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Governor draws praise, scorn for AIDS-testing plan Most health workers, patients would be given antibodies test

Gov. William Donald Schaefer's plan to require AIDS antibody tests for many health-care workers and patients drew praise yesterday from some state physicians, but others scorned him for feeding widely held misconceptions about the disease.

There was no consensus from health-care professionals. But one thing seemed clear: If it becomes law, Governor Schaefer's proposal would give Maryland the most stringent testing requirements in the nation.

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"This is the first state I know of where the governor has come out for something this strong," said Peggy Rayhawk of the AIDS Policy Center at George Washington University in Washington, which tracks legislation addressing the epidemic.

Although the fine details have not yet been worked out, Health Secretary Nelson J. Sabatini said the governor wants to require AIDS antibody testing of all health-care workers engaged in high-risk procedures -- and of all patients undergoing the procedures.

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The requirement would affect doctors, nurses, dentists and other operating room personnel who come into close contact with a patient's blood, Mr. Sabatini said. Health-care providers who test positive would either have to limit themselves to "safe" procedures or ask a hospital advisory council for permission to continue their practices unchanged.

Infected professionals who get the go-ahead to practice risky procedures would have to disclose their test results to patients, Mr. Sabatini said. Doctors would still be obligated to treat patients who test positive, but would be alerted to the need to use extra caution in protecting themselves from the blood-borne virus.

For months, Mr. Schaefer has publicly stated that he was leaning toward a testing policy that would protect patients from the remote possibility that they could contract the infection from a health professional. But in yesterday's Evening Sun, he was quoted for the first time as saying that he planned to introduce a bill when the legislature convenes in January -- and that he wanted to require testing of patients and doctors alike.

In the coming months, officials with the health department and the governor's office will craft a more precise proposal, answering such tricky questions as which procedures pose a risk of transmission from doctor to patient, or from patient to doctor.

Another thorny issue, he said, is how often a physician should be tested in order to give patients a reasonably up-to-date picture of a doctor's health.

Mr. Sabatini admitted that he and the governor were aware that it often takes months for an infected person to develop the antibodies that will trigger a positive test result. Thus, an infected person can test negative even though he carries the virus -- possibly creating a false sense of security that the patient or doctor poses no risk.

"We recognize it's not an absolute," Mr. Sabatini said. "It's not perfect. The fact of the matter is, both health-care providers and patients have a right to know and assess the risk they are facing."

The proposal is more severe than an Illinois bill, approved June 15 by that state's Legislature, that would require infected doctors there to tell patient about their test results. If a doctor refuses, state health officials would have the right to pull patient names out of the physician's records and contact them, themselves.

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That bill, which has not yet been acted upon by Gov. Jim Edgar, would not require patients to be tested.

In Maryland, widespread disagreement was voiced within Maryland's medical establishment and among rank-and-file doctors.

"We cannot let fear dictate what should be a rational and scientific approach to a medical illness," said Dr. David Nagel, president of the Medical and Chirurgical Faculty of Maryland, the state's medical society.

But Dr. Nagel said he supported the governor's proposal despite reservations: "Currently, the risk of passing AIDS from a health-care worker to a patient is minimal. On the other hand, we need to recognize the need to allay the fears of the public."

Government findings that a Florida dentist who died of AIDS last year transmitted the virus to five patients aroused considerable fears over the potential risk faced by patients undergoing dental or surgical procedures. In Maryland, news that a surgeon at Johns Hopkins Hospital died of AIDS in November also drew media and public attention.

But Dr. Richard Johnson, a neurologist who was recently chosen to head the governor's advisory council on AIDS, pointed out yesterday that no one has documented a single case of a surgeon passing the virus to a patient.

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"There's an amazing situation where there are 10 million people infected in the world . . . and there are over 3,000 people with the disease in Maryland, and we're talking about something that's never been reported," Dr. Johnson said.

Mandatory testing is both pointless and dangerous, he contended. Doctors who learn that a patient tests negative could be lulled into a "false sense of security," easing up on infection controls even though the patient could in fact carry the virus, he said.

Dr. John Barlett, chief of infectious diseases at Hopkins, voiced similar concerns, adding: "This is a time when Maryland is cutting back on medical care services to a group that desperately needs help. This policy will do nothing to stop HIV-1 transmission and certainly will not help people who are afflicted."

Elsewhere, some doctors commended Mr. Schaefer for his proposal.

"I believe all indications are that we're moving slowly in this country to testing of doctors and patients," said Dr. Garth McDonald, a heart surgeon at St. Joseph Hospital in Towson. "I would support that movement 100 percent. I don't know why it's taken this long."

Dr. McDonald said he would not refuse to operate on a patient who tests positive, but the test result would alert him to perform surgery with heightened caution.

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"Would I alter my technique dramatically? Probably not. But I do take issue with people who say you ought to be at maximum vigilance 365 days a year, 24 hours a day. Not everyone can do that," Dr. McDonald said.

Dr. Ken Lewis, a cardiologist at Franklin Square Hospital, said AIDS -- unlike any other major epidemic -- has become so politicized that doctors have been barred from taking rational measures to stem the epidemic, such as testing patients and tracking their contacts.

The governor's bill would be a first step toward breaking down those barriers, he said.

"There may be some physicians who feel so strongly about this they would decline to treat a patient," Dr. Lewis said, adding that he would continue to perform such "invasive" procedures as inserting pacemakers whether or not a patient carried the virus. "The majority of people, of physicians, would feel they have an obligation to take care of the individual under their care."

But Dr. William Armiger, a Baltimore plastic surgeon, said: "It is the wrong message to send out at this point that doctors are a potential source of infection."

Testing patients, he said, makes sense because the virus might hamper someone's ability to heal or fight infection. He said a positive test result might be a good reason to pass up an

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"elective" procedure such as cosmetic surgery.


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