- The Quebec College of Physicians is launching an investigation
into the case of a Montreal pediatric surgeon who was infected with AIDS
and continued operating on children for 13 years without administrators
being aware of her status.
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- The college, the self-regulating body that oversees the
behaviour of doctors in the province, is not so much concerned with the
actions of the doctor herself -- she is deceased -- but with those responsible
for overseeing her work.
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- "We have questions about the behaviour and actions
of some of our members and we want to prevent analogous situations,"
said Yves Robert, assistant director of the college.
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- He said that under ethical guidelines a physician who
is infected with a disease like HIV-AIDS has an obligation to consult an
expert committee, which determines what work is appropriate.
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- In the current case, which has prompted Sainte-Justine
Hospital to urge 2,614 surgery patients to get tested for HIV-AIDS, the
surgeon, Maria Di Lorenzo, told her supervisor in 1991 that she was infected.
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- An expert committee for Dr. Di Lorenzo's case, including
another pediatric surgeon at the hospital, was created and its work carefully
documented for five years. But, in 1996, the paper trail went cold.
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- Dr. Di Lorenzo continued working until June, 2003, when
her health deteriorated.
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- She died in August. Hospital administrators said they
learned only on Jan. 9 of this year that Dr. Di Lorenzo had been infected
with HIV-AIDS.
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- Dr. Robert said that while there is no evidence the surgeon
did anything wrong, there was clearly a responsibility for oversight to
continue, and the investigation will try to determine why the process broke
down. It is that breakdown that prompted the unprecedented warning, even
though the risk of infection is extremely low.
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- Sainte-Justine Hospital has already launched an internal
investigation, and public health authorities are also reviewing the case.
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- The hospital's hot line continued to be bombarded with
calls from nervous parents yesterday. More than 4,000 calls have been fielded
by a team of 14 nurses and physicians. "We have a lot of calls, but
the situation is under control," said Raymond Roberge, director of
communications at Sainte-Justine.
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- The College of Physicians is also reviewing its guidelines
to determine if they should be strengthened by, for example, making it
mandatory for HIV-positive physicians to report their status to the college
-- something that is not done anywhere in the world.
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- Sunil Patel, president of the Canadian Medical Association,
said it has no need to modify its guidelines, which state that health-care
workers should not be obliged to disclose their HIV status to patients,
except where there has been exposure to their blood. (There is no evidence
that Dr. Di Lorenzo's patients were ever exposed to her blood during surgery.)
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- "What possible purpose would it serve to publicly
declare a physician's positivity or negativity?" he said. "If
we create a culture of shame and blame it will not serve patients, it will
just discourage health-care workers from coming forward."
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- The provincial patients rights group also weighed in
against the notion that the status of doctors be made public, or that mandatory
testing be introduced.
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- "If you start testing physicians and surgeons, are
you also going to test all nurses, auxiliary workers, home-care aides and
everyone who works around patients? It would never end," said Dominique
Demers, assistant director of the Conseil pour la protection des malades.
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- Richard Elliott, director of legal research and policy
at the Canadian HIV-AIDS Legal Network, agreed with that slippery slope
argument. In fact, he said, because physicians and nurses are at far greater
risk of contracting HIV-AIDS from their patients than vice-versa, it would
be difficult to justify testing surgeons.
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- With Dr. Di Lorenzo's name and photo splashed across
the front pages of newspapers and prominent on television newscasts, some
of her colleagues stepped forward in her defence.
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- Dr. Sandeep Mayer, a former colleague now working at
the University of Sherbrooke, said he has no doubt that the surgeon never
placed her patients at risk.
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- "Maria was conscientious and devoted to her patients,"
Dr. Mayer told Radio-Canada television. "She was also very meticulous
in surgery."
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