Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, June 7, 1993 TAG: 9306070062
SECTION: NATIONAL/INTERNATIONAL PAGE: A-1 EDITION: METRO
SOURCE: DAVID KIDWELL KNIGHT-RIDDER/TRIBUNE
DATELINE: WEST PALM BEACH, FLA. LENGTH: Long
Murder.
After factoring in the details of the Johnson case, many experts say the only theory that seems to fit all the facts is that Acer deliberately infected some patients.
"Whether it's scientifically valid or not, it is definitely the most prevalent theory today - at least in the dental community," said Dr. David Lewis, a graduate faculty member at the University of Georgia, one of many scientists baffled by the Acer case since it became public in 1990.
Even the federal Centers for Disease Control scientist on the case - who insists there remains no conclusive evidence either way - acknowledges he has increasing concerns about whether Acer deliberately infected his patients.
"There's clearly something peculiar about this case," said Dr. Harold Jaffe, director of AIDS research at the CDC in Atlanta. "The report of the sixth patient has certainly raised more questions about the possibility of criminal intent."
The sixth patient - Johnson, 18, a Martin County High School senior - announced she was infected May 6. She is the sixth identified with a strain of the deadly virus identified as unique to Acer through DNA testing. The latest debate in medical circles swirls around the treatment she received from him during her 15 visits to his Stuart, Fla., office from 1987 through 1989.
She was 13 when the treatments began. The records are gone; Acer is dead. No one can even pinpoint the days she visited his office.
But Johnson has told investigators she had cavities filled, nothing more. In the cases of each of five other victims, more extensive dental work was done - teeth were pulled, root canals performed - procedures that presumably would break the skin and provide the virus an entry way if Acer accidentally pricked himself with a sharp instrument and spilled his own blood.
"She had fillings; the procedures were not nearly as intrusive as the other cases," Jaffe said.
Lewis said that because there are no other reported cases does not mean there are none. "The only reason they found this case was because Kimberly Bergalis screamed her head off until they listened."
Acer, described by acquaintances as a nice man but a loner with few friends, died in 1990. Bergalis, the first of his victims to be identified, died the following year after spurring a national debate over the question of health professionals with AIDS.
Both Jaffe and investigators with the Florida Department of Health and Rehabilitative Services in Tallahassee have received many calls from dentists and the public about Johnson's case.
"We knew they'd be saying, `Aha! This proves it had to be criminal intent, it had to be deliberate,' " said Tom Liberti, administrator of the AIDS program, which is heading the Acer investigation.
"The only evidence we have to support the theory of criminal intent is the lack of evidence supporting any of the other theories," he said. "We will probably never know the answer."
But evidence in Johnson's case has buoyed proponents of the murder theory.
"I think he took a needle and syringe, drew his own blood into it and deliberately injected it directly into his patients' mouths with the anesthetic," said Doug Feldman, a medical anthropologist and associate professor at the University of Miami's School of Medicine.
Feldman said he has interviewed many dentists on the subject, "and every other theory you can shoot holes through. This one you can't. . . . My mind was made up before, but the facts surrounding the sixth victim cement it even stronger than before."
In the wake of the Acer case, dentists have faced intense public scrutiny about sanitary habits. Researchers argue that the idea of Acer as a murderer - and not sloppy dental procedures - is an image-saver for the entire dental profession.
"I'm not too sure our image is improved either way," said Dr. John Zapp, executive director of the American Dental Association. "We just haven't been able to come up with a piece of tangible evidence one way or the other." Johnson's case, he said, "fortifies a lot of people's deep-seated suspicions."
Other viable theories, Jaffe said, have been winnowed to two:
That Acer used teeth-cleaning instruments on himself, then inadequately cleaned them before using them on his patients.
That Acer directly transmitted the disease through bloody injuries on his hands into the bleeding mouths of the six patients.
"That's about all we're left with," Jaffe said.
Lewis said he has more problems with the idea that Acer accidentally injured himself. He said studies have shown that needle pricks are only effective in transmitting the virus one in 250 times.
"That means in order to infect six patients, he would have had to have injuries in thousands of visits," Lewis said. "None of his staff remembers all these injuries."
But investigators say none of Acer's staff remembers any suspicious or deliberate activity that would point to murder.
"You have to fathom up some kind of scenario where he either draws his own blood or pricks himself with a needle every time," Liberti said. "I can't tell you how many times I've asked the question: `Did you ever see a syringe with blood in it?'
"The answer is always no."
by CNB