Surgeon questions link between operation, AIDS

December 17, 1990|By Susan Baer

The senior surgeon at an operation in which Dr. Rudolph Almaraz reportedly contracted AIDS says there has never been any surgical accident in his career "that could have put me or my colleagues at risk for contracting AIDS."

Dr. William Knapper of New York's Memorial Sloan-Kettering Cancer Center said in a written statement to The Sun, "It is clear that the case in question was a routine procedure that was performed with our full knowledge of the patient having AIDS."

Dr. Almaraz, a prominent breast cancer surgeon at Johns Hopkins Hospital, died of acquired immune deficiency syndrome last month. Before his death he told his attorney, Marvin Ellin, that he had contracted the disease while assisting in a surgical procedure at Sloan-Kettering in which there was an arterial blood spurt from an AIDS-infected patient.

Dr. Knapper said he didn't remember the specifics of the operation, which Mr. Ellin believes occurred during a lymph-node biopsy Dec. 12, 1983, nor did he remember Dr. Almaraz. But Dr. Knapper said, "At no point in my career was there ever an arterial spurt while I was doing a biopsy of a subcutaneous [under the skin] lymph node."

After reviewing the operating report from the procedure -- written by Dr. Almaraz -- Dr. Knapper said, "I can assure you that at no point in my career, in any surgical procedure that I performed on an AIDS patient, was there ever any accident that could have put me or my colleagues at risk for contracting AIDS."

In a bedside meeting at St. Joseph's Hospital one month before hedied, Dr. Almaraz told his attorney that the surgery in which he was exposed to the AIDS virus took place "in the latter part of November or December," the end of a six-month fellowship at Sloan-Kettering in 1983, Mr. Ellin said.

Mr. Ellin's review of Dr. Almaraz' operating records for those two months turned up a single procedure that involved an AIDS patient: a Dec. 12 biopsy of a lymph node in the groin of an AIDS patient with Kaposi's sarcoma, a rare cancer. The patient died two weeks later.

"Obviously that was the one," said Mr. Ellin.

"Dr. Almaraz told me that while surgery was proceeding . . . blood squirted in his face, hitting him in the eyes and mouth," said Mr. Ellin, who is considering filing a claim against Sloan-Kettering. "There was such a quantity of blood that it saturated his T-shirt. The blood stains had gone through everything and stained his T-shirt."

But Suzanne Rauffenbart, a spokeswoman for Sloan-Kettering, said Dr. Almaraz described that particular surgery in his report as a "routine procedure" completed "without any apparent complications."

And she added that "there were no incident reports of arterial blood spurts submitted by Dr. Almaraz in the entire time he was here."

Responding to Dr. Knapper's statement, Mr. Ellin questioned the surgeon's memory of an incident seven years ago and said, "The doctor is entitled to his recall as he understands it. I expected that."

Mr. Ellin added that he was in the middle of his own investigation.

Operating-room nurses present for the surgery at Sloan-Kettering did not recall any specifics about the case, Ms. Rauffenbart said.

Mr. Ellin said he believed an arterial blood spurt was not that unusual an incident and therefore would not necessarily be noted on an operating report.

Although Ms. Rauffenbart said an arterial spurt would have been noted on an operating report at Sloan-Kettering, surgeons differ on the reporting of such incidents, generally caused when an artery is nicked during surgery.

An administrator at the medical center at the University of California at Los Angeles who is familiar with operating-room procedure said an arterial blood spurt would "most assuredly" be noted on an operative report since, for one thing, it would suggest blood loss in the patient.

But Magruder Donaldson, associate surgeon at Brigham & Women's Hospital in Boston, said a blood spurt "might not be noted in an operative report." He said such bleeding "might be expected and inconsequential and dealt with in the course of the operation. It might not be brought out as a memorable feature of the operation."

He said that in the case of an AIDS patient, a doctor might instead note such an accident on a special incident report.

Mr. Ellin said Dr. Almaraz would not necessarily have filed such a report with the hospital since, in 1983, far less was known about AIDS and the dangers of its transmission through blood.

"He wasn't that concerned about it any more than any average surgeon would have been back in 1983," said Mr. Ellin, noting that no AIDS test had been developed by December 1983.

But Gayle Lloyd, a spokeswoman for the U.S. Centers for Disease Control, said: "Everybody knew by '83 that the transmission of the [human immunodeficiency virus] was similar to the transmission of the hepatitis-B virus -- blood-borne as well as carried in sexual fluids. We knew it was blood-borne as well as carried in sexual fluids and other bodily fluids."

In November 1982, the CDC published a list of precautions for health care and laboratory personnel encountering AIDS cases, she said.

The publication states, "At present, it appears prudent for hospital personnel to use the same precautions when caring for patients with AIDS as those used for patients with hepatitis-B virus infection, in which blood and body fluids likely to have been contaminated with blood are considered infective."

Although Mr. Ellin said he has not yet contacted Sloan-Kettering in any official manner, he suggested that he plans to file claims against the hospital for workmen's compensation benefits and more.

"Workmen's compensation where someone like Rudolph Almaraz dies as a result of performing an operation is poor compensation," he said. "This is someone who spent years and untold thousands of dollars to achieve a level of expertise."

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