Former U.S. Sen. Daniel B. Brewster, ending his two-year stint as chairman of the Governor's Advisory Council on AIDS, says he favors routinely testing patients for the AIDS virus when they enter a hospital.
The other side of the coin, he said last night, is that surgeons and other medical personnel who do inside-the-body procedures "have a moral obligation" to inform their hospitals if they personally test positive to the HIV virus, and a hospital should not allow a sick doctor to perform such invasive procedures.
HIV, or human immunodeficiency virus, causes AIDS, acquired immune deficiency syndrome, a fatal disease that destroys the immune system and paves the way for killer infections and cancers.
Brewster said he believes Maryland doctors should be required not only to report AIDS cases to the state health department, but also to notify state officials of the existence of HIV-infected patients.
"The patient who has HIV is more dangerous to society because he is well and can get around and that is not the case with AIDS patients, who usually are too sick to infect anyone," he said.
Brewster urged the council to study "these difficult and complex issues because this is an insidious disease and the AIDS epidemic is a long ways from being over."
Alluding to last week's disclosure that Dr. Rudolph Almaraz, a well-known Johns Hopkins Hospital breast cancer surgeon, died of AIDS, Brewster said recent events in the city have brought into sharp focus the worry that health care professionals can be infected by patients and that HIV-infected health care professionals could transmit the AIDS virus to patients.
Brewster said he had promised Gov. William Donald Schaefer to take on the council leadership post for two years. Now that time is up, he said, and the governor has asked him to serve on two other state commissions -- one studying the Port of Baltimore, and the other the Greenways Commission to preserve natural areas.
"Something had to give," he said, "and I found I could be more useful on the other two commissions."
Brewster, described by his colleagues as "very fair" and a person "who always gave everyone an opportunity to speak," said he had recommended Robert Watts, council vice chairman and a retired city Circuit Court judge, as his successor.
But, Watts, who conducted last night's meeting after Brewster said he would be leaving, said he could not accept the post because of the pressure of other duties.
"I don't think I have the time to give the council the kind of attention Danny gave it, and, frankly, I didn't have that overwhelming interest that I think a chairman should have," he said. However, he said he would fill the post until the governor appoints a new chairman.
The council failed to discuss Brewster's recommendations. Instead, some members criticized both Johns Hopkins Hospital and the news media for the way they handled the news about Almaraz, 41, who operated on patients while he was infected and died Nov. 16 without ever having told his patients of his disease.
Curt Decker, an attorney, said a letter Hopkins officials sent out to all of the surgeon's estimated 1,800 patients offering them counseling and free AIDS testing should have been sent only to those patients who had actually undergone surgery.
He said the letter sent a "subliminal message" that people should be concerned about "even being in the same room with someone who has AIDS." The way Hopkins handled the situation "is a scandal," he said.
Council member John Watson said the news media "whipped up the lowest common denominator of fear, the boogeyman of AIDS."
Dr. John Bartlett, head of the Johns Hopkins Health System's AIDS program, defended Hopkins' actions, saying, "People are going to be concerned. We don't think there is an appreciable risk. This was one way to allay their fears." He said more than 400 patients had responded to the letter "and we expect the majority will undergo the test."
Dr. Jack Zimmerman, the only surgeon on the council, said, "I might not have done it the way Hopkins did, but they had a no-win situation. Out of this has come a fair amount of panic. Let's take this opportunity to get before the public the facts about HIV transmission -- what we know and what we don't know."
And, when the sometimes heated debate ended, Dr. John Johnson, head of the pediatric AIDS Unit at the University of Maryland Medical Center, had written a statement that included input from several other doctors on the council.
It was approved, with no dissent. Johnson said it would be widely distributed to news media.
The statement says: "The Governor's Advisory Council on AIDS wishes to reassure the public that HIV infection is transmitted by under the skin or mucous membrane exposure to infected body fluids, that is, blood, semen, vaginal fluids and breast milk, through means such as sexual intercourse, intravenous drug use, perinatal transmission or blood-to-blood contact.
"To our knowledge there are no proven cases of transmission during surgery. There should be no concern about contracting HIV infection among people who have simply been counseled or examined by their doctor or health care worker."
After the 3 1/2 -hour meeting, Zimmerman said, "I think the council has done all it can do at this time. All it did was take advantage now of the public interest that is very high.
"Personally, I'm all in favor of encouraging testing in patients and surgeons and other physicians [who do invasive procedures] and I think Senator Brewster's recommendations will have to be discussed by the council in the future."