AIDS and health care

December 04, 1990

In statistical terms, the chances of a health-care worker transmitting AIDS to a patient have to be rated as infinitesimal. Indeed, there is but one reported case -- that of a woman in Florida who contracted the fatal disease from her dentist.

But statistics will be of little comfort to the estimated 1,800 women who were operated on for breast cancer by Dr. Rudolph Almaraz at Johns Hopkins Hospital over a six-year period. Those women, who already live with the statistical probabilities of cancer, must now add the statistical probabilities of AIDS to their anxieties.

But in its larger implications this case reaches beyond just the 1,800 patients who placed their lives and bodies in Dr. Almaraz's hands. Inevitably the case will raise new anxieties among all hospital patients that they may contract AIDS while undergoing treatment. Inevitably, also, the case raises new questions about AIDS-testing for those who work in hospitals. The 1,800 former patients of Dr. Almaraz who are now being offered AIDS tests will ask: Why was not one doctor tested earlier rather than 1,800 patients later?

It's a reasonable question. After all, no one questioned whether food-service workers, when tuberculosis was rampant, could be required to undergo tests for that disease. Today, there is a general consensus that persons in whom we routinely entrust our safety -- airline pilots and train engineers, for example -- can be required to undergo periodic testing for drug and alcohol abuse.

Yet AIDS testing for health-care workers -- and, for that matter, patients as well -- remains highly controversial.

Surely there is room here for compromise which would reassure a shaken public that the curing process does not become a killing process. One possibility: Health-care workers whose jobs involve any bodily contact might voluntarily undergo periodic screening for AIDS infection -- much as blood donors now do. After all, the health care workers themselves might be reassured by such procedures, since their risk, statistically speaking, is far greater than patients' risks. With voluntary procedures in place, patients could be discreetly reassured, on routine forms that must be completed, that they are in an AIDS-free environment.

We can rest assured that if there are many more publicized cases like that of Dr. Almaraz or the dentist in Florida, there will be a public clamor for mandatory testing.

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