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Hopkins wants CDC rules on care-givers with AIDS, joins study of Almaraz case


An article in Saturday's editions of The Sun implied that the state health department had identified Dr. Rudolph Almaraz as one of 15 physicians in the state who has been diagnosed with acquired immune deficiency syndrome. Although Dr. Almaraz did die of AIDS and was one of the 15 physicians counted by the state, his name was neither confirmed nor denied by the health department, whose AIDS reporting system is based on confidentiality.

Citing a "policy vacuum" regarding the issue of health-care workers with AIDS, Johns Hopkins Hospital officials called yesterday on the U.S. Centers for Disease Control to issue specific policies.

In a news conference, Dr. Hamilton Moses III, Hopkins vice president of medical affairs, also announced that the Maryland Department of Health and Mental Hygiene will join Hopkins and the CDC to conduct a study of the 1,800 patients treated by Dr. Rudolph Almaraz, the surgeon who died last month of acquired immune deficiency syndrome.

The purpose of the study will be to gather data on the risk of infected physicians' transmitting the AIDS virus to patients.

Dr. Moses emphasized that Hopkins is not alone in facing this problem.

"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 has AIDS," he said.

According to the state health department, Dr. Almaraz was one of 15 physicians in the state who have been diagnosed with AIDS. The health department does not know how many of those doctors are still alive or treating patients.

Hopkins is turning to the CDC for guidelines about HIV-infected employees rather than just formulating its own policy, Dr. Moses said, be

cause "this is a controversial topic."

"We want help. We do not feel it is appropriate for us to be in the spotlight," he said. "AIDS is not just a disease, it's a political phenomenon."

In a letter to Dr. William Roper, director of the CDC, Dr. Moses asked that the CDC announce when hospitals and health-care workers can expect specific guidelines. The letter asked a number of questions, including what studies are needed to quantify the risk of transmission from health-care worker to patient, which medical procedures would pose the highest risk, whether HIV-infected health-care workers should be curtailed from patient contact and what legal restraints hospitals could place on infected employees.

The CDC is drafting revised guidelines for health-care workers, according a spokeswoman, and a draft is expected to be ready in the next few weeks. The most recent guidelines, released in 1988 -- two years before the reporting of a case in which a Florida dentist with AIDS apparently infected a patient -- emphasized standard precautions that health-care workers must take, such as wearing masks, eye coverings and gowns.

Earlier this week, Richard H. Wade, vice president for communications of the Maryland Hospital Association, said his group would also begin grappling with the issues raised by the Almaraz case. A task force will be formed, and one issue to be considered is whether an HIV assessment should be a part of doctors' annual licensing process.

In Maryland, regulations say "medical history and an assessment of physician's physical and mental health" should help determine whether a doctor can keep his or her license in the state.

Dr. Timothy R. Townsend, a Hopkins epidemiologist, said he knows of "no other surgeons or people who do perform invasive procedures" at Hopkins who have AIDS or an HIV infection.

There have been "a handful" of other hospital employees known to have HIV infections, he said, and "their cases were evaluated on an individual basis in terms of their activities and potential risk." Some of the workers were re-assigned to the AIDS unit.

Hopkins has received calls from about 400 patients since sending out a letter earlier this month advising

Almaraz's patients that their doctor had died of AIDS. Although many have been tested for HIV infection, the hospital ++ said it would release no results of testing before all the data is collected. According to the health department, that will take at least several months.

"We would like to see every one of Dr. Almaraz's 1,800 patients tested," Dr. Moses said. "We think it is extremely important for as many patients as possible to come forward."

The initial test involves withdrawing a small amount of blood. Patients who test positive for the AIDS virus will be asked to answer questions assessing whether there might have been other ways they could have become infected.

With nearly 2,000 patients to be tested and the incidence of HIV infection in this country from 2 to 4 per 1000, Hopkins officials emphasized that the tests are likely to turn up some positive results not necessarily linked to Dr. Almaraz.

At University Hospital -- which is second in the Baltimore area, after Hopkins, in number of patient beds -- the first case of HIV infection in an employee recently was reported to hospital officials, said Dr. Michael Martin, head of infection control for the hospital. He said that a nursing aide had the infection and that a meeting would be held soon to assess risk to patients. University Hospital requires employees to report infectious diseases to their supervisors.

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