ANN ARBOR, Mich. — Six years ago, supervisors at the University of Michigan hospital were eager to hire David M. Kwiatkowski as a radiology technician. At 27, he was an outgoing candidate who had experience helping doctors set up X-ray equipment and inject traceable dyes.
But after only a month in the $55,000-a-year job, veteran staffers eyed him warily. Twice, vials of narcotics had gone missing from operating rooms he had been in, according to campus police reports, and Kwiatkowski's answers to officers were unconvincing.
"I'm the new guy," he told them, suggesting he was being scapegoated.
Then, two months later, a nurse reported that a vial of fentanyl, a painkiller far more potent than morphine, had disappeared from a counter less than 10 minutes after she left it there. Another nurse had spotted Kwiatkowski swiftly enter and leave the room during that time.
When police interrogated him again, suggesting a lie detector test, Kwiatkowski quit. The hospital barred him from returning, noting in his personnel file that he "resigned during suspension while under an ongoing investigation."
But hospital executives did nothing to stop him from working elsewhere. No one alerted the national registry that certifies radiology technicians. University of Michigan police did not file charges. And under legal advice to avoid defamation suits by former employees, hospital officials stood by their standard personnel policy to only confirm dates of hire if any future employer inquired about Kwiatkowski.
A Globe investigation has found that time after time, over the course of eight years, hospitals ignored the long-term danger posed by this deceptively charming technician, allowing him to move from state to state endangering the lives of patients as he adopted more elaborate methods of stealing drugs. When he was finally arrested this summer, prosecutors say, Kwiatkowski had committed one of the most egregious medical crimes in US history, infecting at least 39 patients throughout the country, mostly in New Hampshire, but also in Kansas and Maryland, with a life-threatening virus often spread by tainted needles.
With a muscular swagger and upbeat personality, he maneuvered through 19 hospitals in eight states, despite leaving graphic evidence while working in Pennsylvania and Arizona, and perhaps elsewhere, that he was descending into addiction, according to a Globe review of federal and state records and interviews with colleagues, friends, and neighbors.
He was reeling, but he kept getting work. He took advantage of the plethora of short-term assignments available to him nationwide through temporary staffing agencies, counting, as he moved from job to job, on his well-placed faith that angry former employers were too harried, or legally intimidated, to try to derail his career with damning references. They simply rushed him to the exit door and searched for a new hire.
Kwiatkowski's double life ended only when a public health crisis erupted at Exeter Hospital in New Hampshire that drew the attention of government officials. In mid-May, several patients in the cardiac catheterization unit tested positive for a specific strain of hepatitis C, a life-threatening virus that attacks the liver. By July, a wider screening of patients and staff found 31 had tested positive — 30 patients and just one employee, Kwiatkowski.
It seemed clear to investigators that Kwiatkowski had adopted a particularly dangerous drug-stealing tactic: Grab a new syringe loaded with the narcotics, then replace it with a syringe he had used, filled with dummy fluid. In Kwiatkowski's case, the substitute syringes were contaminated with traces of the virus he acquired during his state-to-state travels and years of drug abuse.
Kwiatkowski declined to be interviewed for this story.
His case has become a stark reminder that health care workers are not immune to the drug problems that plague 10 percent of all Americans at some point in their lives. Abuse of prescription painkillers has skyrocketed, making hospitals, with their well-stocked supplies, potentially desirable places for addicts to work.
Kwiatkowski apparently had a reason to try painkillers: He told friends he had Crohn's disease, a chronic intestinal inflammatory disorder, and they now wonder whether that led to his troubles. As Kwiatkowski sits in a federal lockup awaiting his next court hearing, after pleading not guilty, his stunned friends are questioning just about everything they know about this fun-loving young man with a penchant for telling tall tales.
Kwiatkowski's personality helped him dupe one employer after another, but he also was able to hide his past problems because of the poor communication and fractured vetting process at many hospitals. When patients visit hospitals these days, the employee in scrubs may be a beloved veteran with roots in the community. Or he or she could be a little-known agency worker on a three-month contract who just flew in from out of state, with a background easy to hide because nobody took the time — or showed an inclination — to investigate.
Lost Michigan dream
In David Kwiatkowski's early life, there were few signs of the troubles to come.
He grew up in Canton, Mich., a suburban, middle-class township outside Detroit where many auto workers in the 1970s bought their first homes. His family stood out as the one with four athletic boys. His father, a supervisor for an auto plant, coached various teams, and his mother was an enthusiastic fan. Kwiatkowski, the second oldest, came off to his neighbors as a normal, somewhat rowdy kid who loved the Detroit Tigers. While his oldest brother was a pitcher for Canton High, Kwiatkowski was a catcher. He later went to Madonna University, a Catholic commuter school in nearby Livonia.
Along the way, he gained a reputation for exaggerated story-telling, which many friends just saw as a sign of insecurity. While playing baseball at Madonna for two years, he entertained teammates with fanciful stories about how he could talk any cop out of giving him a traffic ticket. It was clear to them that he saw himself as someone who could charm his way out of trouble.
He also talked about becoming a "big-time doctor," pursuing a career in the health care field that was the region's top employer with the car industry in decline. As with much of his bluster about himself, there was an element of truth to it. He spent seven years at Madonna finishing a bachelor's degree in allied health administration, which he earned in 2005. While at Madonna, he also completed a two-year program in 2003 at a local hospital to become a certified radiologic technologist.
"He was always trying to make himself sound cooler than he was," said Matt Rigley, an electrician who, like Kwiatkowski, was a catcher at Madonna.
By the time he was in his mid-20s, there were warning signs on two levels. It appeared he was starting to struggle with Crohn's disease. And he was running into trouble with police over issues related to alcohol and drugs.
One winter night in 2005, he approached the front counter of the Canton police station and reported the alleged theft of his pills, including prednisone, an anti-inflammatory drug often used for Crohn's patients, and Vicodin, a narcotic painkiller, from an apartment, a police report said. He said he didn't want an investigation, but "just needed a report filed so he could get a new prescription."
Three months later, Kwiatkowski would have an encounter with the same police department, though not at his initiative. After observing a 2004 gray Saab swerving and speeding shortly after midnight on April 15, 2005, police pulled over the driver. Kwiatkowski, according to the police report, told the officers, "I was on the cellphone, that's why I was swerving."
He failed a breathalyzer test, registering a blood-alcohol level of .114, well over the legal limit of .08.
He also struggled with the field sobriety test. When asked if he had any medical issues influencing his balance, Kwiatkowski told the officer he had Crohn's disease, but indicated it would not affect his ability to walk. But he strayed when trying to keep to a straight line and spent a night in a lockup. Two months later, he pleaded guilty to operating while intoxicated, paid a $1,070 fine, and served six months of probation.
If he had any fears that this guilty plea would affect his work life, they would prove unfounded.
In the months to come, after getting his college diploma, Kwiatkowski got his first significant job at Harper University Hospital in Detroit and seemed destined to achieve what many of his hometown classmates considered the good life. He made a decent living and settled down near family, buying a modest 1,000-square-foot, Cape-style house for $165,000 in nearby Westland. He began dating — and later became engaged to — a nurse he met on the job. He also got a dog named Pudge, named after the former Tigers catcher Ivan "Pudge" Rodriguez.
At the time he started the job in October 2005, his resume already listed jobs at four local hospitals. He had also received his certification from the American Registry of Radiologic Technologists, a must-have credential at most hospitals. It requires, among other things, passing a standardized test and answering questions about criminal charges, including drunk driving. He never updated his initial denial of a criminal record.
His colleagues at Harper immediately took to this sturdy young man who stood about 5 feet 10 inches and weighed 215 pounds. He liked to party, but also seemed devoted to his work, which included helping to delicately thread catheters, moving CT scan equipment, and chit-chatting with patients to relax them.
"He was pretty energetic," recalled veteran nurse Kim Detrick.
He was making a positive impression on some of his neighbors as well. Wayne Mueller, who lived across the street, recalled watching Kwiatkowski's father help him bring equipment to renovate his son's Westland home. Kwiatkowski struck him as a "level-headed" man with ambition and a lovely girlfriend from the hospital.
But months later, Kwiatkowski's life took a noticeable turn for the worse.
At Harper, he became prickly. Detrick said he started developing "an attitude," including challenging doctor's orders. His fiancee allegedly broke off the relationship. Detrick also recalled that colleagues noticed Kwiatkowski showing up at work during his off hours, something that often arouses hospital suspicions about drug pilfering.
"He'd be there where he wasn't supposed to be," she said.
When Kwiatkowski left his job at Harper, apparently voluntarily, Detrick said colleagues were "not sad to see him go."
In September 2006, he received the job offer to work at the University of Michigan medical center — an offer that was, almost immediately, reconsidered.
Just after offering him the position, supervisors conducting a routine criminal background check spotted his 2005 drunken-driving arrest. A staffer typed an e-mail to a colleague asking for more information, so there aren't "any surprises down the road."
A hospital spokesman declined to reveal what the inquiry yielded or if officials called previous employers, such as at Harper, but they did not pull the job offer, a decision they would later regret after vials of narcotics went missing.
"Nothing like this had ever happened," said Laura Bushey, a now-retired nurse at the hospital who had spotted Kwiatkowski in a room in December 2006 when he was suspected of stealing drugs for the third time. "It was totally unusual for our department."
Even though a co-worker found the missing vial hidden under a cart hours later, campus police grilled Kwiatkowski more rigorously than ever before. His colleagues were wary of him, knowing he had made up stories about playing Big 10 baseball at the University of Michigan. He resigned under a dark cloud of suspicion.
Hospital spokesman Pete Barkey said the hospital might have told other hospitals if Kwiatkowski had been fired, but he added, "We did not fire him."
Around this time, Kwiatkowski's neighbors in Westland noticed changes in his life, though none suspected drug addiction.
Some mornings he was dressed in scrubs for work, other mornings he lounged around his backyard. He confided in some neighbors that he was let go from a job — though he did not specify, nor did they ask, which job it was. He cited past drunk-driving problems, or complaints from colleagues.
"He told me he lost his job because of his DUI and smelled of alcohol at work," said a neighbor, 20, who asked not to be named to avoid getting involved in Kwiatkowski's legal case.
The life of a traveler
In the fall of 2007, Kwiatkowski bolted from Michigan, bringing only his dog, and jumped into the fast-expanding world of temporary health care staffing agencies, specializing in transient workers, called travelers.
These agencies started to proliferate in the 1970s in response to a nationwide nursing shortage, and rapidly expanded in the past decade to include other health care professions, including radiologic technologists, often referred to as RTs, who focus on procedures, including minimally invasive ones, involving X-rays, CT scans, and MRIs.
The arrangement had benefits — and downsides — for the traveler and the hospital.
Travelers, who became employees of the agencies, got a chance to satisfy their wanderlust while earning higher hourly rates than hospital employees, plus often receiving agency-paid housing and transportation. Their assignments, however, typically lasted for only three months, so their lives were filled with constant uncertainty.
Budget-conscious hospitals could gain lower permanent payrolls and tremendous staffing flexibility, though they lost some control in the candidate-vetting process.
Staffing agencies would take on this time-consuming work, including drug testing. Such tests were typically scheduled, making it possible for drug abusers to cleanse their system prior to testing. Agency profits vary widely, but industry specialists say firms typically earn about 15 to 25 percent of a worker's wages.
On paper, Kwiatkowski appeared to be a highly qualified candidate, having acquired the technical skills to work in cardiac catheterization, a high-demand, profitable area for hospitals. In little time, he was on the list of at least a half-dozen nationwide agencies. A technician with his skills could command as much as $70 an hour, plus other perks.
It did not take long for Kwiatkowski — within his first year as a traveler — to alarm staffers at one Pittsburgh hospital.
In March 2008, he was hired by Maxim Staffing Solutions for an assignment at UPMC Presbyterian, affiliated with the University of Pittsburgh in Pennsylvania. One day two months into the job, Kwiatkowski, apparently thinking he was alone, allegedly walked into an operating room, lifted his shirt, put a narcotic-filled syringe in his pants, then left the room. A co-worker spotted him in the act, according to a federal investigator's report filed this year in New Hampshire.
Workers later found that syringe had been replaced by a different syringe containing a substitute liquid,one of the first signs that Kwiatkowski had started to employ the swapping tactic to avoid detection.
And more items would soon be discovered related to Kwiatkowski.
"Three empty syringes bearing fentanyl labels were found on his person," said the federal affidavit. "An empty morphine sulfate syringe and a needle were later found in his locker."
Gloria Kreps, a spokeswoman for the Pittsburgh hospital, said Kwiatkowski was escorted to the emergency room. After a urine test found drugs in his system, he was terminated, and Maxim Staffing was notified of the drug-stealing incident, Kreps said.
She also said that "we relied on Maxim, as his employer, to file reports with the appropriate agencies."
Despite the graphic evidence, neither the hospital nor Maxim reported the incident to local police. Nor did they report Kwiatkowski's drug abuse to the American Registry of Radiologic Technologists, which had the power to yank Kwiatkowski's certification.
In fact, Maxim reassigned him to another job in another state six months later. When asked about the repeat placement of Kwiatkowski, a Maxim official said they "take this matter very seriously" but cannot comment because of pending litigation and "ongoing investigations."
Even as Kwiatkowski's life appeared to be spiraling out of control, his resume circulating nationwide looked better than ever.
Around this time, his educational credentials were beefed up to include a master's degree in allied health administration in 2006 from Madonna. The university said he earned no such degree.
His agency paperwork included some positive references, although the authenticity of at least one is in question.
In a typed reference from Advance Med, based in Frisco, Texas, Detrick, the nurse from Harper Hospital, describes Kwiatkowski as an exemplary employee who was "great in all respects" and says she would want to rehire him "in a heartbeat." The reference was on file at a Baltimore veterans hospital where he once worked and was obtained by the Globe through a public record request. But Detrick said in a phone interview with the Globe that she was never contacted by this agency, and would never say such glowing things about Kwiatkowski.
Advance Med authorities declined to respond to the Globe's questions about the reference.
Though his resume named all the hospitals where he worked, negative references did not plague him, possibly because former employers are fearful that former workers will sue for depriving them of a job offer based on unfounded charges. Legal specialists say, however, that employers overstate this risk. They emphasize that the truth is always a defense, and that proof of a failed drug test, for instance, should protect former employers from a defamation lawsuit.
Still, specialists in employment law say hospitals are understandably confused, given that this area of the law is constantly shifting and differs state to state. The result is that many hospitals just confirm a former workers' dates of employment.
Obtaining accurate information about Kwiatkowski's past was complicated by another factor. Hospitals can avoid reference checks for an agency-placed worker by stating that the agency employed them, not the hospital. For example, when the Globe called Kreps at UPMC Presbyterian in Pittsburgh to ask how it had handled reference checks on Kwiatkowski, after staffers caught him stealing drugs, she declined to answer, referring all questions to the staffing agency.
In the two years after he was ousted from Pittsburgh, agency recruiters found him assignments in a half-dozen hospitals across the country. In the spring of 2010, Kwiatkowski was hired by SpringBoard staffing agency to work at Arizona Heart Hospital, and within two weeks, a crisis erupted.
Kwiatkowski was discovered slumped in the men's bathroom near a toilet, his breathing shallow and barely conscious, according to a hospital report. He had a puncture wound near his elbow, and floating in the toilet bowl was a syringe with a blue fentanyl label.
After staffers roused him, he blurted some profanity, then added, "I am going to jail."
He was taken to the emergency room.
In an interview the next day with hospital staff, Kwiatkowski stated that he had grabbed a fentanyl syringe that he found and injected himself with the drug to reduce his abdominal pain.
He denied any history of using intravenous drugs. When asked why he did this, he replied, "I had a lapse of judgment. I was stupid."
The Arizona hospital's medical staff called Phoenix police to the scene, but they did not press for charges, and the police did not file any. A hospital report refers to Kwiatkowski's father taking responsibility for bringing him back home.
Kwiatkowski's parents declined to be interviewed for this story.
After the incident, SpringBoard called the national registry that certifies radiologic technologists and the Arizona state regulatory board for his profession — but the investigations led to no disciplinary action.
The registry dropped its investigation, saying that Kwiatkowski provided a "plausible explanation" for the events of that day and showed proof of passing a subsequent drug-screening test, said spokesman Christopher Cook. Cook declined to say what explanation Kwiatkowski gave.
The regulatory board for radiology technicians in Arizona — one of 39 states that license or certify radiology technicians to work in their state — began collecting information about the incident and apparently learned of his medical condition. The board also received a letter from Kwiatkowski about how he was taking responsibility for his life, including going into counseling.
Kwiatkowski later wrote the agency saying he did not want to fight the allegations, but wished to voluntarily surrender his license to practice in Arizona. Doing so prevented him from getting jobs in that state, but not anywhere else.
One of the agency's entries about Kwiatkowski read: "Consent agreement rather than revocation. No other incidences, very good recommendations."
From Arizona, he went on to find work at hospitals in Pennsylvania, Kansas, and finally Georgia, where he began dating a co-worker.
The woman, who asked to remain anonymous because she doesn't want to be drawn into his criminal case, said she witnessed him suffer intense abdominal pain, but was unaware that he abused drugs to cope with it, though he often drank to excess.
"Whenever I was around, he never took anything. It was like – you just have to stick it out," the former girlfriend said.
One day, he wrote her a heartfelt letter in which he revealed some of his struggles. "It's been hard to let down some walls in my life to let you in, and it has been a blessing," he wrote. "I never thought just talking or just laying with you when I'm feeling so sick would actually make me feel better physically and mentally."
Arrival in New England
In April 2011, despite his problematic past, Kwiatkowski was hired by Triage Staffing agency for an assignment at Exeter Hospital in Exeter, N.H. A hospital spokesman said Exeter relied largely on the agency's vetting of Kwiatkowski's credentials, which included positive references and reports that he had passed drug tests.
At this job, he worked long hours, his beeper often going off at night and on weekends when emergency heart procedures came up. His dedication paid off. After six months as a contract employee through Triage, he was given glowing reviews and hired full time by Exeter in October 2011.
In many ways, his life seemed to be changing for the better. Despite his grueling hours, he used to spend hours at the gym, and he began to take an interest in designer clothes, said a close female friend whom he lived with. He told many friends that he had a fiancee in Michigan who died in a car accident. He enjoyed the attention he got from many women, while working hard to impress his bosses at Exeter.
"He was very good at his job," said the close friend, who also worked at the hospital. "He took his job very seriously."
Still, she saw some distressing signs. She found needles in his laundry, but believed him when he said they were for cancer treatments. Federal authorities have said there was no evidence he had cancer.
It was his Crohn's disease that he talked most about. While in New Hampshire, he got a tatoo on his arm, featuring multiple squiggly lines, which he told friends was a well-established symbol for those fighting Crohn's.
Kwiatkowski now and then seemed physically unsteady. Some staff members alerted supervisors that he sometimes showed up at work with bloodshot eyes, or skin drenched in sweat. Sometimes he raced to the bathroom, saying he felt ill.
This past spring, Kwiatkowski talked of making changes in his life, including possibly returning to his home state of Michigan to work. On April 2, he posted a message to his Facebook page referring to attending the Detroit Tigers' opening day, and how he "might not come back" to New Hampshire.
"Beaumont hospital Friday am wants to talk with me. I didn't bring any dress cloths though," he wrote.
But he would not move back to his home state. A month later, several patients in the cardiac catheterization lab at Exeter inexplicably tested positive for a specific strain of hepatitis C. After rounds of testing, public health authorities traced the source of that strain to Kwiatkowski.
Scouring his medical records, federal authorities learned he had first tested positive in June 2010, though they are not saying why he was tested then, citing the privacy of medical records.
Public health officials reviewed his work history and sent letters to thousands of patients about the need to get screened for hepatitis C.
Meanwhile, law enforcement was building its case against Kwiatkowski. In late June, a few days after police had interviewed his parents, Kwiatkowski abruptly fled his apartment in New Hampshire. For many days, friends and family could not locate him.
In mid-July, a family member called Exeter police to say they worried that Kwiatkowski was suicidal and had a gun. Officers in Marlborough, Mass., located him at a Holiday Inn close to midnight. They found no weapons but an array of prescription bottles.
After he was taken to a hospital, police uncovered an apparent suicide note, with a message to be conveyed to his close friend in New Hampshire. It read in part, ". . . let her know I passed away. Tell her I couldn't handle this stress anymore."
Kwiatkowski faces up to 20 years in prison after being arraigned on two charges: obtaining a controlled substance through fraud and tampering with a consumer product. He is expected to be indicted soon on a far broader range of charges based on new evidence — and patient infections — that have emerged since the summer. His lawyer, Bjorn Lange, has declined comment other than to say "the case is tragic."
Though Kwiatkowski's alleged crimes are remarkable for their national reach, he was not the first addicted technician carrying the hepatitis C virus to think of this syringe-swapping scheme. Three years ago, Kristen Parker, 26, was arrested for doing just that at the Rose Medical Center in Denver, infecting 18 patients. In May 2011, Steven Beumel, 48, was arrested in a similar scheme that infected at least two patients while he was at Mayo Clinic in Jacksonville, Fla.
Some lawmakers have called for tighter hospital security over narcotics, as well as a new national data bank, similar to one now available for troubled doctors and nurses, that would help hospitals identify health care professionals who have disciplinary actions against them in other states. Also, some legal specialists say that new laws have to be passed to protect hospitals from litigation if they give candid — and negative — references. The institutions with personnel policies designed to avoid legal exposure are now swamped with lawsuits from furious patients and their families.
With each passing month, more hepatitis C cases are linked to Kwiatkowski. Though all patients have yet to be fully screened, 32 have tested positive in New Hampshire, six in Kansas, and one in Maryland, all infected with his strain of the virus. Some additional patients have tested positive, but are awaiting results indicating whether their strain matches Kwiatkowski's.
A 65-year-old former Army sergeant who fought in Vietnam is believed to be among the first infected by Kwiatkowski. Linwood Nelson said he was stunned and angered to learn that he acquired a liver-damaging virus after going to the Baltimore Veterans Affairs Medical Center in 2008 for two procedures, one involving a kidney stone, another an imaging test for his lungs.
"I've learned not to trust everyone who wears hospital scrubs and a hospital ID," said Nelson, who has yet to show symptoms.
The veterans hospital was the 10th of 19 hospitals where Kwiatkowski worked. Officials there are not saying whether, prior to hiring Kwiatkowski, they had made a call to his previous employer to check on his past performance.
If they had asked — and received an honest answer — they would have been told by UPMC Presbyterian hospital in Pittsburgh that Kwiatkowski just weeks before had been caught swiping a fentanyl syringe, and had tried to conceal that theft by putting in its place an old syringe rigged to look new.
Patricia Wen can be reached at email@example.com.