Newsday - June 16, 1992
Laurie Garrett
Health and Human Services Department lawyers have rejected proposed federal guidelines for health-care workers infected with the AIDS virus, negating more than two years of work marked by contentious hearings and intense lobbying.
Last year Congress ordered creation of clear federal guidelines aimed at protecting the public from exposure to HIV in a health-care setting and required that all states meet those standards by Oct. 1 of this year. The department's rejection of the draft guidelines creates serious doubt whether most states will be able to meet that deadline.
Dr. James Mason, director of the U.S. Public Health Service, worked over recent weeks with representatives of the National AIDS Commission and the Centers for Disease Control to draft standards, and passed them on to Health and Human Services Secretary Louis Sullivan's office for approval. There, according to departmental spokesman William Grigg and National AIDS Commission member Dr. David Rogers, the guidelines were rejected by general counsel Michael J. Astrue, who said they would not satisfy the congressional mandate.
Astrue said in an interview that the proposed regulations would have put too many decisions in the hands of local officials - decisions his office felt Congress had ordered the Centers for Disease Control to make.
"I am convinced they are using this legal excuse as a total subterfuge," Jeffrey Levi, executive director of the AIDS Action Coalition in Washington, D.C., said.
Levi charged that election year politics prompted the department to find a way to avoid taking a clear position on issues that have sharply polarized members of Congress and the public. Astrue said only that "everyone knew this was an election year."
Ever since experts determined that Florida dentist David Acer had infected five patients, tempers have flared in discussions of standards for control of HIV-positive health-care workers.
According to Rogers, who was closely involved in every stage of drafting the new regulations, the guidelines rejected by the general counsel "were still not what they should be" and would have entailed more restriction than seems warranted by what's known about HIV transmission.
The disease centers' director, Dr. David Roper, is considering mailing a letter this week to state health directors suggesting they try to follow recommendations issued by the agency a year ago, agency spokesman Kent Taylor said.
But those guidelines were considered unworkable by many states, including New York, because they make local medical boards and hospitals decide which "dangerous invasive procedures" practitioners with HIV should avoid to protect their patients from getting the virus.
"Could you imagine 50 states? If the CDC can't do it [define invasive procedures] after two years, how can each of the states do it by October 1? How can they come up with anything but atrocious guidelines?" asked Dr. Neil Schram, of the American Association of Physicians for Human Rights.
Harvard University law professor Lawrence Gostin, a lawyer and director of the American Society for Law and Medicine, said that in turning regulation over to the states, the federal department could be making "a very big mistake. The whole purpose of having the CDC come up with regulations is to make sure states don't pander to local constituencies and victimize HIV-positive health-care workers."
Last month, New York issued the most detailed regulations in the nation, under which health care workers' rights to confidentiality and job protection are ensured. To protect the public, the regulations mandate regular training in infectious disease control measures for all health-care workers, and institute a confidential state review board procedure for HIV-positive providers who want advice about how to limit their practices and protect their patients. The regulations are now before the state Legislature for ratification.
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