Hepatitis outbreak in NH strikes fear in six other states
POSTED: Wednesday, July 25, 2012 - 4:00pm
UPDATED: Wednesday, July 25, 2012 - 4:14pm
Hospitals in at least seven states want to know how many hundreds or thousands of their patients have come in contact with a lab technician accused of spreading hepatitis C.
The man, David Kwiatkowski, has the disease, which can pass through contact with contaminated blood, most often via shared needles. Authorities say the Michigan native injected himself with painkillers meant for patients when he worked at Exeter Hospital and left the syringes for reuse.
He was arrested this month in New Hampshire in connection with spreading the disease at Exeter Hospital and has been charged with obtaining controlled substances by fraud and tampering with a consumer product, according to an affidavit filed in federal court. He is suspected of stealing Fentanyl, a powerful anesthetic that is substantially more potent than morphine, the affidavit said.
Thirty Exeter patients have been diagnosed with the same strain of hepatitis C that Kwiatkowski has. Now, officials want to be sure that outbreak has not spread past New England.
Kwiatkowski, 33, worked as a traveling medical technician on a contract basis for hospitals in Arizona, Georgia, Kansas, Maryland, Michigan and New York in the last five years, hospitals and health officials in those states confirmed.
Authorities in those states want patients who may have come in contact with the man to be tested for the disease. Kwiatkowski told authorities he found out he had hepatitis C in May 2012, but further investigation revealed he tested positive for the disease in June 2010.
New Hampshire's health department is asking that anyone who was a patient in Exeter's operating rooms and the intensive care unit between April 1, 2011 and May 25 of this year be tested.
They are two areas that Kwiatkowski visited during his "routine duties to transport patients but was not involved with procedures or patient care," Exeter Hospital said in a statement.
The hospital said "there is an extremely small chance that anyone will be found to have been infected with a hepatitis C strain that is genetically linked to Kwiatkowski outside of the Cardiac Catheterization Unit."
"However, as we continue to learn about Kwiatkowski's history in other states from the ongoing criminal investigation, and out of an abundance of caution, Exeter Hospital supports the (health department's) decision to offer expanded testing to patients treated in these two other areas even though Kwiatkowski had no formal role supporting procedures in those areas."
According to state and hospital officials, he worked in as a radiology technician and in cardiac catheterization labs in the following locations:
-- Oakwood Hospital, Trenton, Michigan, January to September 2007;
-- Saint Francis Hospital, Poughkeepsie, New York, November 2007 to February 2008;
-- Baltimore Veterans Affairs Medical Center, May 2008 to November 2008;
-- Southern Maryland Hospital, Clinton, Maryland, December 2008 to February 2009;
-- Johns Hopkins Hospital, Baltimore, July 2009 to January 2010;
-- Maryland General Hospital, Baltimore, January 2010 to March 2010;
-- Hays Medical Center, Hays, Kansas, May 2010 to September 2010;
-- Houston Medical Center, Warner Robins, Georgia, October 2010 to March 2011.
Arizona health authorities and Maricopa County public health officials have been told the man worked briefly in Maricopa County during 2009 and 2010 "for a temporary health care staffing agency." It is not known exactly where he worked.
"We are in the process of confirming details so that we may accurately inform the public of any potential risk and actions to take," said Bob England, director of the Maricopa County Department of Public Health
Hopkins is calling in about 200 patients who had a procedure at the lab during the time Kwiatkowski worked there. About 460 patients had procedures at the lab in Kansas during Kwiatkowski's stint there.
But the numbers of people who may be tested might change as officials peruse medical records and see who needs to be seen.
These and the other institutions are calling old patients in and offering free testing. The U.S. Centers for Disease Control and Prevention is helping state health officers and hospitals tackle the problem.
Like Exeter and New Hampshire, other hospitals and states are, as Johns Hopkins puts it, "erring on the side of patient safety and contacting anyone who came in during that time."
"He didn't necessarily have contact with all patients who were at the lab during that time period," said a statement from Johns Hopkins.
Kansas Department of Health and Environment Secretary and State Health Officer Robert Moser said he understands patient concerns but is reassuring people that "we have no reason to be concerned about additional risks to the public" because Kwiatkowski worked in Kansas two years ago.
Authorities across the United States want to know as much as they can about Kwiatkowski's whereabouts since he became infected. The New York health department asked the state's hospitals and radiology facilities to identify any place where Kwiatkowski might have worked since January 1, 2007 either as a facility employee or as a "traveler" employed by a contracting agency.
He faces more than 20 years in prison if convicted.
Several employees at the Exeter Hospital said Kwiatkowski exhibited suspicious behavior, according to the federal affidavit. He would leave the lab during procedures, sweating profusely, and attended procedures on his off days, according to the affidavit.
On several occasions, syringes were discovered in a restroom in the vicinity of the cardiac catheterization lab, the affidavit said.
One witness even said that she thought Kwiatkowski "was on something" and unfit for patient care. Another co-worker said he remembered an incident in which Kwiatkowski was red in the face and eyes and had white foam around his mouth while he was on duty.
"The evidence gathered to date points irrefutably to Kwiatkowski as the source of the hepatitis C outbreak at Exeter Hospital. With his arrest, we have eliminated the menace this 'serial infector' posed to public health and safety," said U.S. Attorney John P. Kacavas.
Kwiatkowski appeared in New Hampshire federal court Tuesday and waived his right to a detention hearing.
A negligence complaint and a class action lawsuit have been filed in U.S. District Court in Omaha, Nebraska, against Triage Staffing, a health care company that hired and placed Kwiatkowski at Exeter.
One of the cases, filed by Seabrook, New Hampshire, resident Robert Oliver Fowler claimed Kwiatkowski was negligently hired and retained.
"Triage failed to excercise reasonable care in view of all of the circumstances surrounding the job Mr. Kwiatkowski was to perform at Exeter Hospital. Triage failed to exercise the degree of care required related to the severity of risk to Mr. Fowler. Triage knew or should have known of Mr. Kwiatkowski's likelihood of causing harm to Mr. Fowler when it supervised Mr. Kwiatkowski. Triage failed to conduct a reasonable investigation that could have found Mr. Kwiatkowsi's likelihood of causing harm to Mr. Fowler," the suit said.
Triage could not be reached for comment.
Fowler's attorney, Domenic Paolini of Boston, said firms like Triage need to perform due diligence in vetting employees. At present, he said, a cashier at a hardware store gets "more scrutiny" for hiring than people working in important health care jobs.
Firms that employ traveling health care workers need to rethink their hiring procedures, he said, and "hospital policies and procedures need to be changed as well."
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