Mary Lynne Desmond thought she had found the perfect dentist. Philip Feldman, a graduate of the School of Dental Medicine at the University of Pittsburgh, had an engaging manner and seemed meticulous. Soon Desmond, a fourth-grade teacher who lives in Coram, N.Y., and her two children, husband, sister and brother-in-law all became Feldman's patients. "But in the last five or six years, he changed," Desmond recalls. "He did three shoddy root canals on me and even left a drill bit in one tooth." Now she has a lot more than a few botched operations to worry about. Last week state health authorities confirmed that they are trying to determine whether Feldman, 45, who died of pneumonia in June, had unwittingly infected any patients with the AIDS virus.
Chances are that Desmond will not test positive. In the past decade, out of the nearly 200,000 people who have developed AIDS in the U.S., only five are known to have been infected by a health-care worker. And epidemiologists quickly point out that all five cases can be traced to the same Florida dentist, David Acer. But the fact remains that it did happen, despite the odds and with devastating results. Already one of Acer's patients, Kimberly Bergalis, is near death; her plight and her understandable fury have moved millions to feel insecure when they go for teeth cleaning or an annual physical exam. Nearly 6,800 health-care workers in the U.S. are known to have AIDS -- including 170 dentists and dental hygienists, 730 physicians and more than 1,450 nurses. Should they tell patients? Should they get out of medicine altogether?
In response to public concern, the Centers for Disease Control in Atlanta last week restated the strict standards of infection control that it began developing in 1982 and that it believes should eliminate any opportunity for doctor-to-patient transmission. But for the first time, the federal agency also urged dentists, doctors and nurses who perform invasive procedures such as surgery to get tested for HIV, the AIDS virus. If they are HIV-positive, said the CDC, they should stop doing operations unless they reveal their condition to patients.
Soon after that policy was announced, the U.S. Senate moved aggressively beyond the CDC and passed two measures to make the agency's recommendations, including disclosure, mandatory. Under one proposal, sponsored by Senator Jesse Helms of North Carolina, physicians could receive prison terms of 10 years and fines of up to $10,000 if they refused to reveal their HIV infection before an operation -- whether or not they passed on the virus to their patients. The second bill, backed by Senators Robert Dole of Kansas and Orrin Hatch of Utah, threatens any state that does not implement the CDC guidelines over the next year with loss of its federal public-health funding. Congressional leaders expect the Dole-Hatch proposal to attract greater support from the House of Representatives.