When Your Doctor Has AIDS

By Christine Gorman

Surely there are only a handful of people in the U.S. who have not heard about or witnessed on television the suffering of Kimberly Bergalis -- the 23- year-old Floridian who contracted AIDS from her dentist. Her anguished letters and poignant testimony before Congress have sparked a nationwide campaign, endorsed by the Centers for Disease Control (CDC), to test health- care workers for HIV and inform their patients if they are infected.

But last week the New York State health department decided to put Bergalis' plight into perspective. She is but one of 1 million HIV-infected Americans and one of only five ever to have been infected by a health-care worker -- all five by the same dentist. These facts, state health officials concluded, did not merit what they saw as a witch hunt to track down and expose every health- care worker who carries the deadly virus.

Rejecting the emotionalism surrounding the Bergalis case as well as the , Federal Government's response to her highly unusual predicament, New York proposed its own set of guidelines governing the lives of infected doctors and their patients. By charting an independent course, the state, which leads the nation in AIDS cases, could lose tens of millions of dollars in federal health-care funds if authorities in the national government determine that New York's rules depart too radically from its own.

In most respects, the state's proposed policy matches that set forth last summer by the CDC. Both urge health-care workers to undergo voluntary HIV tests. Both recommend setting up expert panels to determine, on a case-by-case basis, whether infected health-care workers should continue practicing medicine and what procedures they may safely perform. Where the feds and state part company is over the issue of informing patients about their doctor's health status. Under CDC guidelines, an infected health professional may continue to perform invasive procedures, such as cardiac or abdominal surgery, if he or she informs patients; New York makes no such demand.

Why? Because state health officials are convinced the CDC's requirement will backfire. The state has discovered that hospitals, worried about their liability under the CDC guidelines, have begun to force the resignations of HIV-infected workers, regardless of whether or not they perform invasive procedures. With their livelihoods thus threatened, argues the state, infected doctors have a big incentive to hide their condition from hospital colleagues as well as patients. That, say state officials, will be far more dangerous than protecting the doctors' privacy while formally advising them to refrain from invasive procedures.

Furthermore, state health officials argue, the best way to minimize the remote chance of patients getting HIV from a medical worker is to make sure that strict infection controls are followed. New York is now requiring all health professionals who perform invasive procedures to undergo mandatory training in the latest sterile techniques. Such measures not only protect patients from an infected doctor, they also protect patients from one another by ensuring that instruments are thoroughly decontaminated between uses. Infection control also protects the doctor. In New York City, where 1 in 50 people carries the AIDS virus, and in most other places, doctors have far more to fear from their patients than vice versa.

Dr. Hacib Aoun of Baltimore is one of 40 U.S. health workers known to have ) become infected with AIDS on the job. Like many doctors, he deplores the CDC recommendations and prefers New York State's approach. "The CDC guidelines mean that hospitals will just get rid of their infected doctors no matter what," says Dr. Aoun. "I understand the Bergalis family's pain. I understand it better than anybody else. But their efforts have set AIDS education and treatment in this country back by many years."