Case Study: Dr. David Case Study: Dr. David A look at the CDC and A look at the CDC and

ADA’sADA’s Corporate Medical Ethics Corporate Medical Ethics

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The David Acer StoryThe David Acer Story

Dr. David J. Acer, a Florida Dentist, sent a letter to all his former Dr. David J. Acer, a Florida Dentist, sent a letter to all his former patients informing them that he was infected with the AIDS virus patients informing them that he was infected with the AIDS virus and that they should all be tested. (This just a few months before and that they should all be tested. (This just a few months before he succumbed to the disease.)he succumbed to the disease.)

Dr. Acer continued to treat patients after learning in 1986 that he Dr. Acer continued to treat patients after learning in 1986 that he was infected with H.I.V. and after developing AIDS symptoms in was infected with H.I.V. and after developing AIDS symptoms in 1987. 1987.

When Dr. Acer stopped practicing dentistry he told his patients When Dr. Acer stopped practicing dentistry he told his patients that it was due to Cancer. Although he knew, he never disclosed that it was due to Cancer. Although he knew, he never disclosed that the Cancer was in fact AIDS related and that he had been HIV-that the Cancer was in fact AIDS related and that he had been HIV-positive since 1988. positive since 1988.

While assuring his patients in his letter that he had followed every While assuring his patients in his letter that he had followed every measure to keep them safe, he also included in his letter before he measure to keep them safe, he also included in his letter before he died of AIDS in 1990, "I am a gentle man, and I would never died of AIDS in 1990, "I am a gentle man, and I would never intentionally expose anyone to this disease. I have cared for intentionally expose anyone to this disease. I have cared for people all my life, and to infect anyone with this disease would be people all my life, and to infect anyone with this disease would be contrary to everything I have stood for." contrary to everything I have stood for."

To date, 6 of Dr. Acers patience have been confirmed to be To date, 6 of Dr. Acers patience have been confirmed to be positive for HIV, all directly linked to the doctor’s practice. These positive for HIV, all directly linked to the doctor’s practice. These patients rage in age from 15 yrs old to 65 yrs old. patients rage in age from 15 yrs old to 65 yrs old.

He died in September 1990.He died in September 1990.

Dr. Acer & Kimberly Dr. Acer & Kimberly BergalisBergalis

Kimberly Bergalis had a Kimberly Bergalis had a December 1987 procedure to December 1987 procedure to have her have her molarmolar teeth teeth removed. By Dr. David Acer, removed. By Dr. David Acer, had been diagnosed with had been diagnosed with AIDSAIDS three months before three months before performing the procedure. performing the procedure.

Kimberly, a self proclaimed Kimberly, a self proclaimed virgin, claimed she never virgin, claimed she never used intravenous needless or used intravenous needless or engaged in sexual intercourse engaged in sexual intercourse learns that she is HIV- learns that she is HIV- positive, the investigation positive, the investigation leads to the procedure she leads to the procedure she had done by Dr. Acer. had done by Dr. Acer. Kimberly then became an Kimberly then became an advocate for patients and advocate for patients and urged Congress to demands urged Congress to demands laws that require healthcare laws that require healthcare workers to be tested for HIV workers to be tested for HIV to protect patients.to protect patients.

Major ProblemsMajor Problems

After extensive investigation, it was found that Dr. Acer had in fact After extensive investigation, it was found that Dr. Acer had in fact infected 6 of his patients. The six patients, all of whom were probably infected 6 of his patients. The six patients, all of whom were probably infected by mid-1988, include four women and two men ranging in age infected by mid-1988, include four women and two men ranging in age from about 15 to about 65. from about 15 to about 65.

Instead of the ADA(American Dental Association) and the CDC (Center Instead of the ADA(American Dental Association) and the CDC (Center for Disease Control) accepting responsibility for the oversight in their for Disease Control) accepting responsibility for the oversight in their ethical policies regarding healthcare workers, and looking into changing ethical policies regarding healthcare workers, and looking into changing things, they began attacking the patients claims, lifestyles and things, they began attacking the patients claims, lifestyles and reputations. This then caused a snowball effect of “cover-ups.” reputations. This then caused a snowball effect of “cover-ups.”

It wasn’t until after the CDC was forced to conduct Epidemiology reports It wasn’t until after the CDC was forced to conduct Epidemiology reports ( investigation caused by the death of the 4( investigation caused by the death of the 4thth patient of Dr. Acer from patient of Dr. Acer from related symptoms) where the strand of the disease that infected Dr. related symptoms) where the strand of the disease that infected Dr. Acer was compared to that of the patients claiming to have been Acer was compared to that of the patients claiming to have been infected by Dr. Acer, that these patients were vindicated.infected by Dr. Acer, that these patients were vindicated.

The Epidemiology reports taken by the scientists at the disease control The Epidemiology reports taken by the scientists at the disease control centers determined that the H.I.V. strain carried by the six of Dr. Acer's centers determined that the H.I.V. strain carried by the six of Dr. Acer's patients matched his strain. It was then determined that the patients patients matched his strain. It was then determined that the patients could not have contracted the disease anywhere else but from the could not have contracted the disease anywhere else but from the doctor. doctor.

It was then up to the ADA and CDC to determine whether or not Dr. It was then up to the ADA and CDC to determine whether or not Dr. Acer’s patents were infected intentionally. Statistics showed that Dr. Acer’s patents were infected intentionally. Statistics showed that Dr. Acer’s case was the only reported case of healthcare provider to patient Acer’s case was the only reported case of healthcare provider to patient transmission of a disease recorded in history. The insurmountable transmission of a disease recorded in history. The insurmountable number or patients infected by the patient was no coincidence……. So number or patients infected by the patient was no coincidence……. So what happened in the doctors office?what happened in the doctors office?

Major problems Major problems continued..continued..

A possible motive was suggested by A possible motive was suggested by Edward Parsons, a nurse who was a Edward Parsons, a nurse who was a friend of Dr. Acer. He told The Palm friend of Dr. Acer. He told The Palm Beach Post last year that Dr. Acer had Beach Post last year that Dr. Acer had said to him in 1988 that mainstream said to him in 1988 that mainstream America was ignoring AIDS because it America was ignoring AIDS because it affected mostly homosexuals like affected mostly homosexuals like himself, hemophiliacs and drug himself, hemophiliacs and drug addicts. "When it starts affecting addicts. "When it starts affecting grandmothers and younger people, grandmothers and younger people, then you'll see something done," Mr. then you'll see something done," Mr. Parsons said Dr. Acer told him. Parsons said Dr. Acer told him.

Center for Disease Control MissionCenter for Disease Control Mission

CDC MissionCDC Mission To promote health and quality of life by preventing To promote health and quality of life by preventing

and controlling disease, injury, and disability. and controlling disease, injury, and disability. As the Nation's prevention agency, we accomplish As the Nation's prevention agency, we accomplish

our mission by working with partners throughout the our mission by working with partners throughout the Nation and the world to:Nation and the world to:

monitor health monitor health detect and investigate health problems detect and investigate health problems conduct research to enhance prevention conduct research to enhance prevention develop and advocate sound public health policies develop and advocate sound public health policies implement prevention strategies implement prevention strategies promote healthy behaviors promote healthy behaviors foster safe and healthful environments foster safe and healthful environments provide leadership and training provide leadership and training

CDC ValuesCDC Values

CDC Core ValuesCDC Core Values AccountabilityAccountability — As diligent stewards of public trust — As diligent stewards of public trust

and public funds, we act decisively and and public funds, we act decisively and compassionately in service to the people’s health. compassionately in service to the people’s health. We ensure that our research and our services are We ensure that our research and our services are based on sound science and meet real public needs based on sound science and meet real public needs to achieve our public health goals. to achieve our public health goals.

RespectRespect — We respect and understand our — We respect and understand our interdependence with all people, both inside the interdependence with all people, both inside the agency and throughout the world, treating them and agency and throughout the world, treating them and their contributions with dignity and valuing individual their contributions with dignity and valuing individual and cultural diversity. We are committed to and cultural diversity. We are committed to achieving a diverse workforce at all levels of the achieving a diverse workforce at all levels of the organization. organization.

IntegrityIntegrity — We are honest and ethical in all we do. — We are honest and ethical in all we do. We will do what we say. We prize scientific integrity We will do what we say. We prize scientific integrity and professional excellence. and professional excellence.

American Dental American Dental AssociationAssociation

ADA Mission & VisionADA Mission & Vision ADA Mission StatementADA Mission Statement The ADA is the professional association of The ADA is the professional association of

dentists committed to the public's oral dentists committed to the public's oral health, ethics, science and professional health, ethics, science and professional advancement; leading a unified profession advancement; leading a unified profession through initiatives in advocacy, education, through initiatives in advocacy, education, research and the development of standards. research and the development of standards.

ADA Vision StatementADA Vision Statement The American Dental Association: The oral The American Dental Association: The oral

health authority committed to the public health authority committed to the public and the profession.and the profession.

SWOT ANALYSIS-SWOT ANALYSIS-StrengthsStrengths

The CDC and the ADA participants doctors/dentist adhere to The CDC and the ADA participants doctors/dentist adhere to the oldest most sacred vow/promise known to man and that the oldest most sacred vow/promise known to man and that is the HIPPOCRATIC OATH which states:is the HIPPOCRATIC OATH which states:

I do solemnly vow, to that which I value and hold most dear: I do solemnly vow, to that which I value and hold most dear: That I will honor the Profession of Medicine, be just and generous to its members, and help sustain them That I will honor the Profession of Medicine, be just and generous to its members, and help sustain them

in their service to humanity; in their service to humanity; That just as I have learned from those who preceded me, so will I instruct those who follow me in the That just as I have learned from those who preceded me, so will I instruct those who follow me in the

science and the art of medicine; science and the art of medicine; That I will recognize the limits of my knowledge and pursue lifelong learning to better care for the sick That I will recognize the limits of my knowledge and pursue lifelong learning to better care for the sick

and to prevent illness; and to prevent illness; That I will seek the counsel of others when they are more expert so as to fulfill my obligation to those That I will seek the counsel of others when they are more expert so as to fulfill my obligation to those

who are entrusted to my care; who are entrusted to my care; That I will not withdraw from my patients in their time of need; That I will not withdraw from my patients in their time of need; That I will lead my life and practice my art with integrity and honor, using my power wisely; That I will lead my life and practice my art with integrity and honor, using my power wisely; That whatsoever I shall see or hear of the lives of my patients that is not fitting to be spoken, I will keep That whatsoever I shall see or hear of the lives of my patients that is not fitting to be spoken, I will keep

in confidence; in confidence; That into whatever house I shall enter, it shall be for the good of the sick; That into whatever house I shall enter, it shall be for the good of the sick; That I will maintain this sacred trust, holding myself far aloof from wrong, from corrupting, from the That I will maintain this sacred trust, holding myself far aloof from wrong, from corrupting, from the

tempting of others to vice; tempting of others to vice; That above all else I will serve the highest interests of my patients through the practice of my science That above all else I will serve the highest interests of my patients through the practice of my science

and my art; and my art; That I will be an advocate for patients in need and strive for justice in the care of the sick. That I will be an advocate for patients in need and strive for justice in the care of the sick. I now turn to my calling, promising to preserve its finest traditions, with the reward of a long experience in I now turn to my calling, promising to preserve its finest traditions, with the reward of a long experience in

the joy of healing. the joy of healing. I make this vow freely and upon my honor.I make this vow freely and upon my honor. (above is one of many revised editions of the HIPPOCRATIC OATH from Weill Cornell Medical(above is one of many revised editions of the HIPPOCRATIC OATH from Weill Cornell Medical

College)College)

SWOT ANALYSIS CON’TSWOT ANALYSIS CON’T

WEAKNESSESSWEAKNESSESS While the CDC and ADA rely heavily on the While the CDC and ADA rely heavily on the

Hippocratic Oath that doctors/dentist take when they Hippocratic Oath that doctors/dentist take when they become doctors… this oath still is based on personal become doctors… this oath still is based on personal morals and integrity and if the doctor/dentist does morals and integrity and if the doctor/dentist does not possess those traits he or she’s oath is not possess those traits he or she’s oath is meaningless.meaningless.

Both the CDC and ADA’s participants “pay” their way Both the CDC and ADA’s participants “pay” their way into the associations. Meaning, any dentist willing to into the associations. Meaning, any dentist willing to pay the monthly/quarterly/ or yearly dues can say pay the monthly/quarterly/ or yearly dues can say that they are CDC or ADA certified. It does not seem that they are CDC or ADA certified. It does not seem as though the associations base their membership on as though the associations base their membership on values and traits that would make the members values and traits that would make the members more reputable. more reputable.

The CDC and ADA seem to be more concerned about The CDC and ADA seem to be more concerned about protecting the healthcare professionals that keep protecting the healthcare professionals that keep their associations running rather than protecting the their associations running rather than protecting the safety and lives of the public. safety and lives of the public.

SWOT ANALYSIS -ThreatsSWOT ANALYSIS -Threats

As the public becomes more As the public becomes more aware of the health risks aware of the health risks associated with some procedures associated with some procedures performed by healthcare performed by healthcare providers, the CDC and ADA risk providers, the CDC and ADA risk being under extreme scrutiny for being under extreme scrutiny for their lack of concern for patients. their lack of concern for patients.

Recommendations…..Recommendations…..

My personal recommendation for the CDC and also My personal recommendation for the CDC and also the ADA would be to implement a “Right to Choose” the ADA would be to implement a “Right to Choose” regulation. Within this clause, healthcare workers regulation. Within this clause, healthcare workers with communicable diseases are to make their with communicable diseases are to make their patients aware of their status and any possible threat patients aware of their status and any possible threat before any procedure is performed. Thus giving the before any procedure is performed. Thus giving the patient the “choice” whether or not they wish to be patient the “choice” whether or not they wish to be treated by said provider. treated by said provider.

Another recommendation would simply cause for a Another recommendation would simply cause for a deeper look into the Code of Ethics within the deeper look into the Code of Ethics within the healthcare profession. Coming up with such healthcare profession. Coming up with such regulations that accommodate those healthcare regulations that accommodate those healthcare providers who may be apprehensive to disclose providers who may be apprehensive to disclose certain things to patients for fear of prejudice and certain things to patients for fear of prejudice and also for the best interest of patients without ignoring also for the best interest of patients without ignoring possible dangers to the general public. possible dangers to the general public.