How do you make sure that doctors, dentists and other health-care workers infected with the AIDS virus don`t pass the deadly infection on to their patients?
You ask them nicely, the American Medical Association`s policymakers said, in essence, in June. They voted that health-care workers who think they might be infected should have themselves tested, please, and those who are HIV-positive should voluntarily stop doing invasive procedures unless their patients are informed and consent.
Last Monday, the Centers for Disease Control, after stalling for months, also decided on an ask-nicely approach. The CDC recommended voluntary testing of doctors, dentists and other health-care workers who do what it calls
”exposure-prone” procedures. Those found to be infected with HIV are urged to stop doing such work unless they have the approval of an expert review panel and their patients are notified.
But the U.S. Senate hasn`t been in a mood to ask nicely. On Thursday, by a vote of 81 to 18, it approved a proposal by Sen. Jesse Helms to impose a prison term of at least 10 years and a fine of up to $10,000 on doctors, dentists and other health-care workers who know they are infected and continue performing invasive treatments without telling patients.
Senators then passed, by 99 to 0, a second measure, backed by Senate leaders, that would require states to adopt the CDC`s guidelines within a year or lose millions of dollars in federal Public Health Service grants. Health-care workers who fail to comply would be subject to discipline by the state`s licensing agency and could lose their licenses to practice. Bush administration officials support this bill.
So much for asking nicely.
The Senate tacked its measures onto a multi-purpose appropriations bill that the House has already approved without the AIDS provisions. A conference committee is expected to work out the differences.
The Helms penalties aren`t likely to survive in the final version of the bill because the Bush administration has already agreed to accept the less stringent provisions. But legislators with their eyes on public-opinion polls know the vast majority of American people aren`t willing to trust in voluntary compliance and, despite valid objections, want tight, mandatory controls on HIV-infected health-care personnel.
Opponents of non-voluntary regulations say that although 6,436 health-care workers are reported to have full-blown AIDS, only one-the Florida dentist who infected five patients-is known to have passed on the virus in the course of treatment. Scrupulous use of universal protective measures should prevent the virus from spreading, health officials insist-except, perhaps, in the case of accidental needle-sticks or scalpel nickings during invasive procedures. Besides, they add, testing isn`t a total protection; a person may be infected-and infectious-for as long as six months before the standard HIV test registers as positive. It is not clear how often repeat testing should be required.
But a case can no longer be made for just asking HIV-infected health-care workers nicely not to take risks with their patients` health, while allowing them to protect their jobs and their privacy. Several cases have now been reported in which dentists and doctors who must have known they had full-blown AIDS have continued to perform invasive procedures. After they died from AIDS, their patients have been offered HIV testing-a sad substitute for the protection these patients should have had.
(The Illinois General Assembly this week passed legislation requiring the state to notify the patients of a health-care worker who may have exposed them to the AIDS virus-again doing nothing directly to prevent the danger of exposure. Health-care personnel are also to be warned about patients who have AIDS. But the state does not know the identities of people who are infected with HIV but do not yet have full-blown AIDS. So whatever protection this legislation provides will be very limited.)
The Helms legislation with its prison terms and fines is unnecessarily harsh. The compromise measure makes more sense. Revoking a health-care worker`s license to practice is an appropriate penalty and does help protect patients.
Granted, the Senate has acted largely in response to public-opinion polls and exaggerated fears of the risks imposed by HIV-infected health-care workers. But politics and pressure groups have long interfered with efforts by public health officials to combat the AIDS epidemic. Maybe it`s time politics provided some help for people who are not yet infected with HIV and are trying to protect themselves from it.
