San Francisco Chronicle (SF); Friday, October 18, 1991
Sabin Russell, Chronicle Staff Writer

California Medical Association president Dr. Howard Lang yesterday warned that to develop such a list would send society on a "slippery slope" toward segregated medical care for AIDS patients.

"We'll end up with leper colonies where only HIV-infected physicians are treating HIV-infected patients," he said. HIV is the human immunodeficiency virus that leads to AIDS.

The federal Centers for Disease Control had requested that physician groups throughout the country draw up lists of "exposure- prone procedures" by November 15.

Physicians who are known to be infected with HIV were to avoid performing such surgeries unless they cleared them first with a panel of experts and also notified their patients that they have the disease.

But the CMA, whose own staff coined the term "exposure-prone procedures," yesterday said there is no scientific evidence to date that any medical or surgical procedure, with appropriate infection- control precautions, puts patients at risk from HIV-infected doctors.

The organization joined a growing list of medical groups that are rejecting the federal guidelines and defying the CDC request to prepare lists of risky procedures. Last week, New York became the first state to formally reject the guidelines.

Lang denied that his group is backing away from the theory that some surgeries might pose more risk than others.

He said that it will take more research to properly define such surgeries. Current efforts, he said, have found no evidence that surgeries by AIDS-infected doctors pose a special danger.

"The relative risk is so low that we cannot even measure it," said Dr. Merle Sande, director of the AIDS Coordinating Council at the University of California at San Francisco.

Supporting the stand were a coalition of health policy leaders from the UCSF and the city Department of Public Health as well as Dr. George Rutherford, chief of the California Department of Health Services Infectious Disease Branch.

Rutherford said that the state Patient Protection Act passed this year will satisfy anticipated federal rules for states to devise policies to prevent the transmission of blood-borne infectious diseases in health-care settings.

A bill passed by Congress would cut off medical financing to states that fail to comply.

The new California law calls on state licensing boards to enforce infection control guidelines -- such as the use of gloves and rigid sterilization procedures -- as the most effective means of preventing infection by an HIV-infected health-care worker.

The term "exposure-prone procedure" was deleted from earlier drafts of the bill, authored by state senator Mike Thompson, D-Napa.

The federal agency developed its recommendations after finding that Dr. David Acer, a Florida dentist who has since died of AIDS, had apparently infected five of his patients.

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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