AREA HEALTH CARE PROFESSIONALS TAKE PRECAUTION AGAINST AIDS

Local health care professionals disagree over the merits of mandatory testing for AIDS.

But both doctors and dentists said that in their professions they run the risk of coming in contact with AIDS-infected persons and, as a result, must take necessary precautions.

A recent survey for Newsweek magazine indicated that most Americans believe health care professionals should be required to tell their patients if they are infected with the deadly AIDS disease.

Local doctors and dentists interviewed said they believe that any ethical doctor or dentist who had AIDS would avoid practicing medicine in situations that could put patients at risk.

Dr. Melvin C. Kasten of Cape Girardeau said he believes doctors with AIDS should inform their patients. But by the same token, he said, patients with AIDS should inform their doctors or submit to AIDS tests.

"If doctors are going to be tested, we should be able to test our patients," said Kasten, who was in Chicago this weekend for the American Medical Association's annual meeting.

The issue of AIDS was among the topics discussed at the meeting.

"We're expected to take care of AIDS patients, and I have," Kasten said last week prior to the AMA meeting. "But we cannot test them unless they agree to the test. Those we want to test say, `no,'"

Kasten said about 10 years ago, every patient in the hospital was routinely tested for syphilis. "They didn't know they were being tested," he said. "But everyone was tested and occasionally we found someone with syphilis."

He said if hospital patients were tested for AIDS, within five years 80 percent of the population would be tested.

"They are going to find a cure some day," said Kasten. "But if you can't diagnose the disease, you can't treat the disease."

Kasten said the Missouri Senate recently approved a bill that would have allowed doctors to test anyone they suspected of having AIDS. But the bill never passed the House.

Kasten predicted the measure will be reintroduced in the next legislative session.

Kasten's wife, Mary, who is a state representative from Cape Girardeau, said she supports the legislation.

She said health care workers are put at risk when they unknowingly deal with patients who have AIDS. Such legislation, she said, could help reduce that risk.

But Dr. Brock Whittenberger, a Cape Girardeau physician who deals with AIDS patients, said he doesn't see the need for mandatory testing, particularly in this area where the incidence of HIV infection is very low. HIV is the virus that causes AIDS.

"It is probably not a good idea to screen large populations of people just to know if they are (test) positive or not," said Whittenberger.

"It is not going to be cost effective" to test large populations of people who are not in the high-risk categories, he said.

"In this area, the risk is so low. We just don't have the high risk behavior in this area," he added.

Homosexual activity accounts for more than half of the AIDS cases nationally and intravenous drug use is blamed for 24 percent of the cases, according to national health statistics.

Nationally, it's estimated that by year's end AIDS deaths since 1981 will top 150,000 and that more than 41,000 additional cases will be diagnosed, bringing the total number of cases to about 250,000.

Also, it's estimated that another 1 million to 1.5 million people carry the HIV virus, which festers into AIDS after an average 10-year incubation.

Worldwide, there are an estimated 1.5 million AIDS cases, with another 8 million to 10 million people infected with the virus.

But Whittenberger said that locally there are few AIDS cases. Since 1982, eight people in Cape Girardeau County have died from AIDs, health officials have reported.

According to the Missouri Department of Health, 14 county residents now have AIDS.

Whittenberger said he doesn't believe in mandatory testing. "I don't think physicians should do things to patients without their consent."

He said that on the occasions he has requested his patients be tested for AIDS, all have complied.

Whittenberger said he, like other doctors, takes necessary precautions to lessen the risk of contracting AIDS. "We do what we call universal precautions. We assume that any patient we may come into contact with may pose a risk."

Two Cape Girardeau dentists said AIDS has prompted changes in the dental profession as dentists and dental workers have sought to protect themselves from the deadly disease.

"I think it has definitely changed the whole field of dentistry," said Dr. Pat Ruopp. "We have to be more thorough with our medical histories (of patients).

"We have to take precautions, such as wearing safety glasses, gloves, masks and coats."

While patients are asked if they have AIDS or have ever been exposed to AIDS, Ruopp said that one can't assume that all patients will give an honest answer.

"I don't know how many people are going to tell you that they have AIDS," he said. "You just have to assume that there is that possibility with any patient that he or she could have the HIV virus."

Dr. Jeffrey Patton agreed. "What you have to do is assume that anyone who walks in may be infected."

Both Ruopp and Patton said AIDS has led to increased operating costs for dentists in terms of protective measures.

Patton said that until four or five years ago, many dentists didn't wear gloves. "Until AIDS came along, the biggest concern we had was catching hepatitis."

Now, dentists and dental workers wear gloves and "have gone to surgical scrubs." Patton said his office goes through $8,000 worth of gloves a year.

"There's more sterilization going on (in dental offices)," he added. "I think that's good."

Patton said he doesn't believe AIDS poses a great risk to dentists. "I really do not believe that there is really much of a hazard in the dental office. You're not seeing dentists leaving the profession and you're not seeing dentists die like flies."

Both Patton and Ruopp said they don't believe the well-publicized case of a Florida dentist, who contracted AIDS and apparently infected at least five patients, has caused Cape Girardeau area residents to stay away from local dental offices.

"I think people are staying away from dentists more just from fear of going to the dentist than from fear of contracting a communicable disease," said Ruopp.

Said Patton, "If they are concerned about it, they are not coming in to tell me."

He said there are 250,000 dentists in the United States. "There's a case in Florida involving one dentist. That's one dentist in 250,000 and I think people understand that."

Some information for this story was provided by staff writer Peggy Scott.