MIAMI — 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."