Deborah A. Brower, a 33-year-old nurse's aide from Long Island, saw her dentist three times in the last four months. Today she has a fourth medical appointment, this time to find out if the dentist infected her with the AIDS virus.
Ms. Brower is one of at least 200 patients who fear they were exposed to the AIDS virus by Dr. Philip M. Feldman of Coram, L.I., who died of pneumonia last month. The New York State Health Department has set up hot lines and clinics to offer counseling and testing to his patients and is investigating reports that Dr. Feldman did not follow proper infection-control practices, like sterilizing or disinfecting dental instruments between patients.
Publicity about Dr. Feldman's case, which was first reported in Newsday last weekend, coincided with yesterday's announcement by the Federal Centers for Disease Control of guidelines for health-care workers who are infected with the AIDS virus.
But the new Federal standards, which rely on the workers' willingness to voluntarily be tested for the virus and disclose their infection to patients, drew angry responses from people like Ms. Brower, herself a health-care worker, who said that testing should be mandatory and that those infected should be prevented from practicing.
"What dentist, what surgeon can you trust if there are people like these who allowed people to come in and bring their children in when he knew he had AIDS?" she asked. "I'm disgusted. I'm terrified."
But Dr. David E. Rogers, chairman of the New York State AIDS Advisory Council, said mandatory testing would consume "enormous amounts of money" for a very low yield, considering the low risk of infection from health-care workers to patients. The guidelines, he said, "put the emphasis where it should be, which is, what kinds of procedures are HIV-infected people using in taking care of patients?"
The inquiry into Dr. Feldman's practice is the first such official investigation of a health-care worker in a state with the highest number of reported AIDS cases in the country, 718 of them among health-care workers, state health officials said. The vast majority of these cases involved doctors, nurses and other medical personnel who do not perform the types of procedures that could lead to transmission of the virus, they said.
And even as they seek access to Dr. Feldman's records to insure that all patients are notified of the available help, the health officials called the risk of dentist-to-patient infection "exceedingly low" and said they did not expect to find a single instance in this case. Any patient who tests positive would be evaluated to rule out other known risk factors, such as sex with an infected partner, they said. Suffolk County health officials said 147 of the dentist's patients have scheduled tests and counseling. Those seeking appointments can call (516) 348-2749.
In a statement released yesterday, the New York State Health Department said that the new Federal guidelines were similar to those that have been in place in the state since January for health-care centers and HIV-infected medical personnel. Both call for voluntary, rather than mandatory testing, and both recommend special evaluations of infected workers who engage in high-risk medical work such as dental and surgical procedures to determine whether they should continue performing them.
Department officials said they did not know the extent to which the guidelines were followed.
"The C.D.C. and the New York state guidelines set up a standard for a doctor to follow so one would expect health-care workers to follow standards that are explicitly stated," said Dr. Lloyd F. Novick, the State Health Department's director of community health and a consultant to the centers on the issue of HIV infection among health-care workers.
"What is the alternative?" he said. "The only other way to approach this is to know the HIV status of every health-care worker who's performing invasive procedures and to know it at repeated intervals. We've rejected that approach as unworkable because it would require repeated testing and would not give full assurances that the health-care worker is free of infection."
The department requires the state's 260 hospitals to adhere to infection-control procedures issued by the centers and violations are punishable with fines, said Frances Tarlton, a department spokeswoman. She said that hospitals had generally complied.
The state, however, does not have authority over individual practitioners, she said.
"The best protection for both patients and health-care workers is rigid infection control. Patients can make sure that dentists are wearing gloves. They can ask about their infection-control practices," Ms. Tarlton said.
"Anyone can ask point blank if the person is infected with HIV," she said.
Still, many say protection should not be left up to the patient.
"If they say testing is not economically worthwhile, do they realize the economic devastation to my family," asked Paul A. Pallmann, a 48-year-old exterminator whose wife and two sons, ages 22 and 14, were Dr. Feldman's patients.
" What about the human cost? People aren't replaceable with money."