget."
Dr. John P. Johnson, who runs the pediatric AIDS clinic at the University of Maryland Medical Center, said the governor's action surprised him because "there was no discussion or warning of this." But he acknowledged that the group had lost momentum in recent months. It lacked a chairman and had several other vacancies.
"It's my hope the governor is making a sincere attempt to rekindle the effort to combat AIDS and AIDS infection," Dr. Johnson said. "But I am concerned about the governor's priorities. He did not include patient care as one of his priorities."
Dr. Johnson said the issue of infected health care workers is "an overplayed issue" because the risk to patients is remote.
Dr. Jack M. Zimmerman, chief of surgery at Church Hospital, said he wasn't sure why the governor disbanded the commission although he noted past differences over increased funding for patient care. Disagreement over the testing issue, he said, "was not a big enough issue to warrant just dissolving the council."