Arrest made in hepatitis C outbreak

Last modified: 7/20/2012 12:00:00 AM
In an investigation likely to have "very far reaching implications" in at least six other states, U.S. Attorney John Kacavas announced yesterday that a "serial infector" has been arrested in connection with the hepatitis C outbreak at Exeter Hospital.

David Kwiatkowski, 32, with no fixed address, was arrested at an undisclosed Massachusetts hospital yesterday, Kacavas said. He was charged with obtaining controlled substances by fraud and tampering with a consumer product.

Authorities believe Kwiatkowski is responsible for at least 31 cases of hepatitis C contracted at the cardiac catheterization laboratory at Exeter Hospital.

When Kwiatkowski - who lived in Exeter while working at the hospital - is released from the hospital, he will be remanded to New Hampshire authorities, Kacavas said.

Kacavas declined to identify in which other hospitals or states Kwiatkowski has worked, but according to at least one court document, Kwiatkowski told authorities he's worked in New York.

Kacavas said Kwiatkowski engaged in "diversion," an act in which a person injects a drug with a syringe and leaves behind another syringe filled with a substance such as saline. By doing a switch, rather than just taking the syringe, it becomes more difficult to detect drugs that have gone missing.

The arrest culminated weeks of "night and day" efforts by more than a dozen law enforcement agencies to address the "menace" Kwiatkowski posed, Kacavas said.

Kacavas did not rule out the possibility that others at the hospital, and the hospital itself, could face criminal responsibility for the outbreak.

"The evidence is that he was probably working alone, but we're not excluding anyone at this time," Kacavas said. "To put a horizon on our work would be somewhat reckless."

 'Deeply disturbing'

Hospital officials called Kwiatkowski's arrest a "critical milestone" in an "incredibly difficult and painful situation."

Because of the ongoing criminal investigation and because Kwiatkowski has been both an employee and patient at the hospital, officials said they could not comment on the specifics of the case but lamented the "disruption" the outbreak has caused.

"It is deeply disturbing that the alleged callous acts of one individual can have such an impact on so many innocent lives," Kevin Callahan, president and CEO of Exeter Hospital, said in a prepared statement.

As of yesterday, 90 former patients have joined a class-action lawsuit against Exeter Hospital, the Concord-based McGrath Law Firm announced.

A viral infection transmitted by blood, hepatitis C inflames the liver and leads to chronic health problems. Approximately 3.2 million people are "chronically infected," the Centers for Disease Control and Prevention says.

Hepatitis C causes more deaths annually than HIV, according to the CDC.

In a conference call yesterday, Dr. Jose Montero, the state director of public health, said 1,292 people need to be tested in connection with this case. So far, 1,119 specimens have been received by the lab.

About 121 cannot be tested at all because the patients have died, Montero said, though not necessarily from complications of hepatitis C.

"We are still looking for 36 people that we have been unable to . . . reach," Montero said.

The investigation began in the middle of May.

Officials have asked anyone treated at the hospital's catheterization lab since October 2010 to be tested at the hospital or alternative sites in Hampton and Portsmouth.

Authorities said Kwiatkowski is from Michigan and became a traveling lab technician in 2007. Such employees "travel around the country in order to plug a staffing hole that a hospital may have," Kacavas said.

Kacavas said Kwiatkowski was abusing Fentanyl, an opiate similar to morphine but stronger. Fentanyl is often used before and during cardiac procedures, officials said.

Officials said Kwiatkowski infected patients with hepatitis C by giving himself the Fentanyl, which is injected with a syringe, and then leaving behind a syringe he'd previously used.

When the syringe that Kwiatkowski left behind still had traces of his infected blood on it, which is what authorities said happened, then the patient could have also contracted the virus.

Authorities said Kwiatkowski was diagnosed with hepatitis C in June 2010 but did not disclose it to the hospital until May 2012.

According to court documents, Kwiatkowski told at least one person in 2011 that he had the virus and advised the person to get checked.

In April 2011, he began working at Exeter Hospital as a temporary employee.

"As with all travelers at Exeter Hospital, pre-employment drug testing and standard and criminal background checks were performed," the hospital said.

About six months later, in October 2011, Kwiatkowski became a full-time employee.

Kwiatkowski was put on leave in May, the hospital said, and "later terminated."

He could appear in a New Hampshire court within a week, Kacavas said.

 'Fabricated' life

During his time in New Hampshire, Kwiatkowski "often told stories about himself that have proven to be false," FBI Special Agent Marcie DiFede wrote in a 21-page affidavit.

Earlier this month, for example, Kwiatkowski told authorities he had "lied to a lot of people" and "fabricated" his life.

"He stated that two of the biggest lies he had told were claming he played baseball at the University of Michigan and that his fiancee had died," DiFede wrote.

His colleagues at Exeter Hospital recount a variety of behaviors that Kacavas said were "odd."

For example, Kwiatkowski would come to the hospital when he wasn't on duty and would attend procedures where he wasn't needed. At least one person told a hospital official she believed Kwiatkowski was unfit to provide medical care. One witness said Kwiatkowski appeared to be "on something" and another claimed to have seen "track marks" on him.

Kwiatkowski "denied having track marks and claimed he is 'not a shooter' and that he is scared of needles," DiFede wrote.

DiFede also wrote that other witnesses said Kwiatkowski often needed to run to the rest room and "frequently vomited."

Those behaviors, combined with reported profuse sweating, could have been signs Kwiatkowski was in withdrawal, DiFede wrote.

At least one witness said Kwiatkowski claimed to suffer from cancer. Other witnesses, including his own parents, said he had told them he suffered from Crohn's disease. A doctor who examined Kwiatkowski said there was no evidence to support that claim.

Kwiatkowski's parents also said he had "issues with alcohol, anger, and depression."

When the director of the hospital's cardiac catheterization laboratory confronted Kwiatkowski about his bloodshot eyes, Kwiatkowski replied he had been up since 3 a.m. "crying about his aunt's death."

The director was unable to console Kwiatkowski and sent him home.

DiFede said Kwiatkowski's parents, interviewed in Michigan, said there had been no recent deaths in the family.

DiFede wrote that an empty syringe labeled "Fentanyl" was recently found in Kwiatkowski's car.

 Questionable behavior

It wasn't the first time hospital colleagues had observed Kwiatkowski behave in what they felt were questionable ways.

In 2008, according to the DiFede affidavit, an employee at an unidentified hospital watched Kwiatkowski "enter an operating room, lift his shirt, put a syringe in his pants . . . and exit the room." A syringe of Fentanyl was later found missing and was replaced by a syringe with a different liquid, DiFede wrote.

"A drug test found Fentanyl and opiates in Kwiatkowski's urine," DiFede wrote.

At Exeter Hospital's cardiac catheterization laboratory, Fentanyl and other controlled substances are available through only two "Pyxis machines," DiFede wrote. To access the drugs, nurses need to enter a username and provide "biometric information via a fingerprint," DiFede wrote.

Kwiatkowski did not have access to those machines.

In DiFede's affidavit, one hospital employee speculated that Kwiatkowski might have been able to get ahold of the Fentanyl during medical procedures after nurses had drawn up the medication on the Pyxis machine but before they would have been delivered to the patients. The procedures often occurred when the lights were dimmed so doctors could see video screens located above the patients, DiFede wrote.

In yesterday's conference call, Montero said it was unlikely patients would have suffered more pain because saline had been switched with Fentanyl. In all likelihood, Montero said, the doctors performing the procedure would have simply ordered the nurses to give the patient more Fentanyl.

 History with the police

Although Kwiatkowski was arrested yesterday, he's had several interactions with the police since he stopped working at the hospital in May.

On June 23, 2012, one of Kwiatkowski's relatives told the Exeter police that Kwiatkowski might be suicidal and had a gun. Eventually, DiFede wrote, officers from the Boxborough (Mass.) Police Department located Kwiatkowski at a hotel in Boxborough. They conducted a brief "protective sweep" and found prescription bottles but no weapons, DiFede wrote. Kwiatkowski was later transported to a hospital.

On July 11, a bench warrant was issued for his arrest after he failed to appear in court on charges related to "conduct after an accident," DiFede wrote.

Two days later, the Marlborough, Mass., police located him in a hotel room in an intoxicated state and took him to a medical facility, DiFede wrote.

An officer there said "he believed that Kwiatkowski may have been attempting to harm himself," DiFede wrote.

Yesterday, Kwiatkowski was arrested at an undisclosed hospital in Massachusetts.

If convicted, Kacavas said, Kwiatkowski faces up to 24 years in prison and a $250,000 fine for each offense.

On July 2, when officials interviewed Kwiatkowski for a second time, he identified himself as a victim, DiFede wrote.

Kwiatkowski's parents had told investigators that Kwiatkowski said he got the illness when he "was pricked by a needle at work," DiFede wrote.

But in his July 2 conversation, Kwiatkowski said he didn't know how he got the disease.

Shortly before he ended the interview and demanded a lawyer, DiFede said Kwiatkowski was asked how the patients at Exeter Hospital got hepatitis C.

"You know, I'm more concerned about myself, my well being," Kwiatkowski replied. "I've learned here to just worry about myself and that's all I really care about now."

(Molly A.K. Connors can be reached at 369-3319 or mconnors@cmonitor.com or on Twitter @MAKConnors.)


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