San Francisco Chronicle (SF); Thursday, July 18, 1991
Jerry Carroll, Chronicle Staff Writer

More than 113,000 Americans have died from AIDS, but it seems Bergalis will be the first to die because of a lifestyle decision previously thought risk-free -- she got her teeth cleaned.

Bergalis, 23, was one of five people infected by Dr. David Acer, a Florida dentist who passed on the disease scraping plaque from teeth or drilling cavi ties. Then he sold his practice and died last year of AIDS, leaving behind questions that don't seem to have very good answers.

In the wake of the Bergalis tragedy, patients are beginning to eye doctors and dentists with a nervousness they didn't feel before. Dr. Morey Filler, a San Francisco obstetrician, was asked by a patient before major surgery a couple of months ago whether he'd been tested for HIV.

"As I poll my peers," he said, "they say they are starting to hear that, too."

Rather than go into a complex explanation about how somebody tested for AIDS with negative results could have picked up the disease since -- maybe even the very night before -- Filler finesses the problem by simply assuring patients, "I'm not at risk for AIDS."

"You start looking at everything in a new light," said Mill Valley businesswoman Pam Hamilton. "If I was starting with a new doctor, my radar would be more finely tuned. I'd be looking for different signs, signs of gayness. When you go into a doctor's office, you're putting your faith at his doorstep. So you have to become a little wary."

Her fears are misplaced, say experts. A study by Dr. Albert Lowenfels, a medical professor in New York, concluded that for every hour of a surgical procedure conducted by a doctor with HIV, the chance of a patient's getting the disease is one in 48,000. If all surgeons are included, the chance of catching AIDS from an hour under the knife are one in 11 million.

The odds of a patient getting it from dentists are said to range from one in 263,000 to one in 2.6 million.

Those numbers put the chances of getting AIDS in the range of getting hit by lightning or winning the lottery. That having been said, it must be admitted that a few people get hit by lightning every year and somebody wins a lottery jackpot almost every week.

Was Acer an apprentice mass- murderer or merely sloppy? Some in the health-care field find the first possibility the likeliest, given his victim toll. So far, those patients are the only people to become infected from a doctor or dentist.

An investigation showed Acer didn't wear gloves, sterilize instruments between patients or use the other standard methods to prevent the spread of infection.

'UNBELIEVABLY LAX'

"He infected patients," said Mark Madsen of the California Medical Association, "not because he was a doctor or dentist per se, but because he was incredibly, unbelievably lax in infection control guidelines, so much so one can question whether it was intentional."

If HIV-positive doctors and dentists were sources of infection, there would be a solid record of patient infections scattered across the country, instead of the single cluster in Florida, he said.

Bergalis, although forgiving Acer in the belief that AIDS had broken his mind, elected not to go quietly into the night. In a letter to Florida health officials, Bergalis gave an accounting of the long inventory of excruciating symptoms that have dogged her from 1989 down to her last days.

"Whom do I blame?" she wrote in a letter to Florida health officials who knew about Acer's medical condition and did nothing. "Do I blame myself? I sure don't. I never used IV drugs, never slept with anyone and never had a blood transfusion. I blame Dr. Acer and every single one of you bastards."

Her point was that the public should be protected from doctors, dentists, nurses and other health-care professionals who are HIV-positive or suffering from full-blown AIDS. Her anguish touched a chord throughout the country.

Other cases came to light, including a Minneapolis doctor with AIDS who continued seeing patients, even delivering babies, although his arms were so covered with oozing sores it looked as if he had third-degree burns. Another doctor in the same practice revealed that he also had AIDS, and letters were sent to hundreds of horrified patients advising them to be tested for the disease.

KAISER AIDS DEATHS

Then Kaiser Permanente revealed that four of its physicians had died in recent years from AIDS, opening four hotlines to take calls from panicky patients. More than 1,600 telephoned, a third of whom accepted offers to be tested for AIDS.

Because Kaiser employs its own physicians, it retains those kinds of records. Other health- maintenance organizations, like Bay Pacific, contract with doctors and would hear only indirectly, if at all, if one died of AIDS.

It's one of those problems society must fumble with despite a sinking feeling that nothing in the way of a good solution is in the cards. Polls show the public favors mandatory testing of health-care workers by huge margins.

This approval comes in the face of experts who say it would be prohibitively expensive, ravage a system already shorthanded and do little to lessen the threat of AIDS transmission.

The most recent Gallup Poll showed Americans by a 9-1 ratio favor laws forcing doctors and dentists with AIDS to tell their patients. Yet it showed that 65 percent of those polled would switch to another doctor or dentist if they were told this, hardly an incentive for candor.

Dr. Eric Treselner, a Bay Area radiologist, said a Dallas clinic changed its mind about offering him a job. "When they found out I was gay -- it was basically me telling them -- they became very apprehensive."

First the clinic told Treselner that he'd have to take an AIDS test every six months, then they "asked me not to come." He's now weighing job offers from two Santa Clara County medical practices.

"When you have someone like Kimberly who becomes a symbol," said Beverly Hayon, a Kaiser spokeswoman, "it's very difficult to dissuade the general public from their scariest prejudices, even though the facts completely contradict what they may be feeling."

U.S. Representative William Dannemeyer, a conservative Republican from Orange County, recently introduced legislation he named for Bergalis requiring AIDS testing for health-care workers. A spokesman for Dannemeyer conceded that the measure hasn't got a chance of getting out of committee, much less being approved.

"After he's elected to the Senate next year it'll be another story." In the Republican primary Dannemeyer is expected to contest Senator John Seymour, who was appointed to succeed Governor Pete Wilson in the Senate.

AMA'S POSITION

The American Medical Society and the American Dental Society recommend that doctors and dentists who are HIV-positive refrain from performing invasive procedures that carry a higher risk of spreading the disease, low as that risk may be in actuality.

An invasive procedure is one in which there is a possibility of the exchange of body fluids, such as during surgery. Or doctors should make sure that patients are told about their condition so they can decide whether to see somebody else.

"It's a realistic approach to an epidemic," said Dr. Raymond Scalettar of Washington, D.C., a member of the AMA board of trustees. "It reflects the fact that there is a tremendous concern about the possibility of a doctor transmitting disease to a patient, even though the reverse is even more likely."

The AMA guidelines hold that a doctor or hospital should have the right to test a patient for HIV "with informed consent." Failing to get that consent, they should still provide treatment but assume the patient is HIV-positive and take suitable precautions.

"I'm getting calls from HIV- negative doctors who can't get jobs because people are afraid they're HIV-positive," said Ben Schatz, a lawyer who is president of the American Association of Physicians for Human Rights.

"I'm getting calls from physicians who are in noninvasive practices whose partners are forcing them out of the practice, from medical residents who are being restricted and are in limbo."

"People have to understand," said Schatz, "that we're seeing the beginning of a McCarthy-era witch-hunt. One of the ironies is that the people who do restrict their practice (to eliminate invasive procedures) are being rewarded by being sued. The AMA and ADA may issue elegant statements and walk away, but thousands of lives are left in ruins."

The ADA has launched what it calls the most important public- education program in its 132-year history. It urges patients to become more aggressive about asking what precautions are being taken to protect patient safety.

HIV-infected health workers should not perform heart surgery, abdominal and gynecological procedures or pull teeth, the Health and Human Services Department said in new guidelines released Monday. They also apply to those suffering the most virulent form of hepatitis B.

QUESTIONS FOR PATIENTS

The ADA recommends that patients check the following in a dentist's office: Do staff members wash their hands each time they enter the examination room? Is every staff member wearing gloves? Do they put on new gloves each time they enter the room and remove them when they leave? Do they wear protective eye wear and masks? What kind of disinfectant and sterilization process do they use and how are needles and other infectious waste disposed of?

"In this day and age," said an ADA spokesman, "people are going to have to take a more active role in health care. But a lot of people will take more time researching how to buy a TV set."

CAPTION: PHOTO (3)

(1) Kaiser has a special container for disposing of used needles./BY MICHAEL MALONEY/THE CHRONICLE, (2) Obstetrician Morey Filler wears the protective gear that he puts on before performing surgery at California Pacific Medical Center. 'I'm not at risk for AIDS,' he assures patients who ask./BY SCOTT SOMMERDORF/THE CHRONICLE, (3) Dr. Keith Flachsbart checks his sterile gloves in a cardiovascular operating room at Kaiser Hospital./BY MICHAEL MALONEY/THE CHRONICLE

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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