in the health care setting? Should the patient be told that the surgeon recently had a
heart attack, he [or she] had two drinks the night before, or that he [or she] took an
antihistamine that could cause grogginess?" asks Povar.16
(3) Since there is some uncertainty in all-human encounters, the patient
should only be told about risks that are significant. A patient is more likely to be struck
by lighting than contract AIDS from a health care provider. Federal Center for Disease
Control (CDC) data on the comparative risks of various diseases suggest that the risk of
contracting AIDS in the health care setting is relatively small (24 in 1 million). Other
sources put the risk even lower (one or two in 1 million). When compared to the risks of
contracting cancer or developing heart disease, the risk of contracting AIDS from a
health care provider seems miniscule, indeed.17
(4) Dr. June Osborne, a public health specialist, and chairperson for the
National Council for AIDS, contends that universal precautions (wearing gloves, gowns
and goggles) are sufficient to protect patients. One indicator of the efficacy of universal
precautions is the rate of hepatitis B, another blood-borne disease. Since 1987, when
universal precautions were instituted, there have been no cases of a health care
provider infecting a patient with hepatitis B.18
(5) Despite low odds, many hospitals are taking the ethically correct step of
notifying patients if health care providers have AIDS. The Johns Hopkins Hospital, in
Baltimore, notified 1,800 breast surgery patients when their surgeon, Dr. Rudolph
Almaraz, died of AIDS. Two Ohio hospitals offered free testing for patients of a surgeon
who had died of AIDS. (So far, none has tested positive.) Dr. Osborne contends that
the decision to inform patients is not taken on moral grounds, but as a result of liability
advice from lawyers.19
(6) Despite the assurances of a low risk rate, people are frightened. The
deathbed appeal of Kimberly Bergalis, a young Florida woman apparently infected with
the HIV during a dental extraction, has drawn much public attention. As a result, the
CDC has revised its guidelines. They are no longer leaving it up to the hospitals. At
this writing, they have recommended that patients be advised when health care
providers performing invasive procedures (for example, dental extraction and other
surgeries) are infected, and that these health providers be removed from direct patient
care.20 (Since guidelines on AIDS are subject to constant change, refer to the most
current CDC guidelines if you want information on how they may apply to you.) Many
infected providers, however, have decided not to follow the guidelines, contending that it
"is unfair and unscientifically warranted to have to sacrifice their livelihoods when the
danger of transmission to a patient is infinitesimal--much smaller than the danger any
doctor faces in treating someone with an unknown history."21
e. The Risk of Health Providers Contracting Acquired Immunodeficiency
Syndrome From Patients. Of the 164,129 cases of AIDS reported to the CDC as of
January 31, 1991, about 5 percent have involved health care workers. Fewer than 40
are thought to have been infected on the job.22 Of those infected on the job, most
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