Some Surgeons Quit Over Fear of AIDS, Orthopedists Meeting in Anaheim Told

Thousands of health-care workers nationally have been infected with AIDS, and some surgeons, faced with the threat of contracting the disease from patients they operate on, are abandoning their practices, a panel of doctors gathered in Anaheim said Friday.

“I know there are surgeons who are contemplating leaving the field,” said Dr. Lorraine Day, an orthopedic trauma surgeon who stopped practicing about two years ago because she worried about catching the disease from her patients.

“I was told early on the things I was doing in (the operating room) were not dangerous,” she said, adding that she found out later that they “were very dangerous.”

“Even with a surgical mask on, the AIDS virus can go right through the mask,” said Day, who estimated that she operated on hundreds of AIDS patients over a period of five years.

Speaking at an Anaheim press conference organized by the American Academy of Orthopaedic Surgeons, which is holding its annual meeting here this week, Day and other surgeons said there are many ways the HIV virus can pose dangers for doctors in the operating room. These include small pin pricks caused by needles and skin tears, as well as blood and maybe even sneezing, coughing or saliva from an infected patient.

Surgeons conduct four to five such operations a week, panel members estimated, with as many as 400 a year, making them highly vulnerable to infection.

“The virus does not die on contact,” Day said, adding that transmission of the HIV virus by blood splattering or other similar means may be possible. “We know it stays alive for at least 2 feet,” she said.

Dr. Mary Chamberland, chief of the Centers for Disease Control’s epidemiological studies unit, agreed with Day. She said much is still unknown about ways the disease can be contracted.

As AIDS has spread, it has raised new and profound concerns among doctors and health-care workers, who often come in close contact with AIDS patients. Many of those fears were expressed at the academy’s conference, which has brought together more than 9,000 doctors from the United States and Canada.

An academy study, distributed Friday, said there were 5,815 cases of AIDS among health-care workers reported to the Centers for Disease Control from 1978 to 1990. How many workers were infected through their work is unknown, the report said, but as of December, 1990, there have been 40 published incidents of work-related infections.

That has prompted some doctors to advise their peers to take special precautions, for their own safety as well as for that of their patients.

“What we worry about is cutting ourselves and bleeding into the patient . . . or mixing blood,” said Dr. James Luck, a member of Friday’s panel. Poor surgical precautions and a large number of ill-equipped operating-room workers both contribute to the risk of infection, Luck added.

“We all recognize there is a risk of infection,” said Luck, who suggested that surgeons and their staffs wear two latex gloves with a cloth glove in between when operating. “I don’t feel they (residents and other operating-room workers) have adequate protection.”

In an effort to gauge the effects of AIDS on the surgical community, surgeons attending the convention are being asked to volunteer for AIDS testing as part of a study conducted by the Centers for Disease Control. So far about 1,400 have complied, said Dr. Daniel R. Benson, a UC Davis professor of orthopedic surgery who heads the academy’s HIV Task force, which is overseeing the project.

Benson told the media that information gleaned from the test “may be valuable in the future . . . for our own protection and protection of the patient.”

The testing--an attempt to determine what percentage of the nation’s surgeons are infected with the AIDS virus--is done anonymously, and only the doctors themselves will know the results.

Still, the academy’s board of directors urged those surgeons who test positive to avoid invasive surgical procedures that could transmit the disease to patients.

“If only (the surgeon) knows the results, he has to make the ethical decision.” Day said. “We feel he should withdraw from surgical practice. It’s a personal issue.”

Because of controversy surrounding the deadly disease, those surgeons who have tested HIV positive or already know that they have AIDS may not come forward to be tested, the panelists said. As a result, the final numbers gathered at the conference may not reflect the true figures of infected surgeons nationally.

“We are concerned. The more we educate ourselves, the more (we) know,” Benson said. “If you are not concerned about it, then you are pretending that something is not wrong.”