Health-care workers infected with AIDS face painful dilemma XTC 628 doctors have disease, CDC reports

December 16, 1990|By Jonathan Bor

Dr. Joseph Nkwanyou, a Baltimore internist who has treated many AIDS patients, recalls a young man in his 20s who had lost his job, exhausted his savings and become homeless after he was stricken with the disease.

Destitute, he left the city where he lived and came to Baltimore, hoping to find treatment and work.

The man showed up in Dr. Nkwanyou's office after hearing the physician had accepted other AIDS patients without insurance.

The other day, Dr. Nkwanyou recalled with a smile the man's cultured speech and his sophisticated manner -- traits that seemed curiously out of place for a man with no foothold in society.

"I was really struck by his diction. Something struck me about him," said Dr. Nkwanyou, who also treated Dr. Rudolph Almaraz, the Johns Hopkins Hospital surgeon who died of AIDS last month.

The destitute patient regained his strength for a while, worked as a labtechnician in a local hospital and salvaged some productive months.

After his death, a friend of the patient gave Dr. Nkwanyou a letter the man had written before he died. He thanked Dr. Nkwanyou for his kind service. And he revealed something else: that he was a doctor who had given up his practice after he became too sick to work.

The man is one of about 10 local physicians with AIDS or its precursors whom Dr. Nkwanyou has treated -- a detail, he adds, that is significant only in light of the recent uproar over news that Dr. Almaraz, a cancer surgeon with a thriving practice in Baltimore, had AIDS.

"There are many people in this country who think AIDS is a disease of the underclass, of drug addicts . . . This is a problem that stretches evenly across society," Dr. Nkwanyou said.

"Doctors reflect the general population of patients. I'm sure there are a lot of infected doctors taking care of people around the country. I take care of a lot of them."

The federal Centers for Disease Control has reports of 40 surgeons, 588 nonsurgical doctors, 144 dental workers and 1,063 nurses who have been diagnosed with acquired immune deficiency syndrome. A spokesman said the agency has no idea how many are dead, how many are alive and how many are still practicing.

In Maryland, the health department knows of 15 physicians who have been diagnosed with AIDS since the epidemic surfaced a decade ago. That agency, too, isn't sure how many are alive today.

Dr. Nkwanyou doesn't believe that any of the infected doctors he treated -- besides Dr. Almaraz -- performed surgery.

But he finds it logical to assume that there are infected surgeons in operating rooms across the country, knowing or not knowing that they carry the virus. "You're looking at just one glamorous case," he said.

His belief that the Almaraz case is not unique is shared by Hopkins officials.

"We are absolutely certain that at this very minute, there is at least one surgeon or other health-care worker in every major urban hospital in this land who is HIV positive or who had AIDS," Dr. Hamilton Moses, Hopkins vice president for medical affairs, said Friday at a news conference.

Complicating the issue of infected health-care workers is the virus' incubation period: Medical evidence suggests that patients harbor the virus for an average of 10 years before they become sick with the full-blown disease. During this period, people are capable of transmitting the virus even though they may have no idea they are infected.

Dr. Nkwanyou said the long incubation period casts a curious irony on the decision by Hopkins officials to disclose Dr. Almaraz's illness to 1,800 former patients and offer them testing for the HIV infection.

"A surgeon can go on operating for 10 to 15 years without knowing he's infected," he said. "So if you're going to test 1,800 patients you should test everybody else in the place and test all your surgeons. Then there'd be pandemonium."

Although he believes there are other infected surgeons operating, Dr. Nkwanyou is eager to shatter fears that they pose a significant risk to their patients.

"It's natural to be paranoid and overly concerned with the risk, and the debate is a healthy one," he said. "The truth is, I don't think that the relationship of a surgeon to a patient constitutes any risk. There's no evidence to support that it is."

The CDC, he noted, has evidence to suspect only one practitioner-to-patient transmission -- a case of a Florida dentist who appears to have infected a female patient during a tooth extraction. Even that link, he said, hasn't been fully established.

In Tennessee, the state health department tested 616 patients who had been operated on by an infected surgeon.

Only one patient tested positive for the human immunodeficiency virus (HIV), which causes AIDS. He was an intravenous drug user, which makes it more likely that he contracted the disease through shared needles than surgery.

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