A Baltimore dentist, who at times reportedly did not wear surgical gloves in treating about 4,000 Maryland prison inmates, has died of AIDS, sending officials scrambling to set up counseling and testing programs and to assess the state's financial liability.
Victor Joseph Luckritz, 47, who lived in Mount Washington and at one time had a private practice, was the chief dentist at the Maryland Penitentiary between June 1988 and April 1990. He was responsible for over seeing dental care for inmates in the six Baltimore-area prisons, state officials said at a news conference. Inmates and officials said they learned that Dr. Luckritz had acquired immune deficiency syndrome through a death notice published in The Sun three days after he died May 7.
Since the staff in the Division of Correction headquarters learned of it Monday, they have been working "around the clock" on an investigation, said Correction Commissioner Richard A. Lanham Sr.
Correction and health department officials also are investigating reports that a second dentist who treated inmates in the Baltimore region also may have died of AIDS, he said. Officials would not name the second dentist because of privacy protections.
While correction officials have not yet identified specific inmates treated by Dr. Luckritz, they are estimating he saw "several thousand" prisoners, Mr. Lanham said. Correction officials said privately they estimate the number could be as high as 4,000.
Inmates were notified late yesterday through each prison's inmate council, Mr. Lanham said. They were told that once Dr. Luckritz's patients have been identified, they will be offered counseling and the option of being tested for the AIDS virus. Former inmates will be notified by certified mail and advised to see their local health department or private physician.
Mr. Lanham described the chances of an inmate contracting the AIDS virus during a dental procedure as "minimal," and a health official later put the odds at 2 in 1,000.
In the 10 years since the epidemic surfaced, federal authorities have documented three cases in which patients contracted the AIDS virus from a health-care worker. All three -- two women and a man -- werepatients of Dr. David Acer, a Florida dentist who died of AIDS last year.
L More than 170,000 AIDS cases have been diagnosed since 1981.
The Luckritz case has thrust Maryland into the controversy over health-care workers and AIDS for the second time in six months. Last December, The Sun revealed that a popular cancer surgeon at Johns Hopkins Hospital had died of AIDS a month earlier, creating widespread concern that the doctor may have put patients at risk. There have been no documented cases of his passing the virus to patients.
Dr. Luckritz was not a state employee, but an independent contractor working for Correctional Medical Systems, a St. Louis-based subsidiary of ARA Group Inc., the company with a $26 million, 3 1/2 -year contract to provide medical services at the state's prisons.
The dentist initially was hired by CMS' predecessor, PHP Health Care Corp., and was kept on after the contract went to CMS, Mr. Lanham said.
State records show that Dr. Luckritz was first licensed by the state in 1984 and that his license was renewed every two years afterward. No disciplinary action had been taken against him, said Larrie L. Bennett, administrator of the State Board of Dental Examiners.
John D. Hilburn, vice president of operations for Correctional Medical Systems, said his company's records show that Dr. Luckritz had a private practice before he worked in the prison system, but he could not offer any more details. Mr. Hilburn said Dr. Luckritz and the company "mutually agreed" to part April 9, 1990, because of his difficulty in "interpersonal relationships" with staff and patients, and because he did not wear protective surgical gloves all the time, contrary to the company's "infection control procedures."
Mr. Hilburn said the agreement for Dr. Luckritz to leave came on the heels of a March 30, 1990, incident involving an inmate at the Maryland Correctional Adjustment Center in Baltimore, the so-called Supermax prison, where about 280 of the state's worst criminals are housed.
The inmate refused treatment after seeing that Dr. Luckritz was not wearing gloves, telling both the dentist and a correctional officer why, Mr. Hilburn said.
While correction officials said privately that at the time of the incident the dentist had sores visible on his hands, both Mr. Hilburn and Mr. Lanham said they knew of no reports of sores.
Since 1985, the U.S. Centers for Disease Control in Atlanta have recommended that dentists and other health-care workers who come in contact with patients' blood on a regular basis wear gloves, eyewear and masks. The company has had a long-standing policy along those lines, Mr. Hilburn said.
Doctors and dentists have no legal obligation to disclose their illness to their patients or employers, or to limit their practice. The CDC is currently working on guidelines addressing this issue.
CMS' contractual arrangement with the state has raised the question of the state's liability to pay for counseling, testing and ultimate treatment of those inmates who could have been infected with the virus by Dr. Luckritz. It remained unclear yesterday who would pay.
Deputy Attorney General Judson P. Garrett Jr. said the state has asked Correctional Medical Systems to take "immediate and full responsibility" for any cost and liability.
But Mr. Hilburn said the company has not yet agreed to do so and negotiations are under way.
Complicating the liability question further is that the state estimates that about 10 percent of the prison population already has tested positive for the AIDS virus, Mr. Hilburn said.
Dr. Luckritz's friends and colleagues described him as a man who carried his illness with humor and dignity.
James Harp, director of the Baltimore Men's Chorus, recalled Dr. Luckritz as a man with a keen sense of humor who was "a real inspiration to us because he overcame adversity with such good grace."
Dr. Luckritz, a tenor, continued to sing with the chorus when he was extremely ill.
Mr. Harp said he last saw Dr. Luckritz at an Easter Saturday service.
He recalled that even then, while quite ill, Dr. Luckritz managed to make his way to the altar to receive communion. "I was impressed. Even though he was very ill, he maintained his dignity."
Friends said they had a hard time believing that Dr. Luckritz would practice without wearing gloves, a mask and gown -- and without informing prison authorities that he had AIDS.
Carol Hilton, a close friend who coordinates the AIDS vaccine trials at Johns Hopkins Hospital, said she simply doesn't believe the assertions of prison authorities.
"I don't believe it at all. It's just a cop-out," she said. "I've known him for years. He was very conscientious about everything. If there were universal precautions, then he observed them. He was a pro. No question about it."
She said Dr. Luckritz left the prison when his health started to deteriorate. He didn't go into a steep decline, however, until about two months ago -- the point, she said, "when you weren't really sure if he would recognize you."
"His health deteriorated very rapidly," she said. "Faster than most people I know. I think part of that was that he truly accepted that this was his fate, and he wasn't going to fight it. Once these people have no fight in them, they don't survive."
AIDS and health-care workers
As of March 31, 1991, the Centers for Disease Control knows of 6,436 AIDS patients that were health-care workers. That's 4.8 percent of all acquired immune deficiency syndrome cases recorded since the epidemic began. Of these:
* 171 are dentists and hygienists; 120 of them have died.
* 703 physicians; 492 dead.
* 47 surgeons; 32 dead.
The CDC knows of only three patients that have contracted the (( human immunodeficiency virus from a health-care worker. All three were patients of the same Florida dentist.
Forty health-care workers have been infected on the job -- 27 through needle sticks, six through exposure through eye, nose or mouth. The remaining seven cases have not been traced to a specific type of exposure.