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South Australia: Health Commission decides against contacting patients of a dentist who died of AIDS

PHILLIP LASKER: We begin in Adelaide where the State Government has confirmed that patients of a dentist who died last year of AIDS will not be told who they are. The State Health Commission says there would be no benefit to be gained from telling them. The dentist, who has not been named, continued to practise until just a few months before his death and against advice that he should stop seeing patients. Peter Rapp reports that the decision not to inform the patients was made within the Health Commission, not by the Health Minister or Cabinet.

PETER RAPP: Not even the dentists, as a profession, are sure what should happen in these circumstances, although they have had a policy since August last year opposing invasive surgery by dentists carrying the AIDS virus, but as to telling the patients, Dental Association President in South Australia - Dr Peter Burgess:

PETER BURGESS: I think this is very much a moral dilemma. I think there are always two sides to the coin. It's similar to a patient having a incurable illness, and the question: should the patient be told, or shouldn't the patient be told? If you took any two patients, they may give you totally conflicting answers as to what they would like to be done.

PETER RAPP: But in this case, do you think if these facts are correct, do you think that the patients ought to be told? Don't they have a right to know?

PETER BURGESS: I think that's a question you'll have to ask the Health Commission, as it was the Health Commission that would appear to have had the knowledge about this, and we had no knowledge of that.

PETER RAPP: At the Health Commission, Dr Scott Cameron is the Head of the Communicable Diseases Control Unit and he told P.M. the patients of the late dentist would not be informed that he had died of AIDS.

SCOTT CAMERON: In reality, I think you'd find that the collateral damage of doing that - worrying people unnecessarily - overweighs any consideration of benefit because, in reality, there's probably no benefit to be gained.

PETER RAPP: But don't people have a right to know if their dentist has been treating them, and the dentist has had AIDS and has died of AIDS? I mean, everyone's worried whose dentist has died.

SCOTT CAMERON: I suppose that sort of situation may well apply in other instances too, where people have been in contact with people with infectious diseases, but it really depends on whether the perception of risk is such that we are concerned enough to hunt them down. And here, the perception is that the risk is not, certainly doesn't warrant that.

PETER RAPP: You say `we've decided' - who's decided not to tell the patients?

SCOTT CAMERON: Well, I suppose it's the Commission. I mean, well, it's within this area and in consultation with the medical practitioners who manage the case.

PETER RAPP: How far up did it go?

SCOTT CAMERON: Oh, it's within public health.

PETER RAPP: So it hasn't gone to the Health Minister or been discussed by the politicians or into Cabinet, at all?

SCOTT CAMERON: No.

PETER RAPP: Shouldn't it have, for something as important as this?

SCOTT CAMERON: Oh, this is a public health matter and I think it's up to us to come up with a rational decision. If there are other forces which would override the scientific basis for the decision, well, so be it. But currently, and on the basis of advice from overseas, we think this is the correct decision to...

PETER RAPP: Well, with respect, this is a decision in the bureaucracy. Isn't it pretty arrogant and pretty patronising for the bureaucracy, for the Health Commission to make this decision when people out there could be asking themselves: `Did my dentist have AIDS?'.

SCOTT CAMERON: Well, by the same token, I mean, we are bureaucrats, if you want to put it that way.

PETER RAPP: Is it patronising and arrogant?

SCOTT CAMERON: No, I don't think so. No, I think we have to make a decision which applies to our field. If other people would have an ethical interest or a moral expertise and so on, that may entirely override our decision, but so far those sort of decisions have not come forward.

PHILLIP LASKER: The Head of South Australia's Communicable Diseases Control Unit, Dr Scott Cameron.

The Australian Federation of AIDS Organisations has defended the South Australian Health Commission's decision not to inform the dentist's patients. The organisation has, instead, called for a full inquiry into the leaking of information from the Health Commission. Its National President, Bill Whittaker, says Australia's health strategy has been seriously undermined by the leak. Michael Brissenden asked him why the information should be withheld.

BILL WHITTAKER: He has died of HIV infection which is not infectious at all if proper infection control guidelines are followed, and the overwhelming majority - including, as I understand it, this dentist - of health care workers, follow those guidelines, so there is absolutely no risk.

MICHAEL BRISSENDEN: But don't patients have a right to know that their dentist was infected with the AIDS virus?

BILL WHITTAKER: No, I think what patients have a right to is proper standards of care by any health care providers so that they're not infected with HIV, hepatitis B or other illnesses. And the way that can be assured is by us putting a lot of effort into making sure health care professionals follow standard infection control guidelines. That's the easy way of stopping transmission of HIV.

MICHAEL BRISSENDEN: Should dentists or any other health care professionals continue to work and operate on patients if they know they are HIV positive?

BILL WHITTAKER: Well, again, the world-wide body of opinion would say yes, there is absolutely no reason why someone who is HIV positive can't participate in the work force in any capacity, including as a health care professional dentist, doctor or otherwise. The way that we stop transmission of HIV in these situations, or hepatitis B or other serious illnesses, is through following standard infection control guidelines, and that's what protects both patients, and it also protects doctors.

PHILLIP LASKER: Australian Federation of AIDS Organisations' Bill Whittaker.