Johns Hopkins Hospital plans to advise more than 2,000 people to consider being tested for AIDS because their surgeon, who practiced at the Baltimore hospital, died of complications of the disease.
Hospital officials said the unusual letters will go out this week to former patients of Rudolph Almaraz, a respected breast cancer specialist who died Nov. 16 in Baltimore.
First reported in yesterday's Baltimore Sun, the hospital's plans have been defended as essential to the welfare of Almaraz's former patients and have been criticized for their potential to stir up public fears about the disease.
The letters will generate "nothing but panic" among the surgeon's former patients and others, said Marvin Ellin, the Almaraz family's lawyer.
Chai Feldblum, a lawyer with the American Civil Liberties Union's AIDS Project, called the letters an unwarranted intrusion into the Almaraz family's privacy. She said such measures should be taken only where there is strong indication that patients had been infected.
Medical experts say the risk of a patient contracting the AIDS virus from a health care professional is extremely low, particularly when standard precautions are taken, such as wearing gloves and masks. Federal officials are studying the one known U.S. case of apparent transmission of AIDS by a health care professional who used standard precautions, a dentist in Florida.
There is increasing concern in the medical professions about patients accidentally infecting doctors and nurses with the virus. Research has shown that the fatal illness is most frequently transmitted by blood or semen and that symptoms may not appear in an infected person for more than a decade.
Ellin said that Almaraz believed he contracted the AIDS virus while operating on a patient at a New York City clinic in 1983, when little was known about the virus and its effects. Almaraz first noticed symptoms early this year, but it was unclear when the surgeon first tested positive for the virus. The hospital does not test its employees for communicable diseases.
The letters that Hopkins officials plan to send out this week will not name Almaraz because Maryland law bars such disclosure by the hospital, according to Hopkins spokeswoman Joann Rodgers. They will advise about 1,800 people on whom Almaraz operated between 1983 and this year, and several hundred other patients of Almaraz's, that in recent months the hospital has discovered "unconfirmed rumors" that one of its doctors had AIDS, Rodgers said.
She said the hospital has not been able to confirm from Almaraz, his family or his attorney that Almaraz had the disease.
The letters' recipients will be advised to consider being tested for AIDS or counseled about the disease, Rodgers said. The hospital will provide the services free for those with limited means, she said. Almaraz's patients came from throughout the country; it could not be learned immediately how many may be in the Washington area.
In 1987, Baltimore physician Hacib Aoun sued Johns Hopkins for $35 million, claiming that he contracted AIDS there in a 1983 surgical accident. Aoun and the hospital settled the case for an undisclosed amount.
The letter to Almaraz's former patients "is not a legal issue. It was a medical decision" to inform them of the slight chance that they had been infected, Rodgers said. Rumors were increasing in the Baltimore area that Almaraz had the disease, and "we felt, on balance, that women would want to know . . . for their well-being and peace of mind," the spokeswoman said.
Ellin, the family's lawyer, said the hospital "is going out of its way to frighten so many patients . . . . Every ache and every pain they experience is going to cause them to wonder if they have AIDS."
There has been "no suggestion" that Almaraz, who died at age 41, had an operating room accident or otherwise exposed a patient to his blood, Ellin said. The attorney added that "I've heard nothing from Hopkins" attempting to confirm from him that his client had AIDS.
The Rev. Bob Hall, of Arlington, a volunteer with the Northern Virginia AIDS Ministry, said hospitals normally should not advocate "wholesale testing" of patients without good cause because "you're dealing with such fragile emotions."