Four Maryland hospitals are offering free hepatitis C testing to at least 1,750 patients who may have been exposed to the viral disease by a traveling medical technician, as state officials launch a broad regulatory review in response to the case.
The testing and review follow the arrest of David Matthew Kwiatkowski in New Hampshire last month. Authorities say he injected himself with stolen narcotics-filled syringes while working at a hospital there and left the contaminated needles to be re-used by unwitting staff in patients, infecting at least 30 people. He has been charged with federal drug crimes.
The case stoked widespread public health concerns and prompted investigations in several states where Kwiatkowski worked and had contact with thousands of patients. In Maryland, health investigators are looking for potential flaws in the way medical contract workers are regulated and whether better controls over access to narcotics in hospitals are needed.
"This is an extraordinary event, and we want a very aggressive review by the public health team for the purpose of patient safety," said Frances B. Phillips, deputy secretary at the state Department of Health and Mental Hygiene.
"We want to shed light on any weakness in our health system that could result in this kind of transmission," Phillips added.
Kwiatkowski, who worked as a traveling medical technician on a contract basis in at least seven states, was hired by hospitals through staffing agencies. He worked as a radiographer performing diagnostic procedures such as cardiac catheterization, where a tube is placed into the heart usingX-rays as a guide. Doctors are then able to collect blood samples from the heart, examine arteries or measure the heart's blood flow.
In Maryland, Kwiatkowski is known to have worked at four hospitals: The Baltimore VA Medical Center from May 2008 to November 2008; Southern Maryland Hospital from December 2008 to February 2009; Johns Hopkins Hospital from July 2009 to January 2010 and Maryland General Hospital from January 2010 to March 2010.
Phillip said the state continues to research whether he worked at any radiology centers or other hospitals.
According to the FBI, Kwiatkowski learned that he was infected with hepatitis C in May, though investigators have uncovered evidence that he had the disease since at least June 2010. Hepatitis C is a blood-borne disease that attacks the liver.
Maryland health officials say that so far they have no indication Kwiatkowski had hepatitis C or stole drugs while working in Maryland. But they say they want to be proactive in identifying potential victims and reforms.
The hospitals where Kwiatkowski was employed have cast a wide net, testing patients who had direct contact with him, those who may have been in the same room where he was working, and those treated in a room he could have entered. Hospital officials said they are not testing staffers because they weren't at risk.
Hopkins sent letters to 1,567 patients who may have had direct or indirect contact with Kwiatkowski, including 223 patients who may have undergone procedures that involved him. The remaining patients were in rooms he could access. He worked as a contract worker there.
About 130 patients have been tested so far. Of the results that have been returned, one was positive for hepatitis C. It is not clear if that person contracted the disease through contact with Kwiatkowski or already had it.
Maryland General believes that about 23 people may have had contact with Kwiatkowski, but officials said they don't yet know if any contracted hepatitis C. He worked as a full-time employee during his stint at the hospital.
"Any patients having even the slightest possibility of exposure have been notified by letter," said Karen Lancaster, a spokeswoman for Maryland General, which is owned by the University of Maryland Medical System.
Southern Maryland Hospital Center sent letters to 116 patients to warn of possible exposure. So far 40 have been tested and none showed positive results for the disease, said Nancy Norman, the hospital's spokeswoman. She believes chances of exposure are slim. She noted that only nurses at the hospital have access to narcotics, which are locked in cabinets.
At the Baltimore VA Medical Center, a review of records found that 168 patients had procedures involving Kwiatkowski, but the hospital determined only 51 needed to be tested. Officials also are looking at 17 other patients who had procedures in another radiology room where he worked to see if they should be tested as well.
It may be hard initially to determine who was exposed to the disease by Kwiatkowski, health officials said. The disease is under-diagnosed because it is hard to detect. People who have been infected don't exhibit symptoms. Thousands of people are believed to be infected and don't know it. The Centers for Disease Control and Prevention recently launched a campaign to test all baby boomers who may have contracted the disease before reliable testing.
For patients being tested in the wake of the Kwiatkowski case, Phillips said, further testing can be done to determine if the hepatitis C had been in the body for years or contracted more recently. She urged potential victims to be tested quickly because the typically slow-developing disease can be treated to stem advancement. In its worst form, hepatitis C is fatal.
"You don't necessarily have symptoms in the beginning," said Maria Said, an epidemiologist for the state. "But because of the potential treatment options, something can be done now if a patient tests positive."
The Kwiatkowski case spotlights the use of contract workers in the medical field and how they are regulated.
Kwiatkowski was licensed by the Maryland Board of Physicians as a radiographer, but his license has expired. That board also is investigating whether he violated any regulations, Phillips said.
Generally, contract workers in Maryland have to be licensed like any other medical profession, but they are employed by a staffing firm. A contract nurse would be licensed by the Board of Nursing.
Hospitals use contract workers for a variety of reasons, including filling in for staffers on vacation or unexpected departures, according to The Maryland Hospital Association.
The association said contract workers are common in a number of professions and that their use doesn't put patients in danger. What happened with Kwiatkowski is not common, said Jim Reiter, a spokesman.
"There are the same risks as if with any other human being," Reiter said. "It's just a very unfortunate situation that the guy took advantage of his position."
Hospital officials said they do have safeguards for contract workers.
The VA health care system requires criminal background checks, proof of licensure, registration or certification, and references, spokeswoman Rosalia Scalia said. Contractors also have to obtain certification through the American Registry of Radiologic Technologists.
Hopkins officials said procedures for hiring temporary workers are the same as for regular employees. They require drug testing and background criminal investigations. A Hopkins spokesman said that ultimately the staffing agencies are responsible for ensuring their contract workers are properly screened and credentialed.
Reiter said contract workers are needed as much as full-time employees for patient care.
"You're making sure that no matter what is going on with personnel — whether it is vacation, illness or the economy — you're still taking care of patients the right way," he said.