AIDS dilemma confronts hospitals Patient, doctor obligations eyed


Deluged by AIDS policy inquiries from medical centers across the country, the Maryland Hospital Association is forming a task force to wrestle with complex and controversial issues that have surfaced since a Johns Hopkins Hospital breast-cancer surgeon died from AIDS.

"This is pushing us to rethink the whole issue of what we must know about our patients and our care givers and what the responsibility between those two groups [is] to communicate with each other," says Richard H. Wade, the MHA's vice president for communications.

The panel, which will involve people from all over the state, is expected to hold its first meeting next week. It will include surgeons and other physicians, nurses, specialists in acquired immune deficiency syndrome, hospital attorneys, hospital trustees and MHA officials. The chairman has not been appointed.

Wade said today the association office in Lutherville is being flooded with calls asking what is happening in Baltimore with regard to AIDS policies affecting hospitals.

"This story has spread across America and they want to know what kinds of things are being said to hospitals by the MHA and others about what their responsibilities are," he said.

The panel will be looking closely at questions raised by the death of the Hopkins surgeon, Dr. Rudolph Almaraz, and deciding what hospitals need to do, he said.

The questions will include:

* What is any patient or physician required to tell hospitals when asked?

* Should a surgeon who has the HIV virus that causes AIDS have to disclose his condition to the patients he operates on?

* Do hospitals have the right to restrict privileges or the medical practice license of anyone once a hospital knows the person has AIDS?

* Who decides what is an impairment to a particular physician's practice in hospitals and unregulated medical clinics?

Implementation of some of the positions the task force will take probably will require new legislation, Wade said.

The MHA would not be surprised that when state health officials and the assistant attorneys general finish reviewing the state law on physician credentials that there won't be a need for legislation to clarify that, Wade said.

"When the state law tells the hospital it must document the physician's medical history and the status of his physical and mental health, what does that require us to do?" he asked. "Now, hospitals do different things. Some are requiring physicals, and clearly, there is an enormous burden being put on physicians by hospitals to tell them things.

"There are serious questions as to what degree we can invade other people's private lives," Wade said. "And, how can we be the ones to determine what our rights are? I'm not sure we can. A lot of this will have to be sorted out by the courts ultimately."

Between 1984 and last March, Almaraz treated or operated on an estimated 1,800 patients. His attorney, Marvin Ellin, said the Hopkins surgeon believed he contracted AIDS from an AIDS patient he operated on while a surgical fellow in 1983 at Memorial Sloan Kettering Cancer Center in New York City.

Almaraz kept operating on patients until last March, eight months before he died. He never told his patients he had a fatal disease. And, when the nature of his death was confirmed by his attorney, at least 400 or more of his former patients notified Hopkins, which sent letters to all his patients.

Many accepted Hopkins' offer of free counseling and free blood tests for human immunodeficiency virus, which causes AIDS. Some called news outlets, saying it was time for mandatory nTC testing for HIV for surgeons as well as patients. And, at least two suits have been filed by former patients against Almaraz's estate because he failed to disclose his disease.

"When you think of what Hopkins has been faced with, they have handled the situation brilliantly," Wade said. "This situation with Dr. Almaraz became public here and I'm not so naive as to believe this has not happened in San Francisco, New York or elsewhere across the country.

"The point is, that Hopkins has been the first one that has had to grapple with it in the harsh light of publicity. Hopkins is carrying the burden of defining these issues for every other medical institution in America."

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