AIDS: Putting Doctors to the Test

WASHINGTON. — Washington. -- Should all health-care workers be tested for the AIDS virus? Should tests be limited to those who do invasive work, like surgeons? Should tests be voluntary, or required by the state?

Such questions did not arise in earlier epidemics of serious communicable disease; even the worst of them was not as deadly as AIDS. Fear of it has embroiled doctors, hospitals, patients and now the government in a debate that weighs physicians' right to privacy against patients' asserted right to life.


As the argument rises through the courts, some anti-abortion crusaders are sure to find parallels between it and the fight over whether women have a constitutional right of private choice that outweighs a fetus' right to live. But the similarity is more of terms than substance -- most potential victims of AIDS are already independently functioning human beings.

This week, the Centers for Disease Control in Atlanta recommended that health-care workers who do "exposure-prone" procedures, such as surgeons and dentists, voluntarily take tests for both AIDS and hepatitis B, another blood-transmitted disease. It said those testing positive should stop doing such work unless they have special permission and then advise their patients of their illness.


The guidelines eased concerns among many health workers and civil liberties advocates that the government would push mandatory testing. But they further alarmed some patients and parents who maintain that doctors will be unwilling to risk lucrative practices by voluntarily disclosing that they carry AIDS.

Before the Centers for Disease Control recommendation, there already were cases proving both points of view.

On Long Island, a dentist whose death was attributed to pneumonia has left behind 200 or more patients who are now being tested by the state health department to find out whether he had AIDS without telling them, and may possibly have infected them.

Not long ago this would have seemed a hysterical fear -- an official at the disease control center is quoted as saying the risk is "overblown," and no doubt it is. Estimates of the likelihood of patient infection by different health workers range from one in 40,000 to one in 2.6 million. But, while the only documented case of such transmission was from a Florida dentist to five patients, even these long odds suggest that more cases are inevitable.

There are 2 million U.S. nurses, 600,000 doctors, 180,000 dentists and millions of other health-care workers. The Centers for Disease Control reported that as of last month, 6,782 of them had been diagnosed with AIDS, and about two-thirds had died. Earlier it estimated that 300 surgeons and 1,200 dentists were infected.

One of those still living is a young Pennsylvania doctor who had himself tested and found he had AIDS -- and then found that his diagnosis had been recorded in the hospital computer. The hospital went to court for permission to disclose his condition to his patients. Although the hospital has already notified patients that a Dr. "John Doe" has AIDS, he is appealing on grounds that its action invades his privacy and endangers his career.

That example speaks two ways against the government's call for voluntary testing. The doctor volunteered, but the result quickly got out of his control. And his response suggests that he would not have willingly admitted his condition as a way to continue his practice.

But in New Hampshire, another case shows what can happen when a health worker apparently does the right thing by resigning promptly after testing positive for AIDS. The clinic where he worked notified 1,800 patients, asking them to be tested. But according to the Associated Press, it is still trying to find another 250 to 300 -- and though the odds against their having been infected are astronomical, their chances of infection are not zero.


The remote possibility that she or her son might have contracted the AIDS virus this way infuriated one woman who declared that "If I test positive, I will kill the surgeon, I will kill the person who made us have the accident that made us have the surgery, and then I will kill myself." Even after she and her son tested negative, she is campaigning for legislation to require that AIDS-infected health care workers be identified so all patients would realize their risk.

A Gallup poll last month found that more than 90 percent of Americans think they should be notified if their doctor or dentist has AIDS. Significantly, 65 percent said they would quit going to that person if told. That puts the issue squarely before the practitioner, who can see his income disappearing with his health. It is strong evidence against the chance of success for voluntary testing.

Ernest B. Furgurson is a Sun columnist.