The HIV-Infected Health Care Professional: Public Policy,Discrimination,and Patient Safety

Gostin L. , “HIV-Infected Physicians and the Practice of Seriously Invasive Procedures,” Hastings Cen. Rep. 1989; 19(1):32–39.

Centers for Disease Control Consultants Meeting, Prevention of Transmission of Bloodborne Pathogens to Patients During Invasive Procedures, August 13–14, 1990, Atlanta.

Nesland V. Matthew G. Curran J. , “The Role of CDC in the Development of AIDS Recommendations,” Law, Med. & Health Care 1987, 15:73–79.

Gostin L. , “Physicians and AIDS” (letter), JAMA 1990; 264:452–453.

Centers for Disease Control, “Possible Transmission of Human Immunodeficiency Virus to a Patient during an Invasive Dental Procedure,” MMWR 1990, 39:489–493.

Altman L. , “U.S. Health Officials Link Dentist with Two More AIDS Infections,” N.Y. Times, Jan. 13, 1991, p. 17 (at the time of writing, these cases were not officially confirmed by the CDC).

Altman L. , “AIDS-Infected Doctors and Dentists Are Urged to Warn Patients or Quit,” N.Y. Times, Jan. 18, 1991, A-18.

Kobren G. , “Hopkins Seeks Law Forcing Disclosure,” L.A. Times, Dec. 6, 1990, 1A; Cimons M. , “U.S. ‘Leaning’ toward Plan to Test Surgeons for AIDS: Carriers Would Be Barred from Surgery,” L.A. Times, Dec. 6, 1990, 1A; Kobren G. Marbella J. , “Hopkins to Alert Patients of Doctor Who Died of AIDS,” The Sun (Baltimore), Dec. 2, 1990.

Mandelbrot D.A. Smythe W.R. Norman S.A. Martin S.C. Arnold R.M. Talbot G.H. Stolley P.D. , “A survey of Exposure, Practices, and Recommendations of Surgeons in the Care of Patients with Human Immunodeficiency Virus,” Surgery, Gynecology & Obstetrics. 1990, 171:99–106.

Lewis C.E. Montgomery K , “The HIV Testing Policies of U.S. Hospitals,” JAMA 1990, 264:2764–2767. See Brandt A. Cleary P. Gostin L. , “Routine hospital testing for HIV: Health policy considerations,” in Gostin L. (ed.) AIDS and the Health Care System, 125–142, New Haven, Yale University Press, 1990.

See Generally, Rhame F.S. , “The HIV-Infected Surgeon,” JAMA 1990, 264:507–508; Goldsmith M.F. , “CDC Ponders New HIV Guidelines,” JAMA 1990, 264: 1079; Peterson L. , “AIDS: The Ethical Dilemma for Surgeons,” Law, Med. & Health Care 1989, 17:139–144.

Altman L. , “AIDS-Infected Doctors and Dentists Are Urged to Warn Patients or Quit,” N.Y. Times, Jan. 18, 1991, A-18.

Marshall P.A. O'Keefe J.P. Fisher S.G. Caruso A.J. Sardukowski J. , “Patients' fear of contracting Acquired Immunodeficiency Syndrome from patients,” Arch. Intern. Med. 1990, 150:1501–1506.

Gerbert B. Maguire B.T. Hulley S.B. Coates T.J. , “Physicians and Acquired Immunodeficiency Syndrome: What Patients Think about Human Immunodeficiency Virus in Medical Practice,” JAMA 1989; 262:1962–1972; Gerbert B. Maguire B.T. Spitzer S. , “Patient's Attitudes toward Dentistry and AIDS,” J. Am. Dental Assn. 1989, November: 16S–21S.

See, St. Louis M.E. Rauch K.J. Petersen L.R. , “Seroprevalence Rates of Human Immunodeficiency Virus Infection at Sentinel Hospitals in the United States,” NEJM 1990, 323: 213–218.

Frederick Precourt v. 595 F.2d 654 (D.C. Cir. 1978).

See Williams W.W. , “Guideline for Infection Control in Hospital Personnel,” Infection Control, 1983, 4 (Suppl)8 326–349, reprinted by the U.S. DHHS, CDC.

Gostin L. Porter L. Sandomire H. , The AIDS Litigation Project: A National Review of Court and Human Rights Commission Decisions, Washington, D.C.: U.S. Government Printing Office, 1990.

Doe v. Washington University Sch., Mo. Cir. Ct., St. Louis; AIDS Litigation Rptr. 12/23/88 and 2/10/89.

Id.

Laredo v. SW Community Health Service, U.S.D.C. N.M. August 1987.

Rhodes v. Charter Hospital, S.D. Miss., AIDS Lit. Rptr. 03/10/89; J.V.A. Medical Center, NYS Division on Human Rights, 1988.

Mark Bible v. Mother Francis Hospital, U.S.D.C. E.D. Tex., 1987.

Gordon v. Blanchard, Super Ct., LA Cty, AIDS Lt. Rptr. 05/13/88.

Hartford Hospital Nurses v. Hartford Hospital, Super. Ct. Hartford, Conn, 6/19/87; Dept. of Health and Human Services v. Charlotte Memorial Hospital, DHHS No. 64-84-3096, 8/5/86.

Altman L. , “AIDS Testing of Doctors is Crux of Thorny Debate,” N.Y. Times, Dec. 27, 1990, A1, A17.

Armstrong F.P. Miner J.C. Wolfe W.H. , “Investigation of a Health Care Worker with Symptomatic Human Immunodeficiency Virus Infection: An Epidemiologic Approach,” Military Medicine 1987, 152:414–418; Sacks J.J. , “AIDS in a surgeon” (letter) NEJM 1986, 313:1017–18; Klein R. Phelan J. Freeman K. , “Low Occupational Risk of Human Immunodeficiency Virus Infection among Dental Professionals,” NEJM 1988, 318:86–90; Mishu B. Schaffner W. Horan J.M. Wood L.H. Hutcheson R.H. McNabb P.C. , “A Surgeon with AIDS: Lack of Evidence of Transmission to Patients,” JAMA 1990, 264:467–470.

Glover v. Eastern Nebraska Community Office of Mental Retardation, 686 F. Supp. 243 (D. Neb. 1988), aff'd 867 F.2d 461 (8th Cir. 1989). In any event, patients cannot expect a 100% risk free environment. They can reasonably expect only that risks are kept as low as reasonably can be achieved, consistent with good care and protection of human rights.

The effect on high prevalence states such as New York could be very serious. See letter from Rango N. Burke G. Barnes M. Chiarello L. (N.Y.S. AIDS Institute) to James Curran (CDC) Sept. 24, 1990.

Nuland V. , op. cit.

Centers for Disease Control, “Recommendations for Prevention of HIV Transmission in Health Care Settings,” MMWR 1987, 36:2S:3S–18S.

Bell D. , “HIV Infection in Health Care Workers: Occupational Risk and Prevention,” in Gostin L. (ed.) AIDS and the Health Care System, 15–24, Yale University Press: New Haven, 1990.

Cruse P. Ford R. , “The Epidemiology of Wound Infection,” Surgical Clinics of North America 1980, 60:27–40; Hagen M.D. Meyer K. Pauker S. , “Routine Pre-Operative Screening for HIV: Does the Risk to the Surgeon Outweigh the Risk to the Patient?” JAMA 1988, 259:1357–59; Klein R. Phelan J. Freeman K. , op. cit.

Gostin L. , “HIV-Infected Physicians and the Practice of Seriously Invasive Procedures,” Hastings Cen. Rep. 1989, 19:32–39.

See note 27 supra.

See note 38 intra.

CDC, “Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health-Care and Public Safety Workers,” MMWR 1989, 38(5–6): 1–37.

Lettau L.A. Smith J.D. Williams D. Lundquist W.D. Cruz F. Sikes K. Hadler S.C. , “Transmission of Hepatitis B with Resultant Restriction of Surgical Practice,” JAMA 1986, 255:934–937, Hadler S.C. Sorley D.L. Acree K.H. Webster H.M. Schable C.A. Francis D.P. Maynard J.E. , “An Outbreak of Hepatitis B in a Dental Practice,” Annals of Internal Medicine 1981, 95:133–138.

Altman L. , “AIDS Testing of Doctors is Crux of Thorny Debate,” N.Y. Times, Dec. 27, 1989, A-1, A-17 (American Public Health Association, NYS Commissioner for Public Health, David Rodgers, Vice Chair, National Commission on AIDS).

See Association for Practitioners for Infection Control, Position paper: “The HIV-Infected Health Care Worker,” APIC 1990, 18:371–381 (workers with any infection carried in the blood should avoid procedures epidemiologically linked to transmission).

Cloren M. , “A Call for Mandatory HIV Testing and Restriction of Certain Health Care Professionals,” St. Louis Public L. Rev. 1990, IX:421–438.

See Field M. , “Testing for AIDS: Uses and Abuses,” Am. J. L. & Med. 1990 XVI: 33–106.

Cleary P. Barry M. Mayer K. Brandt A. Gostin L. Fineberg H. , “Compulsory Premarital Screening for the Human Immunodeficiency Virus: Technical and Public Health Considerations,” JAMA 1987, 258:1757–62; Gostin L. Cleary P. Mayer K. Brandt A. Chittenden E. , “Screening Immigrants and International Travelers for Human Immunodeficiency Virus,” NEJM 1990:1743–46.

CDC, “Public Health Service Guidelines for Counseling and Antibody Testing to Prevent HIV Infection and AIDS,” MMWR 1987, 36:509–515.

Gostin L. , “Public Health Strategies for Confronting AIDS: Legislative and Regulatory Policies in the United States,” JAMA 1989, 26: 1621–29.

Edgar H. Sandomire H. , “Medical Privacy in the Age of AIDS: Legislative Options,” Am. J. L. & Med. 1990, XVI:155–222.

CDC, supra note 44.

480 U.S. 273 (1987).

Letter from Conrad K. Harper, President of the Assn of the Bar of NYC to Roper William L. , Director of the CDC, Nov. 26, 1990.

Arline at 277.

H.R. Rep. No. 485, 101st Cong., 2d Sess., pt. 2, at 56 (1990). See. H.R. Rep. No. 485, 101st Cong., 2d Sess., pt. 3, at 45 (1990).

H.R. Rep., pt. 2, at 56–7.

Strathie v. Dept. of Transportation, 716 F.2d 227 (3d Cir. 1983) (Dept. of Transportation regulation found in violation of the Rehabilitation Act because it treated disabilities of similar magnitude differently.)

Leckelt v. Hospital District, 714 F. Supp. 1377 (E.D. La. 1989) aff'd 909 F.2d 820 (5th Cir. 1990).

Altman L. , “New York Won't Tell Doctors with AIDS to Inform Patients,” N.Y. Times, Jan. 19, 1991, p. 1, 34.