BALTIMORE — Breast cancer surgeon Rudolph Almaraz was considered a gifted healer who inspired trust, but his death last month left some of his former patients frightened and feeling betrayed.
He had never told his hospital or his patients that he had AIDS.
The case has embroiled Johns Hopkins Hospital, one of the nation’s most respected medical centers, in an emotionally charged debate over the responsibility of doctors to inform patients of their own health problems.
Two weeks after Almaraz died, The Sun reported he had operated on some 1,800 patients after becoming infected with the AIDS virus.
After the story broke, Hopkins mailed letters to those former patients and invited them to call if they had concerns. About 400 have called so far.
“The reaction has varied, really, from one extreme to the other,” said Dr. Timothy Townsend, the hospital’s senior director for medical affairs, who has taken about 100 of the calls.
“Some are tremendously shocked that they were not told. He was an extremely charismatic doctor,” Townsend said. “Many, a large majority, have very nice things to say about him. Many of them feel a bewilderment and a sense of betrayal.”
About 90 percent of the callers have indicated they will accept Hopkins’ offer to be tested for the AIDS virus.
Hopkins doctors emphasized the slight risk of contracting the AIDS virus during surgery.
According to one study, a physician who is cut while operating on an AIDS patient has a 0.2 percent chance of picking up the AIDS virus.
The risk of transmission the other way — from doctor to patient — is even smaller. Of the estimated 1 million HIV-infected Americans, only one patient is believed to have been contaminated during medical treatment, experts say.
Hopkins doctors say the only way Almaraz could have passed on the AIDS virus is if he had cut himself during surgery and dripped blood onto the patient. Hopkins knows of no such incidents involving Almaraz.
The case has placed Hopkins in the middle of the growing national debate over whether doctors have a moral obligation to inform patients if they are infected with HIV. The issue arose in July when it was disclosed that a Florida dentist apparently passed on the AIDS virus to one of his patients.
“The risk is almost zero; not zero, but almost,” said Dr. Hamilton Moses III, vice president for medical affairs at Hopkins. “The question is does a patient have a right to know. That question should best be answered in the context of the risk.”
Even Hopkins doctors are split on an HIV-infected doctor’s moral responsibility.
“If the risk is zero or close to zero, then I don’t think there is a responsibility,” Townsend said.
“Personally, I think the patient does have the right to know and to make that choice,” said Dr. Robert Heyssel, president for medical affairs at Hopkins.
Officials at the U.S. Centers for Disease Control said they expect to come up with a policy next month to guide hospitals in deciding whether HIV-infected doctors should be allowed to operate and whether they should inform patients.
Three lawsuits, including one for $22 million, have been filed against the hospital and the Almaraz estate. Plaintiffs claim mental anguish over the fear that they might get AIDS.
Marvin Ellin, the attorney for Almaraz’s widow, complained about a Baltimore law firm’s placement of advertisements offering its services to patients operated on by HIV-infected surgeons. Almaraz’s name was not mentioned.
Gary Strausberg of the firm of Janet and Strausberg, which placed the advertisement, said the firm has been contacted by several of Almaraz’s former patients and lawsuits are under consideration.
“A patient who is treated by a health care provider should not be exposed to extraordinary danger. He has a right to know whether he is being exposed to an additional risk,” said Strausberg.
Hopkins officials say they don’t think the case will have any long-term effect on the hospital.
“This is a flap that will soon pass,” Moses predicted. “We will have a legacy of lawsuits. It will have some educational value for the public and provide better data (on the risk of doctor-to-patient transmission of HIV). But I don’t think this will have major consequences.”
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