STRATHAM — Some 500 patients were checked Friday for possible exposure to hepatitis C as the state began the largest public testing operation in its history in response to an outbreak linked to a former Exeter Hospital radiology technician.
The testing came as hospital officials insisted that violations at Exeter cited by a team of inspectors have been addressed.
Hospital CEO Kevin Callahan also submitted an opinion piece to the New Hampshire Union Leader on Friday in which he called for changes in the health care industry to prevent another outbreak and likened the infections allegedly caused by David Kwiatkowski to a form of “domestic terrorism.”
Kwiatkowski, 33, is accused of spreading his hepatitis C infection to at least 31 patients by allegedly injecting himself with syringes filled with the painkiller fentanyl and then leaving the contaminated syringes behind to be used on unsuspecting patients.
Two patients from a hospital in Kansas where Kwiatkowski worked in 2010 have also tested positive for a strain of hepatitis C that's “closely related” to the cluster in Exeter, Kansas officials announced Friday.
While those diagnosed in Exeter were patients in the hospital's cardiac catheterization lab — where Kwiatkowski worked — the hospital expanded the testing to the operating rooms and ICU after discovering that he also had access to those areas of the hospital during his employment.
The first of four testing clinics was held Friday at the Cooperative Middle School in Stratham, where about 100 workers — some from the state and others volunteers from regional public health organizations — were on hand to assist with the testing that will continue at the school today with another 500 patients expected to be tested.
“In the midst of responding to this tragedy, where a number of these people have been victimized, comes something good where people have really stepped up,” said Nicholas Toumpas, the state's health commissioner, who praised the many health professionals participating in the state clinics that will continue next week in Manchester, Plaistow and Rochester.
The state is working to schedule testing for an estimated 3,300 patients who were treated in Exeter Hospital's main operating rooms and intensive care unit between April 1, 2011, and May 25, 2012, and who may have been exposed to the potentially fatal virus that can damage the liver.
“I'm very nervous. I'm scared,” said Amy Stanley of Brentwood, adding that if she tests negative she'll be relieved and “just go back to being my usual self.”
Like many patients, Stanley was angered by the outbreak and wondered how it could have happened in the first place.
Kwiatkowski was hired at the hospital despite being fired from other hospitals. He was fired from a hospital in Pennsylvania in 2008 after he was found in areas where he wasn't assigned and from another hospital after he was allegedly caught with syringes of fentanyl. He was fired again 2010 while working at an Arizona hospital where he was discovered unresponsive in a locker room with syringes and needles on him. A drug test showed he had cocaine and marijuana in his system, according to the Arizona Heart Hospital, the facility where he was working at the time.
Toumpas, the health commissioner, said the Exeter outbreak was a result of a “massive systemic breakdown,” referring to how Kwiatkowski was able to be hired at other hospitals given his history.
In his opinion piece, Callahan, the hospital's CEO, said investigators probing Kwiatkowski's employment record are “discovering red flags that were not present in his employment and personal history at the time of his hire.”
He wrote, “When Exeter Hospital hired Mr. Kwiatkowski his national criminal background check, a sanctions check in the federal database, and the results of a pre-employment drug screening were all void of any information that would have challenged his appropriateness for employment for which he was applying. In addition, two previous hospital employers had provided outstanding performance reviews, once calling him 'invaluable.'”
Callahan said there should be mandatory reference disclosure by health care providers of problems with former employers that could pose a risk to patient safety. He said a national registry to track health care workers with direct patient care responsibilities and who could be a risk to patient safety is also needed.
Meanwhile, Exeter Hospital on Wednesday issued a “Corrective Action Plan” to address violations raised in a report by the state and federal Centers for Medicare & Medicaid Services. They cited the hospital for clinical and life safety violations, including failure to secure controlled medications — and “allowing an employee with draining wounds to participate in an environment where invasive medical procedures were being performed.” That employee was Kwiatkowski, a state health official confirmed.
The inspection following the outbreak found that syringes filled with medication were placed on a medication cart while workers who were not authorized to handle medications were in the room, including the “cardiac cath technicians.”
In a statement issued Friday, the hospital said the medical preparation process described in the cardiac catheterization lab was designed to enable prompt access to pain medication in connection with life-saving treatment.
“All health care providers expect that medical personnel with access to the treatment area are there solely to help deliver that life-saving treatment and pain control. Individuals with criminal intent undermine this expectation. Exeter Hospital uses state-of-the-art technology to safeguard pain medication. However, based on Exeter Hospital's investigation that uncovered alleged drug diversion by an ex-employee after dispensing from our secure system, the hospital modified the pain medication preparation process several weeks ago,” the hospital said.
As of June 12, once filled, syringes are locked up by a nurse until the moment they are needed and only then are they unlocked, the hospital said.