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AIDS Experts Point in Different Directions at Hearing on Risk

February 21, 1991

ATLANTA (AP) _ Groups ranging from the American Medical Association to the American Civil Liberties Union told federal officials Thursday that the risk of getting AIDS from a doctor doesn’t warrant mandatory testing of health workers.

The first of two days of hearings on the issue by the national Centers for Disease Control brought out dozens of doctors, medical groups and political coalitions with opinions about what, if anything, should be done in the wake of the discovery that three Florida patients got the AIDS virus from their dentist.

Several groups also took the occasion to blast a CDC draft report containing an estimate of the risk to patients of infected physicians. One called the estimate ″a very large instance of mush.″

The AMA and the American Dental Association have recommended that AIDS- infected practitioners either notify their patients or give up surgery.

″A physician who has a transmissible and fatal disease should not place his or her patients at risk,″ said Dr. Nancy Dickey, an AMA trustee.

But mandatory testing would be overreacting to a very slight risk, she said, adding, ″We should not lose sight of the fact that physicians also have rights.″

″Do patients have a ’right to know?‴ asked Dr. Neil Schram of the American Association of Physicians for Human Rights. ″Because of the infinitesimal risk, we don’t think so.″

Michael Merdian of the National Association of People With AIDS, which opposes mandatory testing, said, ″It’s not the CDC’s job to worry about the ADA, the AMA or the insurance companies.″

The American Federation of State, County and Municipal Employees, the union for 350,000 health care workers, and a half dozen other organizations called for increased safety measures for health care workers to protect both patients and practitioners, instead of testing.

And groups testifying Thursday said the AMA and ADA guidelines leaving it up to the health professional to give up surgery won’t work.

″Failed voluntarism is exactly what caused those three patients to be infected in Florida,″ said Dr. Sanford Kuvin of the National Foundation for Infectious Diseases, which supports testing of doctors and dentists. It also backs lifting the licenses of those with the AIDS virus.

CDC officials listened silently.

″We’ve got open minds,″ Dr. William Roper, director of the CDC, said in an interview. ″We called this meeting for real. It’s a complicated matter.″

Roper said a patient’s right to know whether his doctor or dentist is a threat to his health is ″a fundamental question in medicine, but it’s not a simple question and we really can’t give ... a simplistic answer.″

The CDC will take more testimony on Friday and will receive written comments for 30 days after that before taking any action.

Several organizations blasted the CDC’s draft report estimating the risk of AIDS to patients of infected dentists as somewhere between 1 in 263,000 and 1 in 2.6 million. For patients of infected surgeons, the estimated risk ran from 1 in 42,000 to 1 in 417,000.

The CDC arrived at the figures by multiplying three estimates: propensity for cuts during treatment, subsequent contact with a patient’s wound and the risk of AIDS-virus transmission.

Several specialists said the limited studies on those subjects don’t permit using the data like that.

″I’m here to tell you, they don’t even know what A, B and C are,″ said Dr. Ruth Finkelstein, research director of the watchdog AIDS Action Council, speaking with reporters. ″If we multiply these three instances of mush, we get a very large instance of mush.″

The CDC’s Dr. David Ball conceded there is a lack of data. But he added, ″We believe it’s important to make a rough estimate ... based on the data that are available.″

The CDC’s formula yields a prediction that between 13 and 128 Americans have been infected by surgeons or dentists. But only the three Florida cases have been documented.

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