Dozens of patients who had been operated on by Dr. Rudolph Almaraz called Johns Hopkins Hospital yesterday in response to revelations that the breast cancer surgeon died of AIDS.
By midafternoon yesterday, after The Sun reported that the 41-year-old doctor died of acquired immune deficiency syndrome two weeks ago, about 50 people had called the hospital, said Dr. Timothy Townsend, an epidemiologist and senior director for medical affairs at Hopkins. Operators told callers to contact Dr. Townsend at his office today.
The hospital plans this week to mail letters to an estimated 1,800 persons on whom Dr. Almaraz had operated, offering free AIDS testing and counseling. Spokeswoman Joann Rodgers said that the letter, which now refers to unconfirmed rumors that a doctor had AIDS, will be altered if the hospital can indeed confirm the cause of death.
While Dr. Almaraz's attorney, Marvin Ellin, told The Sun Friday that the doctor died of AIDS, the hospital has not been able to speak with Mr. Ellin directly, Ms. Rodgers said.
Even as some of Dr. Almaraz's patients feared that they could have contracted the AIDS virus from him, other doctors said that that is highly unlikely. Doctors face a greater risk of contracting the AIDS virus from a patient, they said.
"When you're operating on a patient, the patient's blood is all around. That's the way surgery is," said Dr. Gregory B. Bulkley, a professor of surgery at the Hopkins Medical School. "It's very rare that a surgeon's blood, however, would get into the patient."
Dr. Bulkley said that a study has found that a doctor operating on a person with AIDS who accidentally pricks himself or herself has a 0.2 percent chance of picking up the AIDS virus.
The risk of transmission the other way around -- a doctor giving a patient AIDS -- is so small as to be immeasurable, he said.
Statistics indicate this is the case. Only 37 health-care workers are believed to have contracted AIDS through their work. In only one documented case is it believed that a patient might have contracted AIDS from a health-care worker -- in that case, a dentist.
Mr. Ellin said that Dr. Almaraz believed he contracted the virus in 1983, while serving a fellowship at Memorial Sloan-Kettering Cancer Center in New York.
Yesterday a Sloan-Kettering spokeswoman said the hospital did not have any records that would indicate Dr. Almaraz contracted AIDS when he practiced at the hospital from July 1 to Dec. 1.
"We have no record at this time. We have not uncovered any blood incident report," Suzanne Raussenbert, vice president for public affairs, told the Associated Press.
Doctors with AIDS are not required by law to limit their practice in any way. Recommendations from such groups as the American Medical Association state that such doctors should consult colleagues to discuss whether they are placing their patients at risk. It is unknown whether Dr. Almaraz did that, although Hopkins officials could not find anyone on their staff who knew directly of his illness.
Dr. John Bartlett, director of the AIDS Care Program at Hopkins, said that he believes current guidelines for physicians with AIDS are adequate given that there are no confirmed cases of doctors transmitting the disease to their patients.
"What precautions should be taken to prevent events that are rare, or may not ever even occur?" he said. "I'm not so sure, biologically, [that doctor-to-patient transmission] can occur. What we need now is better information, because I think policy based on no information is dangerous policy."
Former patients of Dr. Almaraz can call Dr. Townsend's office at (301) 955-0620. The hospital will provide free AIDS testing or will pay for a test if the patient chooses to have the test done by another doctor, Ms. Rodgers said.