Florida’s Dilemma With AIDS-Infected Health Workers Stirs National Attention : Epidemic: Woman who caught the disease from her dentist is the focus. At issue are patients’ rights versus the privacy rights of medical professionals.

The state of Florida does not have the highest number of AIDS cases in the United States, nor the highest rate of infection. But it does have the highest profile case, that of a dentist who apparently passed on the disease to five patients, one of whom is dying.

And in the midst of an epidemic that has now spread into every corner of American life, that one case has made all the difference.

Later this month two Florida state medical boards will begin to wrestle with the most complex, divisive issue they have ever faced: what to do about health care professionals infected with the AIDS virus. Regulatory boards in other states will be watching closely.

At issue is the delicate balance between safeguarding public health and protecting the civil rights of those afflicted with a disease that comes with both a death sentence and a social stigma that can be ruinous.

To many in the United States, 23-year-old Kimberly Bergalis represents the nightmare scenario of AIDS, a horrifying reminder that--high-risk behavior or not--no one is completely safe.

Bergalis, of Ft. Pierce, Fla., apparently contracted the disease when Dr. David J. Acer extracted two of her wisdom teeth. He died last September. She is near death and failing fast, according to her attorney.

The Bergalis case has ignited a heated debate embroiling health care workers, lawmakers, AIDS activists and everyday citizens alike.

Sanford Kuvin, a Palm Beach physician and vice chairman of the board of trustees of the National Foundation for Infectious Diseases, has called for mandatory AIDS testing for every health care worker and every patient involved in invasive procedures.

“It is unconscionable that a lethal infectious disease is nonreportable,” says Kuvin.

He has also urged the Centers for Disease Control to recommend that any doctors or dentists testing positive for the HIV virus, believed to cause AIDS, be barred from performing any procedures in which they could come in contact with a patient’s blood.

Even Florida Gov. Lawton Chiles weighed in, urging lawmakers to pass a bill that would require AIDS-infected doctors to register with the state.

But Margaret Fischl, a University of Miami medical professor and a leading AIDS researcher, calls such proposals “knee-jerk reactions, packed with hysteria.”

“The situation in Florida is unfortunate,” she says. “But registry represents everything we’ve fought against. There’s no doubt emotions with this are high.”

Jeff Peters, an assistant state attorney general and president of the Florida AIDS Legal Defense and Education Fund, charges that efforts to register everyone who tests positive for HIV is a smoke-screen for a massive assault on civil liberties. “The real reason for this is that they want to create a separate society, and put HIV people over in a corner,” says Peters. “Doctors want to be able to isolate these patients and not treat them. That is morally and ethically disgusting.”

Researchers at the CDC have called the Bergalis case an aberration, a statistical longshot, with “staggeringly infinitesimal” odds of greater than 1 in 2.6 million, according to one official. While recommending that AIDS-infected members either voluntarily refrain from performing invasive procedures or disclose infections to patients, both the American Medical Assn. and the American Dental Assn. have opposed mandatory AIDS testing as a waste of time and money.

But fear and public pressure may be taking their toll. In April a New Jersey Superior Court judge ruled that doctors with AIDS must inform their patients, saying in effect that patients’ rights to know outweighed a doctor’s right to privacy.

Last month an editorial in the prestigious New England Journal of Medicine called for routine testing of hospital patients, pregnant women, newborns and health care workers.

“There’s a real groundswell for some kind of testing requirements, possibly for providers, possibly for patients,” says Allen R. Grossman, Florida assistant attorney general who represents the board of dentistry. “It’s that kind of issue.”

In Florida, no fewer that 18 separate bills on AIDS and health care workers were introduced in the Florida Legislature this year. The one that made it out of committee, Senate Bill 1436, would empower the state’s boards of medicine and dentistry to treat AIDS-infected members the same way they now treat carriers of hepatitis B, which like AIDS is blood-borne and communicable. They would have to register with the boards, and undergo monitoring and educational training. Yet their names would remain confidential.

Chiles has said he would sign the bill. Florida Sen. Eleanor Weinstock describes Senate Bill 1436 as “sensible, a continuation of the thinking that the licensing board in each area should have main responsibility. It’s not appropriate for us to make state laws concerning people with AIDS.”

Kuvin disagrees. “Voluntarism has failed,” he says. “The right to know has always come ahead of the right to privacy, and this will have to be carried out through legislation, state by state. It is outrageous that Florida has not enacted mandatory testing and become a model for the rest of the country. As time ticks by, we’re going to have more Kimberly Bergalises.”

The Florida Medical Assn. follows AMA guidelines, which urge physicians who are HIV positive to refrain from any risky procedures. Thus far, both the national and state organizations have opposed mandatory testing or screening of health care workers. But testing, of both doctors and patients, is sure to be a hot topic of discussion at the annual AMA meeting beginning June 22 in Chicago.

The state Board of Dentistry’s sterilization committee is to meet June 18 in Tallahassee to consider new guidelines.

“We’ve got to protect the public, and I expect some stiffening” of the rule requiring the use of impermeable gloves in invasive procedures, says committee chairman Richard Chichetti, a practicing dentist. “But we’re hesitant to go too far until we see the CDC guidelines” on health care workers and AIDS. The guidelines are expected later in the summer.

“Will barrier and sterilization techniques be enough, or are they going to recommend that some practices be curtailed by those who are HIV positive?” asks Chichetti. “We want to be very pro-active in this, while not doing something illegal or morally wrong. One of the messages we’re trying to send out is that we’re not in a panic situation, that patients are safe.

“But we know that Florida is the lightning rod for everything.”

Florida has a history of emotional AIDS cases. In DeSoto County, the home of the Ray family was firebombed in 1987 after a federal court ruled that three hemophiliac brothers with the AIDS virus must be permitted to attend public schools. In 1988 a 7-year-old mentally handicapped Tampa girl with AIDS was allowed to attend school only if she sat in a plexiglass isolation booth. The South Florida town of Belle Glade gained a reputation as the AIDS capital of the country in the mid-1980s when researchers found an extraordinarily high incidence of the disease among farm workers.

In April, a South Florida orthodontist announced he has AIDS and closed his practice. His 600 patients are being tested.

But nothing comes close to matching the reaction produced by the Kimberly Bergalis case. “This is the case that tells us everybody’s vulnerable,” says Bergalis’ attorney, Robert Montgomery. “This tells us: ‘There but for the grace of God go I.’ ”

The case became public last July when the CDC reported that Stuart, Fla., dentist Acer may have passed AIDS to a patient. Two months later, in a letter to patients, Acer acknowledged he had AIDS, and urged his patients to be tested. But he said that he did not believe he could have been the source of the infection. “I am a gentle man, and I would never intentionally expose anyone to the disease,” he wrote.

Bergalis stepped forward a week after receiving the letter. In December, 1989, two years after Acer pulled her wisdom teeth, she was found to have AIDS. After exhaustive investigations of her personal life, and careful study of the strain of virus found in Bergalis and Acer, CDC officials concluded the dentist was the likely cause of the infection. They have been unable to say precisely how the transmission took place. Four other patients of Acer have since proved to be HIV-positive.

According to the latest CDC figures, 6,436 AIDS patients--or 4.8% of all known cases since the epidemic began 10 years ago--are health care workers. Many have now died. And Acer is the only one known to have transmitted the disease to a patient.

The chance of transmission the other way, from patient to doctor, is many times greater, according to the CDC. At least 40 health care workers have become infected while caring for AIDS patients, primarily through accidental needle punctures.

Miami pathologist Daniel L. Seckinger, who chairs the Florida Medical Assn.’s committee on AIDS, sees mandatory testing in the near future if the AIDS epidemic is not brought under control soon. He appreciates the “impact on individual rights,” he says, but adds: “Everyone can benefit from knowing their HIV status.”

That scares Peters of Florida’s AIDS Legal Defense and Education Fund. “The Florida Medical Assn. wants to test at will,” he says, “and that won’t accomplish a thing except create a false sense of security.

“Next year we’re going to see a major move in this direction. And Florida is a bellwether state. If it changes, other states will change too. It hinges on the CDC report. If they make big changes (such as advocating mandatory testing), there’s going to be a battle.”

Researcher Anna Virtue contributed to this story.