A widely respected surgeon who specialized in treating women with breast cancer died of AIDS two weeks ago, and Johns Hopkins Hospital is planning to send letters this week offering free AIDS tests to an estimated 1,800 patients on whom he operated.
The doctor, Rudolph Almaraz, died Nov. 16 at age 41.
Confirmation that Dr. Almaraz died of AIDS came Friday when his family's lawyer, Marvin Ellin, told The Sun, "He had AIDS, and he died of AIDS."
Mr. Ellin said Dr. Almaraz told him he was exposed to the disease in the course of operating on an AIDS patient in New York about seven years ago while on a fellowship at the Memorial Sloan Kettering Cancer Center.
Dr. Timothy Townsend, an epidemiologist who also serves as senior director for medical affairs at Hopkins, said the hospital made repeated efforts, starting in late summer, to determine the nature of Dr. Almaraz's illness amid rumors that he had contracted acquired immune deficiency syndrome.
The letter from Hopkins -- the first of its kind concerning AIDS the hospital has ever sent -- will go to all patients on whom Dr. Almaraz had operated since joining the staff in January, 1984.
Because neither Dr. Almaraz nor his family would discuss the nature of his illness with the hospital, the letter will not name the doctor, said Joann Rodgers, a spokeswoman for Hopkins.
Documents that would confirm the nature of the doctor's illness, including the death certificate and his medical records, are confidential under Maryland law.
Mr. Ellin, a well-known malpractice lawyer who has represented the Almaraz family since October, said he has not been contacted by Hopkins.
Dr. Almaraz also had privileges at Children's Hospital and Homewood Hospital South. A Children's spokeswoman said he never operated there. Homewood officials could not be reached for comment.
Dr. Almaraz had a private medical practice on north Broadway in Baltimore, which he sold March 1. He resigned from the Hopkins staff June 30; Ms. Rodgers was unable to say when Dr. Almaraz last performed surgery at Hopkins.
While Johns Hopkins Hospital could not give a number as to how many patients Dr. Almaraz had operated on, Dr. Townsend estimated the figure at 300 a year. At that rate, he could have operated on more than 1,800 patients since he joined the full-time hospital staff at the beginning of 1984.
Dr. Almaraz also saw patients on whom he did not perform surgery. That number, too, is unknown.
For months, rumors about the nature of Dr. Almaraz's illness have been circulating among women who had undergone breast cancer surgery, including members of an area support group.
One former patient from Pennsylvania on whom Dr. Almaraz operated for breast cancer in February said she heard the rumor from another patient in July.
A draft of the letter informs patients that there is an "unconfirmed rumor" that a doctor who participated in their care had AIDS and offers them free AIDS testing and counseling.
The possibility that the AIDS virus was transmitted to any person during surgery is very remote, the letter says.
"We're not [contacting] people to suggest there's a problem," said Dr. Townsend. "We're trying to allay their fears" if they've heard the rumor.
AIDS most commonly is transmitted through sexual contact or the sharing of needles by intravenous drug users or exposure to tainted blood or other bodily fluids. In only one case is it considered likely that a patient got the disease from a health-care provider, a Florida dentist.
Mr. Ellin said Dr. Almaraz believed he contracted AIDS during an operation he performed at Sloan Kettering while was a fellow at the center from July 1 to Dec. 1, 1983.
"He operated on a great number of AIDS cases in New York," Mr. Ellin said. "There was an incident of arterial bleeding, it ended up with him squirted in the eyes and mouth from an incision he made. He was very much concerned about it. He knew the patient had AIDS."
Mr. Ellin said he does not know when Dr. Almaraz first tested LTC positive for the human immunodeficiency virus (HIV), which causes AIDS, but that the doctor first experienced AIDS symptoms in February of this year.
"There were no episodes at Hopkins," Mr. Ellin said. "He never cut himself. He never stuck himself with a needle. Beyond that, I cannot comment."
The lawyer was initially consulted to file claims against Sloan Kettering on the doctor's behalf. No claims have been filed, he said.
Ms. Rodgers said the hospital had been unable to confirm as of late yesterday afternoon that the doctor referred to in the letter had AIDS.
"The hospital has repeatedly contacted the physician and the physician's family, and requested that the rumor be confirmed or denied. These requests have been refused," Ms. Rodgers said.
Betty Almaraz, Dr. Almaraz's widow, would say only that she had had some communication with Hopkins this summer but was unaware of the letter being sent to patients. She was reached Friday at her brother-in-law's house in San Antonio.