TIME: Almanac 1993/TIME Almanac 1993.iso/time/011491/0114130.000

Text File | 1992-08-28 | 6.0 KB | 126 lines

                                                                                HEALTH, Page 57

When the Doctor Gets Infected


Medical workers who harbor the AIDS virus may face new rules

By ANASTASIA TOUFEXIS -- With reporting by Lee Griggs/San
Francisco and Dick Thompson/Washington


    Many patients are eyeing their doctors and dentists with
growing suspicion these days. The anxiety stems from reports
of medical professionals' dying of AIDS and, most alarmingly,
of a woman who claims to have been infected with the virus by
her dentist during a tooth extraction. Amid the swelling
concern and hyped press, the Centers for Disease Control is
considering a controversial shift in policy that for the first
time would recommend restrictions on health-care workers
infected with the AIDS virus.

    No one knows how many medical professionals harbor the
blood-borne pathogen. But of the 153,000 reported cases of
AIDS, about 4% have involved health-care workers, including
1,199 nurses, 679 physicians and 156 dentists and hygienists.
Current CDC guidelines suggest that infected workers consult
with peers about what duties to perform and that clinics and
hospitals decide on a case-by-case basis what restrictions to
impose in accordance with their state's rules and policies.
Generally, HIV-infected staff members are allowed to practice
freely as long as they follow standard infection-control
techniques.

    The revised guidelines under consideration are primarily
aimed at the doctors, dentists, nurses and technicians who
perform invasive procedures that require putting a hand holding
a sharp instrument inside the body, a definition covering most
surgical and dental activities. These operations carry the
greatest risk of exposure to contaminated blood. The proposals
call for such workers to be tested for HIV infection and, if
they prove positive, to refrain from performing invasive
procedures unless they have the informed consent of the patient
or are faced with an emergency. The new policy would be
voluntary, but medical institutions, already skittish about
potential lawsuits, could be expected to pressure their staffs
to submit to testing and dismiss those who turn up positive.

    The possibility of widespread HIV testing, bruited about for
months, has stirred fierce opposition. The American Public
Health Association, civil liberties groups and unions
representing medical workers contend that a policy change at
this time is misguided and scientifically unjustified. "The CDC
is not focusing on public health," declares Ruth Finkelstein
of the AIDS Action Council, a watchdog group. "It is focusing
on public relations. The issue is being framed as one in which
doctors are being irresponsible. The fact is that the public
health risk from infected medical professionals is
infinitesimal."

    Several studies have tracked the patients of AIDS-infected
doctors and dentists, but to date there has not been a single
confirmed case of the virus' being transmitted from a
health-care worker to a patient. The Florida incident involving
Kimberly Bergalis, 22, who allegedly acquired the virus from
her dentist, is still open to question. Federal investigators
have not determined how she was exposed to the dentist's blood.
Even if the Bergalis case is an instance of doctor-to-patient
transmission, the risk is minute when compared with other
medical dangers. Says Dr. Julie Gerberding, director of HIV
prevention at San Francisco General Hospital: "The chance of
a patient's dying from HIV infection from the care providers
is many times less than the risk from hospital staph infection,
anesthetic complications or treatment by an inexperienced
surgeon."

    In fact, there is a much greater chance of a medical
worker's being infected by a patient than the reverse. So far,
40 such cases have been documented. Doctors and nurses
routinely suffer needle sticks and scalpel nicks that expose
them to patients' blood. If the new guidelines force health
professionals to be tested for AIDS infection, it would seem
only fair to test patients as well, a move that has been
rejected by the general medical community as too intrusive and
costly.

    Firing infected doctors and nurses would destroy their
reputations and livelihoods, even though they pose little risk
to their patients. Such actions could thus provoke legal
challenges. State laws and the Americans with Disabilities Act
passed by Congress last year protect workers from
discrimination based on handicaps that are not a significant
threat to others.

    Patient care would suffer too if infected workers are driven
from practice. And what is a hospital to do every time an
uninfected nurse or doctor suffers a scalpel cut? It can take
six months or more for the AIDS virus to show up in tests. "Do
they sit out those months?" asks Mark Barnes, policy director
of the AIDS Institute, a branch of New York State's department
of health. "In large urban settings you could have half the
surgical staff waiting it out."

    Critics argue that the best way to protect patients and
medical workers is to improve infection-control techniques and
equipment, something that is needed to guard against not only
AIDS but also other potentially deadly blood-borne illnesses
like hepatitis B. Basic precautionary measures call for workers
exposed to contaminated blood to wear gowns, masks and latex
gloves and to discard used syringes in special containers.
Medical personnel would like to see continued development of
needles that automatically sheathe themselves once they are
withdrawn from the skin and flexible scalpels that minimize the
chance of accidental cuts. Some operating-room teams have begun
to wear protective space-suit-like outfits. Cost: $575 each.

    The goal of a revised CDC policy is commendable enough: to
rebuild the trust necessary between doctors and patients. But
the agency may be in danger of overreacting. Pandering to fears
rather than presenting facts is no way to cure public hysteria.