Former N.H. hospital worker held in hepatitis outbreak

Alleged drug user David Kwiatkowski.WBZ-TV

CONCORD, N.H. — Federal prosecutors Thursday charged a medical technician with infecting at least 30 patients with hepatitis C, alleging that he fed his drug habit by injecting himself with medication intended for heart patients and then returned contaminated needles to hospital carts.

For the 13 months he worked at Exeter Hospital, authorities said, the technician was fully aware he carried the potentially lethal virus, spawning the biggest such health crisis in the nation since the 1990s. Authorities called him a “serial infector.”

“He knew he had hepatitis C and continued to use tainted syringes,” said John Kacavas, the US attorney in New Hampshire. “That’s the definition of reckless disregard.”

Kacavas said David Kwiatkowski, 32, worked in six states before coming to Exeter Hospital. Kacavas would not identify the states, but said his office had notified federal health officials and hospitals where the suspect had worked. Massachusetts authorities said they had not received information suggesting the technician worked in the state.

The revelations raised the unnerving prospect that other patients were infected with the blood-borne virus and underlined the dangers drug-addicted health care workers can pose. Kwiatkowski, originally from Michigan, has had the disease since at least June 2010, prosecutors said.

Kacavas said Kwiatkowski showed “extreme indifference” to patients’ health. Kwiatkowski is charged with fraudulently obtaining controlled substances and tampering with a consumer product, a crime that could carry a 20-year jail sentence if he is convicted.

The scope of the outbreak, and the possibility it extended to other locations, was highly unusual, Kacavas said.

“I’m unaware of a scheme with such reach,” he said. Kacavas said that the states where Kwiatkowski had worked were scattered, and that the suspect typically worked at each hospital for a few months before moving on.

Investigators said Kwiatkowski was involved in a similar incident in 2008 in another state, allegedly stealing a syringe containing a painkiller from an operating room. He was confronted, and found to be carrying three empty syringes.

An affidavit described Kwiatkowski as a drug addict who displayed erratic and suspicious behavior before the infections came to light. He often appeared shaky, sweated profusely, and vomited frequently. The federal affidavit said he would frequently “break scrub,” leaving a procedure in the middle, and would often bring lead aprons into the procedure room even when he was not assigned to a case.

“Oftentimes, Kwiatkowski brought the lead aprons and set them down on this table after the nurses had drawn up the medication,” the affidavit said.

A phlebotomist who drew blood from Kwiatkowski in late May said she saw “fresh track marks.”

Joseph Perz, a disease investigator at the Centers for Disease Control and Prevention, said the hepatitis outbreak was the largest caused by narcotics tampering since the early 1990s. Since 2004, there have been three similar though smaller cases of hepatitis C transmission, he said.

Health care facilities have focused on the risks of addiction among workers, but have paid less attention to the damage their addictions can cause patients, he said.

“If there’s a silver lining, it’s really that it’s focusing attention on a problem that had been overlooked,” Perz said.

Mark Abramson, a lawyer representing 14 of the people who tested positive for hepatitis C, said Thursday’s revelations about the suspect’s behavior infuriated his clients.

“They were very angry before,” he said. “They are much angrier now.” Abramson said the hospital should have been aware the suspect was acting erratically and should never have allowed him to be in a position to gain access to drugs.

Abramson has filed suit against the hospital on behalf of 11 clients. His clients range in age from their 50s to 80s. Many are “suffering horribly” from hepatitis, he said. Abramson said that because the suspect used the anesthetic, patients believe they did not receive a full dose during their heart procedures.

“My clients went through a lot of pain during their procedures,” the attorney said.

Kwiatkowski, who worked in Exeter Hospital’s cardiac catheterization laboratory from April 2011 to May 2012, allegedly injected himself with Fentanyl, an anesthetic more potent than morphine. Kwiatkowski allegedly would take a syringe filled with the drug and inject himself, then replace the drug with another liquid, such as saline, to conceal the theft. The tainted needles were then used on patients, transmitting the disease, authorities said.

Blood tests showed that the virus infecting patients shared genetic similarities with the suspect’s infection. All the patients were infected during the period the suspect worked at the hospital, and underwent procedures in the cardiac lab or its recovery room.

“The evidence gathered to date points irrefutably to Kwiatkowski as the source of the hepatitis C outbreak,” Kacavas said. “With his arrest, we have eliminated the menace this serial infector posed to public health and safety.”

In a statement, Exeter Hospital described the arrest as a “critical milestone in this incredibly difficult and painful situation.”

The hospital said drug tests and a criminal background check were administered before Kwiatkowski began working at the hospital. He was placed on leave at the start of the investigation in May and later fired.

The hospital said it could not comment further because the criminal investigation is ongoing, and because Kwiatkowski was a former patient of the hospital.

“It is deeply disturbing that the alleged callous acts of one individual can have such an impact on so many innocent lives,” hospital president Kevin Callahan said in the statement. “As a result of his alleged actions, people in our community, who in many cases are the friends and neighbors of the 2,300 people who work here, now face the challenge of a potentially chronic disease.”

The hospital has tested more than 1,110 people, he said.

The hospital said it realized in May that several patients had tested positive for the disease.

Hepatitis can cause serious liver damage and lead to liver cancer. More than 15,000 Americans die each year from illnesses related to the disease, health authorities reported. The virus can cause damage for years with few noticeable symptoms.

As a technician, Kwiatkowski should not have had access to controlled substances. Kacavas would not say whether Exeter Hospital may also face criminal charges, but said the investigation is in its early stages. He said investigators were exploring the possibility that Kwiatkowski was also dealing drugs he is accused of stealing.

Kacavas said the evidence suggested Kwiatkowski was obtaining the drugs on his own.

Kwiatkowski was arrested at a Massachusetts hospital where he is being treated, said authorities, who declined to identify the hospital or the suspect’s medical condition. He will make a court appearance when he is discharged, probably early next week.

Kwiatkowski had been living in hotels since being dismissed from Exeter Hospital, authorities said.

There is no evidence he has worked at another medical facility since he left Exeter Hospital.

Authorities said Kwiatkowski exhibited odd behavior strongly suggesting drug abuse. Witnesses said they saw him leaving the cardiac lab during procedures, sweating profusely, and visiting the lab on days off.

On one occasion, he was sent home after colleagues noticed his bloodshot eyes, according to authorities. The suspect said he had been up since 3 a.m., crying over his aunt’s death. Interviews with the suspects’ parents indicated there had been no family deaths. His parents indicated their son had Crohn’s disease, and had issues with alcohol, anger, and depression.

Another employee recalled an incident when the suspect had “a red face, red eyes, and white foam around his mouth” while on duty.

A search of Kwiatkowski’s car discovered an empty Fentanyl syringe and several needles, authorities said.