Johns Hopkins Hospital confirmed for the first time yesterday that a well-known breast surgeon who worked there for several years died of AIDS -- and hospital officials began mailing letters to 1,800 former patients offering free counseling and testing for the virus.
But an estimated 100 former patients who had already learned through media reports about Dr. Rudolph Almaraz's death from AIDS called the hospital yesterday and Sunday, expressing a range of emotions from calm concern to extreme upset, a Hopkins official said.
"There are some who have taken it very calmly, very factually, and others who have become quite upset, quite concerned," Dr. Timothy Townsend, Hopkins epidemiologist and senior director for medical affairs, said at a news conference yesterday.
zTC Dr. Townsend, reflecting the tone of the hospital's letter, repeated his belief that the chances the doctor transmitted the human immunodeficiency virus (HIV) to a patient during surgery were "really quite low." Transmission could have occurred only in the unlikely event that the surgeon cut himself and dripped blood onto the patient. Hopkins knows of no such incidents involving Dr. Almaraz.
"Health-care workers generally don't bleed on their patients," he said. Surgeons, he said, generally wear gowns, gloves, masks and protective eye wear to protect themselves from HIV or other infections borne by the patient -- precautions that also protect the patient from any infection carried by the doctor.
Given the small risk, Dr. Townsend said he wasn't sure the hospital would require an infected surgeon even today to disclose his illness to patients. He said, however, that Hopkins is re-evaluating the issue.
So far, The Sun has learned of at least two former patients who got themselves tested for HIV yesterday -- one at Hopkins and another at a private medical laboratory. Another woman said she was tested outside the hospital a few months ago in response to rumors.
In addition, Dr. Townsend said "two, three or four" patients said they were tested in past months for reasons unrelated to Dr. Almaraz. All tested negative, he said.
Dr. Almaraz, widely respected for his compassion and skill as a surgeon, died Nov. 16 at age 41. Hospital officials estimate that he operated on approximately 300 patients a year since he joined the full-time hospital staff early in 1984.
Dr. Townsend said the popular surgeon last operated at Hopkins in either February or March, but he wasn't sure of the exact date. In the spring, Dr. Almaraz wrote to his patients, informing them that he had sold his practice and was moving to Texas to perform research. But he made no mention of his health.
His patients, however, began hearing rumors that he suffered from AIDS last spring. Although concerned patients started calling Johns Hopkins about the rumors several months ago, hospital officials said repeated attempts to get confirmation from Dr. Almaraz and his family were unsuccessful.
Finally, after weekend news reports, a hospital lawyer confirmed the reports yesterday at 8:30 a.m. through attorney Marvin Ellin, who represents the Almaraz family.
It was Mr. Ellin who told a Sun reporter Friday that the reports were true.
Joann Rodgers, a hospital spokeswoman, said efforts to reach Mr. Ellin over the weekend were unsuccessful.
In a carefully worded letter to patients, hospital Vice President Hamilton Moses III wrote:
"We have learned that a physician who was on the Hospital staff and who participated in your care here had the Acquired Immune Deficiency Syndrome. Recently, a number of patients who heard the rumor contacted the Hospital. . . . We obtained confirmation today. You may have seen the news about this over the weekend."
Dr. Moses characterized the risk of doctor-to-patient ( transmission as very small, but he offered free counseling and testing to any patient concerned about the risk.
The hospital "appreciates the concern that even the smallest possibility of transmission of HIV can cause," he said in the letter.
"There are no impediments, no barriers," Dr. Townsend said yesterday, "to our patients getting the full information so they can make decisions regarding their health."
Dr. Townsend said hospitals have yet to devise practical or ethical standards to govern the professional conduct of surgeons who are infected with the AIDS virus.
This leaves hospitals without policies that say, for instance, whether infected surgeons should continue to operate -- or whether they should inform their patients.
He said the issue wasn't considered to be important until July, when the federal Centers for Disease Control reported that a Florida woman apparently caught the virus from her dentist. It remains the only case in which authorities strongly suspect a practitioner-to-patient transmission.