Citing a lack of scientific evidence to support claims that HIV-infected physicians are a threat to patients, the California Medical Assn. last week joined several other major health care groups nationwide that are boycotting federal efforts to restrict the practices of infected doctors.
CMA officials said they have refused to assist the Centers for Disease Control in developing a list of procedures that infected physicians should be barred from performing. The CDC hopes to release such a list by mid-November and has asked medical groups across the nation to help in its preparation.
But increasingly, these groups are refusing to cooperate, citing growing doubts about the scientific basis for the call.
Under guidelines published in July, the CDC urged that HIV-infected doctors not perform certain kinds of "exposure prone" medical procedures without first getting clearance from a panel of local experts and also disclosing their condition to patients.
A CDC spokesman said that the agency has taken its "first shot" in defining the procedures. He said that drawing blood, for example, is not on the list, but "doing an episiotomy on woman (in labor) would probably" be included as an "exposure prone" procedure.
"The basic notion is that these procedures are ones where you're . . . inside a body cavity and can't see what your fingers are doing, and you have a sharp instrument," the spokesman said.
The CDC guidelines were prompted in large part by an investigation earlier this year that found that five Florida people may have contracted the AIDS virus from their dentist, Dr. David J. Acer, who has since died of AIDS-related complications.
The American Dental Assn. had long promised to support CDC efforts to develop a list, but backed off two weeks ago, concluding that such a list would have no scientific basis.
At about the same time, the New York State Health Department refused to cooperate with the CDC, taking the position that doctors should be able to perform surgery and other invasive procedures without informing patients of their medical status.
CMA officials said Thursday there is no scientific evidence to date that any medical or surgical procedures put patients at risk from HIV-infected doctors, assuming that appropriate infection control procedures are followed. "The chance . . . is so small it is almost immeasurable," said CMA President Howard Lang.
"The risk of transmitting HIV from surgeon to patient is minuscule--approximately one in 21 million for every hour on the operating table," said Dr. Albert Lowenfels, professor of surgery at New York Medical College, who attended the CMA press conference Thursday in San Francisco.
He said this minute risk must be balanced against the serious damage that could be done to surgeons by requiring them to disclose their HIV status or restrict their practices.
While the CDC guidelines are voluntary, Congress has passed legislation--not yet signed into law--requiring all states to develop guidelines that are at least equivalent to the CDC's. Otherwise, the states risk losing millions of dollars in federal health care funding.
State health officials in Sacramento said they have not yet taken a position on what, if any, limitations should be placed upon HIV-infected doctors practicing medicine in California.