Miami Herald (MH) - Monday, July 22, 1991
Stephen Smith; Herald Staff Writer

But the rules have caused confusion anew for Florida doctors and hospitals, and stoked the long-simmering debate over the need to test physicians and patients.

"Where do you draw the line?" said Gerry Soud, a spokesman for the Florida Medical Association. "Do you just test health-care workers? Do you test fire-rescue units? Do you test someone who may pierce your daughter's ear?"

And do you test patients? Since 1988, Cedars Medical Center in Miami has asked its patients to take AIDS tests.

Dr. Daniel Seckinger, a physician at Cedars and chairman of the Florida Medical Association's AIDS committee, called the disease a "public health disaster." But, he complained, it has not been treated that way.

"I don't think any civilized person likes to think in terms of 'mandatory,' but if our present posture does not control the spread of the disease, then we have to approach mandatory -- for doctors and patients," Seckinger said. "If we don't control this disease, we're going to be in a lot of trouble."

Dr. Sanford Kuvin figures it this way: Blood donations are tested, military personnel are tested, prisoners are tested. Why not health workers?

Voluntary measures urging testing and disclosure have not worked, said Kuvin, a Palm Beach infection specialist. That has been proved, he said, by the parade of patients seeking blood tests after word seeps out that their doctor or dentist is infected.

"The rock bottom dictum of medicine is do no harm, and universal precautions give a false sense of security because gloves leak, surgeons cut themselves," Kuvin said. "If a 747 goes down, you don't wait for a second one to go down to take steps to prevent it."

The first 747 to go down, Kuvin said, was the case of Dr. David Acer, the Stuart dentist who is believed to have infected Bergalis and four other patients.

"But that doesn't mean you ground all 747s," said Dr. M. Roy Schwarz, a senior vice president of the American Medical Association, which opposes mandatory testing. "It means you go in and evaluate what caused the first one to drop. There are some things in life that the risk is so remote, you just accept it as part of life and go forward."

If pressure grows for the mandatory testing of health workers, the medical establishment is likely to embrace it only if patients are tested, too. Centers for Disease Control research shows that health workers are at far greater risk from patients than patients are from health workers. But the wan, drawn face of Bergalis flickering on TV screens has focused the AIDS war on the medical profession. And that has spawned new questions:

Can this skirmish over the testing of doctors be won by anyone? Or, given the apparently slight risk posed by health workers, is it a waste of time and resources while the epidemic roars on?

"The cost of testing is enormous compared to the benefit," said Dr. Thomas Keys, chairman of the AIDS committee at the Cleveland Clinic Foundation, which runs hospitals in Broward and Ohio. "It's all being blown out of proportion."

The Centers for Disease Control released its guidelines on Monday. By Thursday, the Senate had voted to make them law.

The new guidelines urge doctors to get tested for the AIDS virus, but don't force them to. The guidelines urge doctors to stop performing surgery if they are infected, but don't force them to.

The centers decided against stricter rules, after reviewing reams of evidence suggesting that patients are at little risk of catching the AIDS virus when they go to a hospital for heart surgery or to a dentist's office for a root canal. One study found there was one chance in 416,667 that a patient could get the virus from an infected surgeon.

The federal health agency has a different strategy to prevent the spread of the virus from health workers to patients: wear gloves, gowns and masks, and make sure no blood or body fluids meet those of the patient.

"The message we want to communicate is that the risk is low and for most medical procedures, the risk is zero," Centers for Disease Control spokeswoman Kay Golan said. "We made a decision that mandatory testing of health-care workers was not the answer. Scrupulous adherence to universal precautions, we felt, was the answer."

The new guidelines don't name an enforcer -- there is no AIDS police. But, some experts predict, hospitals and lawsuits will fill the breach.

"You'll see hospitals taking the bull by the horns and saying that if you're going to be engaged in major invasive procedures, if you're going to be involved in gynecological surgery, dental surgery, why not let us facilitate HIV-testing?" said Keys, of the Cleveland Clinic.

Lawyers also could be transformed into enforcers. Kuvin believes hospitals, wary of lawsuits, will make doctors and patients get tested.

But a Broward lawyer who specializes in medical cases believes a lawsuit would not transform the guidelines into firm standards.

"It's a constitutional question," said Walter "Skip" Campbell Jr. "It's the doctor's privacy vs. the patient's right to know. That's the question that has to be answered."

Joyce Stone, a specialist in disease control at Broward General Medical Center in Fort Lauderdale, has one more question: Even if there are tests, what will they really mean?

"If everyone were to be tested today, every doctor, every patient, that would only tell us whether they have the virus today," Stone said. "What would that tell us about tomorrow or next week or the week after that?"

Always watch for outdated information. This article first appeared in 1991. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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