Flooded by more than 200 inquiries from patients of a Johns Hopkins Hospital surgeon who died of AIDS, the hospital has begun mailing a "peace of mind" letter to an estimated 1,800 women he had treated or operated on over the last six years.
The surgeon, Dr. Rudolph Almaraz, who specialized in breast cancer treatment, died Nov. 16.
"You should be reassured knowing that there is very little chance that you could have become infected," says the letter signed by Dr. Hamilton Moses III, the hospital's vice president for medical affairs. The letters began going out yesterday.
The hospital's physicians and other workers follow "many precautions that are designed to prevent the transmission of all infections, including AIDS," the letter says. The protective gear includes masks, gloves, goggles, non-permeable gowns and, in some cases, helmets.
The letter repeats an earlier offer to test patients for the human immunodeficiency virus, which causes the fatal acquired immune deficiency syndrome, and to counsel patients about the possibilities of transmission of HIV.
Almaraz, regarded as a highly compassionate surgeon with impeccable skill and known for an affluent following that included Hollywood celebrities, died of AIDS at his Parkton home. He was 41.
AIDS cripples the immune system, the body's defense system against foreign invaders, and paves the way for killer infections and cancers. It is spread by close contact with blood, blood products or semen from infected people. No one is known to have recovered from AIDS.
Experts say the chance of a doctor's giving a patient AIDS is so small as to be immeasurable. So far, there has been only one known documented case in which a patient is believed to have contracted AIDS from a health care provider and that involved a dentist in Florida.
Meanwhile, Marvin Ellin, the attorney who represents the Almaraz family, says he is pursuing possible benefits the surgeon and his wife, Betty, and his 3-year-old daughter would be entitled to receive from Sloan Kettering Medical Center in New York and from Hopkins. Almaraz told Ellin he believed he became infected in 1983 at Sloan Kettering, where he was on loan from Hopkins under a fellowship.
"Dr. Almaraz told me that in the middle of surgery he was squirted with arterial blood hitting him in the eyes and in the mouth from an incision he made," the attorney says. "The doctor was very concerned about it. He knew the patient had AIDS. He also told me he operated on a great number of AIDS patients while in New York."
Ellin says the rigorous training Almaraz underwent in New York ++ worked to the benefit of Hopkins when he returned.
The attorney says he has asked Sloan Kettering to furnish him the operative and laboratory reports of the patients whom Almaraz performed surgery on in November and December 1983. The names would be deleted to protect the patients' identity, he says.
"These reports will tell me whether any of the patients had an AIDS diagnosis and, more important, what hospital workers wrote with respect to an arterial bleed episode," Ellin says.
Ellin says he questioned Almaraz at length Oct. 18 while the surgeon was hospitalized at St. Joseph Hospital in Towson. When Ellin tried to call Almaraz later, his condition had deteriorated and he had been hospitalized at University of Maryland Medical Center.
Although Hopkins officials report that some patients are worried and even angry that Almaraz performed surgery and saw patients until February, when he developed the overwhelming infections that led to his death, there are others who are taking it stoically.
"It's one of those things. If I'm infected there is nothing I can do about it anyway," says Erica Lindsay, 48, of Baltimore. "If I'm unlucky, I'm unlucky."
Lindsay underwent a mastectomy at Hopkins in August 1987. It was her second cancer diagnosis after she was treated with radiation for kidney cancer in 1962. Almaraz advised her to undergo immediate surgery.
If she had known in 1987 that Almaraz was infected with AIDS, Lindsay says, she "probably would not" have chosen him as her surgeon.
"That is a tough one," she says. "I really don't know. Cancer has its own special fears. When I had it a long time ago, having cancer was kind of like having AIDS now. It was a death sentence and when I had my first round with it, people thought I wouldn't be around very long."
Lindsay says she learned that Almaraz died of AIDS "through the grapevine" from a friend who works at Johns Hopkins Hospital. When Lindsay read Ellin's confirmation in The Sunday Sun that Almaraz died of AIDS, she says, she felt nothing but sorrow.
Ellin says a woman who was only examined by Almaraz but never underwent any surgery called him yesterday, very upset, to ask who would pay for her AIDS test. Her irate call was one of three he has received regarding Almaraz, he says.