San Francisco Chronicle (SF) - TUESDAY July 16, 1991
Sabin Russell, Chronicle Staff Writer

The long-awaited guidelines, announced by Health and Human Services Secretary Louis Sullivan in Washington, D.C., come in response to mounting public concern over the possible risk to patients from contact with health care workers infected by HIV, the virus that causes AIDS.

Sullivan and the CDC recommended against mandatory testing of health care workers, a idea that has gained public support because of the case of Kimberly Bergalis, a 23-year-old woman who is near death after she and four others apparently contracted AIDS during visits to a Florida dentist.

Although the announcement stressed that there is virtually no risk of infection by health care workers in most medical procedures, the CDC acknowledged that there is a "small risk" in certain surgeries.

Dr. James Curran, director of the CDC's Division of HIV and AIDS, said yesterday that the recommendations would cover "most major medical and dental surgeries." The CDC yesterday called on the medical profession to draw up lists of such operations. It suggested as examples abdominal, gynecological and heart surgery, as well as root canals and pulling teeth.

Such procedures pose a greater risk of a doctor nicking a finger with a knife or needle and mixing infected blood with the patient's. Curran said that "well over 90 percent of health care workers are not involved in categories that would be called 'exposure prone."'

A report by the CDC in February concluded that the theoretical risk that an HIV-infected surgeon could infect a single patient during a seven-year period could range as high as 8 percent. The report also said that in certain unspecified specialties, the risk of infecting a single patient during an HIV-infected surgeon's career ranged as high as 18 percent -- about one in five.

The CDC has said that there are 336 surgeons and 1,248 dentists in the United States who are infected with the AIDS virus.

Dr. Julie Gerberding, director of San Francisco General Hospital's HIV counseling and testing service, said the earlier CDC report greatly exaggerated the risk of patient-to-surgeon infections. She called the new CDC guidelines "the best compromise" that could be justified on scientific grounds while responding to the groundswell of public fears.

Ben Schatz, an attorney for the American Association of Physicians for Human Rights, said he was "appalled" by the CDC announcement, which he fears will promote a "witch hunt against HIV-infected health workers."

Schatz said that although the guidelines are voluntary, "they will be looked to by the courts to establish legal standards to which doctors and dentists are held." Driving HIV-infected health care workers out of their jobs, he warned, will have far greater public health consequences than any theoretical risk of infection.

A recent Gallup Poll commissioned by Newsweek magazine found that 94 percent of Americans surveyed believe that all doctors should be required to tell patients whether they are infected.

Yesterday's voluntary guidelines apply both to health care workers infected with HIV and those infected with Hepatitis B, which is believed to be nearly 100 times as infectious as the virus that causes AIDS. The guidelines essentially call on doctors to take the same precautions if they are infected with HIV as they would if infected with the easier to catch Hepatitis B.

Mark Madsen, director of physician education for the California Medical Association, praised the CDC yesterday for making the distinction between most medical tasks and those that could be deemed exposure prone. "These guidelines are very similar to the California Medical Association guidelines," he said.

Dr. Mervyn Silverman, president of the American Foundation for AIDS Research, called the CDC guidelines "a very balanced approach to a very complex and difficult problem." He added that he hopes the guidelines will reassure the American public of the safety of medical procedures. "Hopefully this will prevent what seemed like an inexorable slide toward irrational legislation," he said.

Senator Jesse Helms, R-North Carolina, is expected to introduce legislation this week that would impose a 10-year prison sentence and a $10,000 fine for any HIV-infected health care worker who treats a patient without first disclosing the infection.

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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