Bucking an emotional national crusade, New York decides not to force physicians to tell their patients

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."

Culture

AIDS- acquired immune deficiency syndrome; a deadly disease caused by HIV (human immunodeficiency virus)

Centers for Disease Control (CDC) - federally supported medical research facilities located in Atlanta, Georgia

fed- an official of the federal government. The word is slang, usually plural, and sometimes has a negative connotation.

witch hunt- an extremely emotional investigation in which innocent people are harmed and/or harassed. The phrase refers to the Salem (Massachusetts) witch trials of the 1600s, in which women were accused of being witches.

Vocabulary

backfire - to end in the opposite way of what was planned

buck- to resist or go against something

case-by-case- one-by-one; one at a time

chart a course - to make a plan of action; to choose a direction

incentive- a motive; a reason to do something

part (company) - to disagree

spark- to begin

track down-to search for and find

1. Why do you think people use acronyms like AIDS and abbreviations like HIV and CDC? What is the difference between an acronym and an abbreviation?