State eyes guidelines on doctors with AIDS Md. medical society has task of implementing CDC policy.

The state medical society says it will move forward slowly to take on a leadership role to implement federal guidelines that yesterday urged doctors who perform "invasive" procedures and dentists who pull teeth and do root canals to quit if they become infected by the AIDS virus.

"There are no surprises in the Centers for Disease [Control] guidelines, and I expect everyone will go along with them," Dr. John G. Bartlett, a highly respected Johns Hopkins AIDS expert, said last night.


Bartlett serves as co-chairman of the medical society's AIDS Committee, which will be pulling together the implementation plan that is expected to become "some sort of a standard," he said.

"Whatever plan is developed by the medical society will be offered to hospitals but not necessarily forced on hospitals who may prefer to draw up their own plans," he said. "It wouldn't surprise me if Hopkins had a plan, the state had a plan and Med-Chi had a plan."


The leadership role of seeing that the federal guidelines are put into effect was conferred on the medical society, known formally as the Maryland Medical and Chirurgical Faculty, by the state legislature during its last session, said Dr. David Nagle, Med-Chi president.

Nagle said he is awaiting recommendations from Bartlett and Dr. Frederick Gill of Montgomery County, who head the society's AIDS Committee. Both Bartlett and Gill are infectious-disease specialists.

"The CDC recommendations are right in line with what we have been considering," Nagle said. "We will have to work with the CDC, the Maryland Hospital Association, the state department of health and representatives from the state legislature to come up with a policy."

He said an expert panel would be set up to evaluate infected physicians and set limits on their practice, and Med-Chi might have to seek immunity from the state legislature so panel members could be protected from legal action.

Bartlett described the CDC guidelines as "precise."

"I don't know if anyone knows whether they are correct or not, but at least they tell you what to do," he said. Still, he cited many "vagaries" or "gaps" in CDC's definition of "invasive procedures."

"We're going to have to define what CDC means by invasive," he said. "We're going to have to define who does those invasive procedures and define who has to be tested and decide how often they have to be tested."

The CDC recommendations could affect tens of thousands of doctors and dentists nationwide.


The guidelines urge infected doctors and dentists to refrain from invasive procedures involving blood exposure unless they get permission from a panel of experts and inform their patients.

"Exposure-prone procedures" are defined by the CDC as those in which a health-care worker could be injured -- perhaps with a knife or needle -- and bleed into an opening in a patient, not just on skin.

Examples include abdominal, gynecological, orthopedic or heart surgeries, tooth extractions and root canals.

The CDC stopped short of recommending mandatory HIV infection testing for health care workers and emphasized strict adherence to universal infection-control measures.

Bartlett said, "The CDC has made sweeping statements about invasive procedures with a few examples, and nobody is going to be able to use that comfortably in deciding what procedures can and do not fit, and that's going to take a long time and a lot of energy."

At a December news conference, Johns Hopkins officials said CDC guidelines were "desperately needed." Baltimore became the center of an AIDS scare last winter after Dr. Rudolph Almaraz, a breast surgeon on the Hopkins staff, died of AIDS.


But yesterday, Hopkins refused to react to the CDC guidelines, saying only, "We are very pleased the CDC has issued guidelines that address broadly the question of the HIV-infected health worker. We need to study the guidelines in detail before any changes or additions to policies at Hopkins are made."

Under Hopkins' current policies, health-care workers who become infected with the AIDS virus are urged to report their HIV infection to the head of their department. Each case is evaluated individually.

A second university-affiliated hospital -- the University of Maryland Medical Center -- had no comment on the CDC guidelines.