Johns Hopkins Hospital, dealing with disclosures that one of its surgeons died of AIDS, is calling for legislation that would require all health care workers infected with the virus to report their illness to their supervisors or hospitals.
"Patients have an interest, an expectation and probably a right to know whether the person caring for them has AIDS, hepatitis, tuberculosis or any other communicable disease," Dr. Hamilton Moses III, vice president of medical affairs at the hospital, said yesterday.
The Hopkins proposal would "have to rely on the individual's honesty," Dr. Moses said. Some sort of punishment for those who did not report the disease would have to be part of the state regulation, he said, "but we have not yet thought through what we will advocate as a penalty."
A Hopkins breast cancer surgeon, Dr. Rudolph Almaraz, who operated on about 1,800 people at the hospital, died of AIDS Nov. 16.
The hospital is also calling for a change in how hospital patients get tested for the human immunodeficiency virus to make it a "less burdensome procedure."
When informed of the Hopkins proposals on testing, Susan Kromholz, deputy director for programs at HERO -- the Baltimore-based Health Education Resource Organization, which is devoted to AIDS education and prevention -- was cautious.
"I think our response would be that any actions that involve confidentiality should be looked at very, very carefully," she said. "I think it needs to be looked at from all angles, very, very carefully. I don't think this is a simple ethical or legal situation."
There currently is no statute requiring health care workers to disclose to their hospitals that they have acquired immune deficiency syndrome. The American Medical Association guidelines recommend that an infected physician seek the advice of hospital colleagues.
The dual proposal from Hopkins might help reduce the "fear and anxiety" about the possible transmission of the virus now present among members of the health professions as well as the public, Dr. Moses said.
On the other hand, health workers also are worried about getting communicable diseases from patients. Although the procedures for testing patients for most diseases are fairly routine, getting permission to test people who might have HIV, which causes AIDS, is "rather laborious," according to Dr. Moses.
Maryland law currently requires that patients have a 15- to
30-minute counseling session with a trained HIV counselor before being asked to sign a form consenting to the test, and even when people are brought into emergency rooms, bleeding and unconscious, a test for HIV is not permitted until a relative or guardian signs a form, he said.
Those restrictions are not in place for any other infectious disease, according to Michael Golden, spokesman for the Maryland Department of Health and Mental Hygiene, and according to Dr. Moses.
The consent form for HIV testing, provided to The Sun by Johns Hopkins Hospital, notes that the results of the test will be made be available not only to health care providers but also to the patient's health insurer.
Further, the form states, the hospital will do all it can to maintain the confidentiality of the record, but it says it cannot guarantee that.
People can, however, be tested anonymously.
The Central Maryland Chapter of the American Red Cross is one such anonymous test site.