Medical Board Postpones Policy on HIV Testing : AIDS: Agency that licenses physicians will wait for state to set guidelines before deciding whether to recommend that doctors be screened for the HIV virus.

The Medical Board of California, meeting Friday in San Diego, balked against mounting pressure to establish its position on mandatory HIV testing of doctors and decided to wait for new state health department guidelines, which could be ready in six months.

Opting to take its cue from the health department, the state agency that licenses physicians decided to postpone any policy decisions on whether to screen doctors for the AIDS virus.

In November, the board’s national umbrella organization--the Federation of State Medical Boards--approved a policy requiring HIV testing and careful monitoring of doctors who contract the HIV virus. The federation also suggested that all state medical boards should require testing of any health care workers who perform invasive or surgical procedures.

The federation’s position ignited much debate and led to a number of groups opposing the recommendation, among them the California Medical Assn., the California Nurses Assn., and the American Dental Assn.

After listening to a brief state health department presentation, medical board president Dr. Frederick Milkie pleaded: “Should we support the policy of the federation? Or should we not?”

But Dr. Mary Jess Wilson, public health medical officer with the California Department of Health Services, said she was not in a position to give such advice. Wilson pointed out that in a recent voluntary HIV-testing survey of 3,000 Orange County surgeons, none tested positive for the virus.

Wilson also conceded that there was “a great deal of disagreement about whether (the more stringent) guidelines are necessary.”

As a result, the board decided to wait for the department and the federal Centers for Disease Control to formulate guidelines.

“We’re not rejecting the (Federation of State Medical Boards) policy, we’re just tabling it until we have a fuller picture of what the CDC and California health department are going to do,” said Janie Cordray, spokeswoman for the 19-member board, which meets every two months. Cordray made her comments in an interview.

The controversy over testing health care professionals reached a boiling point with the diagnosis--and subsequent death--of a Florida woman, Kimberly Bergalis, who contracted the HIV virus from her dentist. Bergalis, 23, who had said she engaged in none of the high-risk behavior associated with AIDS virus contamination, died of the disease in December.

Before her death, Bergalis--speaking from her wheelchair--became a poignant, outspoken advocate of mandatory HIV-testing for health care professionals.

The CDC issued guidelines in July after an investigation found that Bergalis and four other Florida people contracted the AIDS-causing virus from their dentist, Dr. David J. Acer, who has since died of AIDS-related complications.

In Bergalis’ case, CDC officials believe Acer--a bisexual who learned he had AIDS in 1987--somehow infected the young woman while removing two molars in December, 1987. It is believed that sloppy sterilization procedures allowed transmission of the deadly virus.

Under its current guidelines, the CDC urged HIV-doctors to not undertake certain “exposure prone” invasive medical procedures unless they told patients about their HIV status and also obtained approval to perform the procedure from a panel of local experts.

But last fall, the Federation of State Medical Boards went beyond the CDC guidelines and called for mandatory testing as well as a monitoring program to track infected doctors--enforcement of which, many say, could prove unwieldy in California.

Opponents to mandatory testing say it is unnecessary because there are no known cases in which a doctor has transmitted the AIDS-causing virus while tending to a patient.

Rather than instigate more rigorous testing, they say, it would make more sense to push increased infection control measures. A testing program, they say, would be an expense that makes little sense.

“I don’t think it would protect the patients,” said Dr. Clarence Avery, former California Medical Assn. president and current board member, in an interview.

Avery, chief of staff at the VA Hospital in Yountville, has himself been tested four times for AIDS and favors voluntary testing.

But even that type of testing, he concedes, can provide a false sense of security. “If I take the test and I am negative today, do I wait six months to make sure before I do an operation?”

Dr. Roger Kennedy, a member of California Medical Assn.’s technical advisory committee, said in an interview that mandatory testing could also make doctors more leery of working with AIDS patients.