Suspect in hepatitis C outbreak portrayed as traveling addict
Case has implications in Maryland, where technician worked at four hospitals
Linwood Nelson, a Vietnam War veteran, was infected with hepatitis C by David Kwiatkowski during a procedure at Baltimore VA Medical Center. Kwiatkowski has been arrested for spreading the disease by using and replacing needles at a hospital where he worked in New Hampshire. (Algernia Perna, The Baltimore Sun / November 4, 2012)
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In his early 30s, he was living out of hotels, hopping among hospital jobs — including four in Maryland — and addicted to the powerful narcotic fentanyl, according to court and police documents. Federal investigators, meanwhile, were hot on his trail as they probed an outbreak of hepatitis C at a hospital where he had worked.
When a police officer entered the room in the Holiday Inn Hotel & Suites after responding to a call about a man "feeling dizzy," he found Kwiatkowski "unsteady on his feet," police records say. He also found a handwritten note amid the pill bottles asking the finder to call someone named Kerry to "let her know I passed away."
"Tell her I couldn't handle this stress anymore," the note read, according to the police report. "She'll know what to do."
Kwiatkowski soon landed in a federal detention center — and in the center of a national spotlight. The Michigan man, who is charged with federal drug crimes, allegedly used contaminated needles in a New Hampshire hospital — and possibly in others around the nation — triggering a hepatitis C outbreak involving dozens of patients. In Maryland, hospitals and patients such as Linwood Nelson, a man treated at a medical center where Kwiatkowski worked, are scrambling to trace infections.
The blood-borne viral infection can cause liver damage or failure, and lead to chronic health problems.
According to an affidavit written by an FBI agent and filed in federal court, Kwiatkowski routinely injected himself with drugs meant for patients during surgeries by swapping prepared syringes with similar ones he'd used before. The affidavit, from Special Agent Marcie DiFede, portrays Kwiatkowski as a drug addict and compulsive liar.
"I know that some of [his] behaviors that witnesses described observing (bloodshot eyes, excessive sweating, and foaming at the mouth) are associated with narcotics use and/or withdrawal," DiFede wrote.
Since then, the FBI investigation of Kwiatkowski's alleged role in a hepatitis C outbreak among more than 30 patients at Exeter Hospital in New Hampshire — all diagnosed with a specific strain of the disease that matches his — has ballooned into a nationwide probe.
From New York to Arizona, patient records have been examined at hospitals where Kwiatkowski worked as a contracted technician, a type of employee often hired to provide short-term assistance when regular staffers go on leave or other temporary fluctuations occur.
Four hospitals in Maryland where Kwiatkowski worked have launched their own investigations, offering free testing to patients who came in contact with him.
Kwiatkowski worked at Baltimore VA Medical Center from May to November 2008, Southern Maryland Hospital between December 2008 and February 2009, Johns Hopkins Hospital between July 2009 and January 2010, and Maryland General Hospital from January to March 2010.
About 1,800 patients at those hospitals had possible contact with Kwiatkowski, the hospitals have said. Many patients have already been tested, but the hospitals have not released any preliminary results or commented on their findings to date.
Nelson, a 65-year-old Vietnam War veteran who lives in Baltimore and is being treated for hepatitis C, believes he was infected while receiving medical treatment at the Baltimore VA Medical Center during the time Kwiatkowski worked there.
Christopher H. Mitchell, one of Nelson's attorneys, said he filed notice of his client's claim that he was infected with the U.S. Department of Veterans Affairs last week. The department has six months to respond, after which time Nelson can file a federal tort claim, the attorney said.
Hospital officials have declined to discuss the cases of any specific patients but say they are investigating links between Kwiatkowski's work there and possible hepatitis infections. An initial review found that 168 patients had contact with the technician, and medical screenings found that 117 did not require further testing. The remaining 51 patients were urged to get tested for hepatitis C.
Nelson, who has emphysema and uses an oxygen machine 16 hours a day, was the first Marylander to come forward in the investigation. He said he underwent procedures for a kidney stone removal and a lung scan in May and September 2008.
"Mentally I'm still trying to come to grips with this," Nelson said in a recent interview. "Physically I feel OK, but I guess the mental [stress] will make the physical feel kind of rough."
Nelson served as an Army supply sergeant in Vietnam between 1965 and 1968, then had a long career as a sales manager at local car dealerships. He now splits his time between his Edmondson Village rowhouse, where he cares for a sister with Alzheimer's disease, and the rowhouse of his girlfriend in Rosemont, where neighborhood kids call him "Pop Pop."
Officials with Maryland's Department of Health and Mental Hygiene have launched a sweeping review of procedures and protocols in the state for licensing radiographers like Kwiatkowski and for overseeing staffing agencies that place traveling technicians in area hospitals. It is also reviewing aspects of the medical system that could allow practitioners with drug abuse issues to go unnoticed.
"We have a review team that is looking into vulnerabilities that are related to the situation," said Dr. Lucy Wilson, the agency's chief of surveillance, infection prevention and outbreak response.
Currently, the agency's Office of Health Care Quality regulates temporary agency placements of nurses but not placements of technicians like Kwiatkowski, officials said. Accredited hospitals have hiring standards and contracts with staffing agencies that require certain employee background reviews, but those reviews might not catch every red flag about a practicing technician in other states.
The Maryland Board of Physicians requires radiographers to be licensed — Kwiatkowski held a license for most of his time in Maryland — but does not require "medical technicians" to be licensed, said Carole Catalfo, the board's executive director.
Some states require neither radiographers nor technicians to be licensed, and the work history of such medical employees, especially those who move from state to state, is much more difficult to vet, Catalfo said.
A full report from the state health department review team is expected to be completed, with recommendations for reforms, by early next year. The department's epidemiological staff is reviewing and monitoring the testing of patients exposed to Kwiatkowski in Maryland.
"That's sort of a lengthy process and it involves samples going down to the Centers for Disease Control for testing, and so far there are no results," Wilson said.
There is also little information available about Kwiatkowski. Who he is — and how he was able to secure placements in so many hospitals despite his alleged drug addiction — is unclear.
David Matthew Kwiatkowski was raised in Michigan. He was admitted to Madonna University, a Catholic university in Livonia, Mich., in 1998 and graduated in 2005 with a bachelor of science degree in allied health administration, according to a school spokeswoman. He then began taking on temporary technician jobs.
According to federal court documents, he would enter secured surgical labs and steal syringes full of fentanyl after they had been removed by nurses from locked compartments before surgeries.
At times, he would do so despite not being properly "scrubbed in" and not being on the team scheduled to perform the surgery, the documents say. He likely replaced the needles with syringes he had previously used and refilled with saline, the documents say.
The continuing investigation has sparked a number of lawsuits related to Kwiatkowski and the hospitals where he worked. In one, an infected patient in Kansas alleges that Kwiatkowski was caught stealing drugs at UPMC Presbyterian in Pittsburgh, but the issue was not reported to authorities by the hospital or by Maxim Staffing Solutions Inc., the Columbia, Md.-based staffing agency that placed him. A second, class-action lawsuit has been filed as well.
Officials with UPMC did not return multiple requests for comment. Heather Chilcot, Maxim's director of strategic communications, said the agency is taking the cases seriously but could not comment on ongoing investigations.
Kwiatkowski's federally appointed attorneys, Bjorn Lange and Jonathan Saxe, said they and Kwiatkowski would not be available to comment to the news media "now or in the near future."
Kwiatkowski is being held as prosecutors and his attorneys continue investigations into his actions over the past few years, according to federal documents.
By the time he was found at the hotel outside Boston, he had already been interviewed by federal investigators, and allegedly told them he'd "lied to a lot of people" and "fabricated [his] life," court documents say. His parents, back home in Michigan, had told investigators they were unaware of any illegal drug use by their son, but that he had "issues with alcohol, anger and depression."
Questioned by the same investigators about dozens of patients infected with hepatitis C at Exeter Hospital, Kwiatkowski allegedly responded, "You know, I'm more concerned about myself, my own well-being."
Six days after the hotel incident, on July 19, he was arrested on federal charges of "acquiring a controlled substance by misrepresentation, fraud, forgery, deception or subterfuge" and of tampering with a consumer product with "reckless disregard for the risk that another person will be placed in danger of death or bodily injury."
The affidavit filed in the case by DiFede, the FBI agent, recounts conversations investigators had with Kwiatkowski's former co-workers, including those at the cardiac catheterization lab at Exeter. They described how Kwiatkowski might have been able to steal, use and replace needles that were then reused on patients.
In the Exeter lab, controlled substances, including vials of fentanyl, are kept in what is known as a Pyxis machine, which scans fingerprints and dispenses drugs to authorized personnel only. Kwiatkowski was not authorized to access the medications.
According to the affidavit, nurses often remove the vials and draw the medications into needles at the beginning of a procedure so they are ready for use. The needles are then labeled.
Co-workers, including a lab supervisor, told investigators that Kwiatkowski would spend more time near the nurses' station than other technicians, would enter the lab during procedures that he wasn't scheduled to assist on, and would at times place lead radiation aprons on a table near the Pyxis machine after nurses had filled needles from vials.
Investigators were also told the lab is usually dark during procedures so physicians can read video screens above patients.
"The Supervisor speculated that upon setting the lead apron on this table, Kwiatkowski may have been able to take a syringe containing fentanyl and replace it with a tainted syringe containing saline or another substance," DiFede wrote. "The Supervisor also said there would be no reason for a technician to be in the nursing area where the medications are located. He noted that it was unusual for an employee to bring in lead aprons for other employees."
It's unclear what consequences were experienced by patients who were prescribed fentanyl but injected with something else.
Those interviewed said syringes labeled as having contained fentanyl were found multiple times outside the lab — once by a patient's relative in a public bathroom.
During a search of Kwiatkowski's car in June, federal investigators found an empty syringe with a blue sticker reading "fentanyl" that appeared to be "consistent" with the stickers used to label needles at Exeter, according to the affidavit.
Some Maryland hospitals where Kwiatkowski worked say they have different control procedures in their labs — for example, requiring that drugs only be drawn into syringes right before use on a patient, and that drugs never be left unattended. They hope those procedures have limited the possibility that their patients might have been infected by Kwiatkowski.
Kwiatkowski faces up to 24 years in prison on the charges, as well as fines of up to $500,000 and a term of supervised release, according to New Hampshire U.S. Attorney John P. Kacavas' office.