In the aftermath of disclosures that a Johns Hopkins Hospital surgeon died of AIDS, the Maryland Hospital Association is asking the state for a clearer definition of the rules for monitoring physicians' health.
"Up to now, the concern has been about the patient's status. But the Hopkins incident raises some questions we need to ask," Rick Wade, vice president for communications at the Maryland Hospital Association, said yesterday.
Those questions concern the degree to which hospitals should examine the health status of medical practitioners. Currently, state regulations regarding doctors require only that hospitals assess the "current mental and physical health status" of physicians to whom they give privileges and that they reassess that status every two years as part of the "re-credentialing" process for the state licensing office in the health department. "That has been interpreted as looking for anything that would impair the physician's ability to practice," Mr. Wade said.
"Now, the incident at Hopkins opens up a whole other area of inquiry. We are trying to get a clearer interpretation of that ruling. We have asked for a more specific interpretation, so we know what kind of guidance to give our members about what to ask their physicians."
Carol Benner, acting director of the office of licensing and certification programs at the Maryland Department of Health and Mental Hygiene, confirmed that those discussions are taking place.
At present, Maryland hospitals do not routinely do blood tests on hospital employees or private practitioners who have hospital privileges to determine whether they have the human immunodeficiency virus or any other communicable disease. To do so would be an invasion of privacy, an intrusion into the doctor-patient relationship, and not very useful, since a person who tests negative today might get infected tomorrow, spokesmen at Baltimore hospitals said.
Experts believe the "universal precautions" required at all hospitals, which call for the gloving, gowning and masking of health-care workers during invasive procedures, protect patients as well as doctors from exchange of infectious body fluids.
The questions are being raised in response to disclosures that Dr. Rudolph Almaraz, who is believed to have operated on about 1,800 patients since joining the Hopkins staff in 1984, died of acquired immune deficiency syndrome Nov. 16. Rumors that he had AIDS had been circulating among his patients for several months and had been reported to Hopkins, but confirmation did not come until Friday, when Baltimore attorney Marvin Ellin, representing the Almaraz family, told The Sun: "He had AIDS, and he died of AIDS."
Hopkins has offered worried patients free counseling and testing for the HIV, which causes AIDS, even though experts throughout the medical community believe the risk that a doctor could infect a patient during surgery is very low. Only one patient is believed to have ever been infected by a health-care worker -- her dentist -- but 37 health-care workers are believed to have been infected by contact with AIDS-afflicted patients.
Mr. Ellin, appearing last night on CNN's Larry King Live, faulted Hopkins, claiming the hospital had caused undue concern by announcing that patients should come in for tests.
According to a study published in today's Journal of the American Medical Association, concern about transmission from patients to health-care workers has led most of the 561 hospitals surveyed to adopt policies that call for HIV testing of patients.
The study did not ask the institutions whether they test health-care workers.
"We were a year too early," said Dr. Charles E. Lewis, professor of medicine at the University of Calfornia Los Angeles and one of the authors of the JAMA article. "If we go back next year, we will certainly want to look at that, because my hunch is that we will have a third player in the ring."
He said the issues -- or "players" -- so far have been the rights of patients who may have AIDS and the concerns of the medical staff about which patients might have the virus.
"Which of the providers might have the virus" is the third issue, he said.
Dr. Almaraz believed he contracted HIV while operating on an AIDS patient at Memorial Sloan-Kettering Cancer Center in 1983, according to Mr. Ellin.
But according to Suzanne Raussenbarg, vice president for public affairs at Sloan-Kettering: "We have received operating room reports and our employee health reports for the period of time of Dr. Almaraz' fellowship. Our records show he didn't file any incident reports on unusual exposures to blood during that time."