To protect patients and doctors from the spread of an escalating disease, former patients of the Johns Hopkins Hospital cancer surgeon who died of AIDS are calling for mandatory screening of hospital patients and hospital surgeons for human immunodeficiency virus, which causes the lethal disease.
And, while state law prohibits mandatory screening for HIV, Dr. Hamilton Moses III, Hopkins' vice president of medical affairs, said the hospital would encourage new legislation now that time has brought "a clarification of the disease."
Instead of mandatory testing of patients and surgeons, Moses said, Hopkins advocates legislation "that would permit routine testing of hospital patients . . . believed to be at high risk for AIDS and would require surgeons and other physicians who are HIV-infected to self-report themselves so hospitals could decide what they should be allowed to do."
The call for mandatory screening came yesterday from former patients who underwent mastectomies in the past year or two by Dr. Rudolph Almaraz. The former patients are associated with Arm in Arm, a breast cancer support group that meets at Greater Baltimore Medical Center.
Almaraz has been described as a "brilliant surgeon" and a "charismatic man who had the deepest empathy and sympathy for his patients" by many of the women who sought his help. He died Nov. 16 at age 41. He had remained in practice until February, when he developed the symptoms of full-blown acquired immune deficiency syndrome.
"It's only reasonable that patients should be screened for HIV when they are admitted to hospitals and that hospital staff who are performing interventions that will expose patients to the possibility of AIDS should be screened," said a nurse operated on by Almaraz 2 1/2 years ago. She spoke for the record only if she could remain anonymous.
"I think people are missing two points when they talk about a person's right to privacy," the nurse said. "One is that, yes, he does have a certain right to privacy, but he is exposing someone to a disease that can kill him. The second part is that as a patient, I go to a physician and his job is to protect me using all his skills and knowledge."
Many hospitals do not allow surgeons to operate if they have hepatitis, she said, so why should they allow surgeons to operate if they are HIV positive?
"I was really very angry that I had been exposed to that risk, but I have calmed down now," the nurse said. "No one really knows what that risk is, and I realize intellectually that the risk is probably quite slight. But, if you happen to be that one person, you're dead."
On the strength of the rumors that Almaraz was ill with AIDS, Sue Ritmiller, a GBMC nurse and an Almaraz patient, decided to have the AIDS test last July, two years after her surgery. She tested negative.
"Even though he was a brilliant surgeon, a very, very charismatic man who genuinely loved his patients -- you could feel it -- I do believe he should have said something about his disease," Ritmiller said.
"I think things have to change in the medical field. There should be mandatory testing every year for doctors and nurses. I think when people go to a surgeon they should have the privilege of knowing whether or not he is an AIDS carrier and that a surgeon has the right to know the same about his patients."
She said her feelings are shared by other nurses and health-care professionals in Arm in Arm.
"This topic is so explosive," Ritmiller said. "It's like the talk of every hospital. And everyone hopes the Almaraz case is going to be the catalyst that brings about change.
"I work in an intensive care area and if I have a herpes lesion on my mouth, I cannot work. Where is the ethical reasoning behind someone who is infected with HIV -- a killer -- and dealing with people?"
Susan Meinhert, an Almaraz mastectomy patient 2 1/2 years ago, said she is "kind of incensed" that a doctor is allowed to function in an institution, like Hopkins, with AIDS.
"I don't think Hopkins handled the Almaraz incident very well," she said. "There must have been some knowledge of his illness since he believed he had contracted the AIDS virus in 1983 [while he was a fellow in surgery at Memorial Sloan Kettering Cancer Center in New York]. It seems strange a doctor can be on a hospital staff and the hospital can't discover this problem."
Another patient, who has been a nurse anesthetist at hospitals in Baltimore, Chicago and Virginia, said she believes Almaraz "went awfully far into his illness" before he stopped practicing and "that does not seem defensible."
She had her surgery in June 1989, found out "from very reliable sources" in July that Almaraz had AIDS, and she was tested in August. She tested negative and plans tests every year for the next few years.
"I'm really on his side because he did so much good for so many people," she stressed. "But, as I continue to think about it, I get a little indignant that he kept doing such invasive procedures."