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Earlier this week, David Kwiatkowski, a former hospital lab technician, was sentenced to 39 years in federal prison after admitting to causing a hepatitis outbreak last summer.  Kwiatkowski admitted to infecting 46 people in New Hampshire, Maryland and Kansas by injecting himself with syringes of fetanyl from patients intended for surgery.  He then replaced the fetanyl with saline before replacing them.  Thus, patients who thought they were getting a painkiller were instead getting saline tainted with Kwiatkowski's infected blood.  One victim in Kansas died.  He also admitted to diverting drugs in other states as well.  Kwiatkowski was staring down the barrel of 98 years in prison had he not taken the plea, but at least had the decency to spare his victims and their families the trauma of a trial.

However, there are several other culprits who have yet to be punished.  When the New Hampshire Union Leader reported on the plea deal Kwiatkowski reached with federal prosecutors earlier this summer, it noted that he worked at several hospitals across the country from 2003 to 2012--and was fired or forced to resign from several of them.

Kwiatkowski was employed at several health care facilities in Michigan between 2003 and 2007. He was fired from a St. Joseph Mercy Health System in 2004 after testing positive for controlled drugs, the plea agreement said. He was fired from William Beaumont Hospital in 2004 for "gross misconduct" and he resigned from a position at the University of Michigan Hospital in 2006 during an investigation into missing drugs, including fentanyl.

Kwiatkowski resigned from a position at Michigan's Oakwood Annapolis Hospital after he was suspended pending an investigation of potential controlled substance abuse, according to the plea deal.
[snip]
In May 2008, Kwiatkowski was terminated from a placement at the University of Pittsburgh Medical Center after he was caught diverting the drug fentanyl. But less than two weeks later, he got a job at the VA Medical Center in Maryland where he worked until November 2008.

He worked at Johns Hopkins University Hospital in Maryland between July 2009 and January 2010, during which time at least six patients became infected with his strain of hepatitis C, according to the plea agreement.

Kwiatkowski moved on to the Arizona Heart Hospital in March 2010 but was let go after he was found unresponsive in a restroom just a month later. A needle and syringe labeled "fentanyl" were seen by witnesses floating in a toilet. Drug testing showed he had marijuana and cocaine in his system, according to the agreement.

And yet, despite all this, Kwiatkowski still managed to get jobs in hospitals.  To put it mildly, this is unconscionable.  As far as I'm concerned, Kwiatkowski's previous employers are complicit in this horror.  

Kwiatkowski will likely be in his mid-70s by the time he gets out of prison, if he lives that long (according to Involuntary Exile, he'll almost certainly die of liver cancer unless he endures a year of debilitating therapy to clear the hepatitis virus from his system).  But there is something fundamentally wrong if Kwiatkowski is the only one who has to answer for this horror.  By all rights, every place that hired Kwiatkowski and didn't look into his background ought to be staring down the barrel of lawsuits.  They not only failed to protect the public, but their own employees.

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Comment Preferences

  •  So you're saying people with a history... (0+ / 0-)

    of drug abuse shouldn't ever work again?

    FYI... it is most likely the hospitals did not know about the hepattitis.

    •  I'm saying that if was fired for drug-related (12+ / 0-)

      offenses, he probably shouldn't have been hired, and urged to seek treatment.

    •  Do they not have an obligation to check his work (14+ / 0-)

      history? Applying for a job in a hospital, with access to drugs, and with a history of being fired repeatedly from hospitals for drug abuse...that would be a big red flag for me.

    •  At the very least, anyone who comes into contact (4+ / 0-)

      with patients should be given a hepatitis test.

      •  And what if they're positive? (2+ / 0-)
        Recommended by:
        kyril, churchylafemme

        There are pretty strict guidelines in place for health care workers so that they don't pass disease from patient to patient or to/ from themselves. Not that it's always followed but that's a whole other thing.

        I'm sort of hoping you aren't advocating that people be
        free of disease as a condition of employment.

        •  contagious diseases..... (5+ / 0-)

          well, yes.  that would be a good idea.  Under treatment, less of a problem.  But he stole their drugs, injected them into himself and then filled the same syringe with saline for them to be injected with the contaminated, used syringe.  But now, could he have avoided sticking his blood into people in his regular work?  Most probably.  But if he were coughing TB all over people, some with depressed immune systems- well yes.  He shouldn't be working in a hospital with the public until his TB was treated.  

          I thought I might have TB after I had chemo, and I stayed home and avoided contact with people until I had a definitive diagnosis (Mycobacterium avium, a relative of TB).  And then I took the drugs.  This guy did bad things and we should keep those facts in mind, not hypotheticals.  If he was stealing drugs, the next hospital should have been told they couldn't recommend him.  full stop.

          You shall know the truth, and the truth shall make you mad. Aldous Huxley

          by murrayewv on Wed Dec 04, 2013 at 06:12:31 PM PST

          [ Parent ]

        •  There are some communicable diseases (0+ / 0-)

          such that no one who has them and is currently contagious should be working with food or in a patient-contact healthcare role. Hepatitis would be one of those.

          •  Healthcare providers have standards known as (0+ / 0-)

            "Universal Precautions", set in place to avoid transmission of diseases such as hepatitis. Universal Precautions include treating all body fluids, including your own as being infectious, washing hands before and after coming into contact with patients (and frequent hand washing in between) and using personal protective equipment, such as gloves. The various forms of hepatitis are primarily spread from person to person through contact with contaminated blood or occasionally other body fluids, not simply through casual contact. It would be discriminatory to bar persons who have chronic hepatitis infections from these jobs. This would be akin to banning persons with HIV.  As long as a person is taking reasonable precautions, there is very little risk of spreading the virus.

            •  They take people with salmonella, etc off the job (0+ / 0-)

              by law, until it is demonstrated they are disease free.  Same with similar conditions.  Remember Typhoid Mary?   Many states also have laws in place that require workers to be paid until they can return to work if ordered to stop working by the health dept.  Places that don't have such laws are being foolish.

    •  People with a history (6+ / 0-)

      of taking advantage of their employer to divert medication from patients for their own use shouldn't work in positions where they have access to patients' medication in the course of their job.

      That's a fairly narrowly-tailored restriction and, as someone who supports legalization of almost all drugs and decriminalization of the remaining few, and who supports much stronger restrictions on the use of criminal and credit records in employment decisions, I still support it.

      I believe in second chances; I believe in functional drug users; I believe in the right to privacy. But I believe that when a person has proven themselves to be unable to handle a specific type of responsibility (like control over medications), then their employers should not allow them to have that type of responsibility again. And in situations like this, where they could and should reasonably have checked, they should be held liable.

      "Let’s just move on, treat everybody with firmness, fairness, dignity, compassion and respect. Let’s be Marines." - Sgt. Maj Michael Barrett on DADT repeal

      by kyril on Wed Dec 04, 2013 at 06:54:00 PM PST

      [ Parent ]

    •  Um, they shouldn't work in places (0+ / 0-)

      that gives them easy access to drugs.

      That one seems like a complete no brainer to me. Would you hire a recovering alcoholic to tend bar?

      •  I know sober alcoholics who tend bar (1+ / 0-)
        Recommended by:
        elmo

        It's their profession.  Alcoholics are in more danger of relapsing if they are hanging out in a social situation with old drinking buddies than they are at their workplace.

        Besides, whether they choose to work in a bar is the individual's choice, not the employer's.  That said, I see your point nonetheless.

  •  one thing I don't understand (9+ / 0-)

    if these patients didn't get the fentanyl, they must have been in agony from all that pain. How was it that the doctors and nurses overlooked this?

    "In America, the law is king." --Thomas Paine

    by limpidglass on Wed Dec 04, 2013 at 04:01:15 PM PST

    •  When I had my shoulder crushed in a motorcycle (9+ / 0-)

      accident I learned something about pain medication. They gave me some synthetic opiate, dilaudid, and asked "Did I feel better?" I said no so they gave me more. Think about that for a second, they expect the patient to tell them they need more medicine. So they give a dose of fentanyl and it doesn't work so they get a second one. It's unlikely this asshole stole that one as well and the second one works and the surgery/etc. continues. And that's the underlying problem with how we treat pain -- we don't really know how to stop it we can mask its symptoms but it's largely guess work as to how much will be needed. Novocain at the dentist to morphine at the hospital. It's imprecise and Kwiatkowski depended on that to avoid detection.

      There are lies, damn lies, and statistics but they all pale in comparison to conservative talking points.

      by ontheleftcoast on Wed Dec 04, 2013 at 04:15:43 PM PST

      [ Parent ]

      •  As I recall, the patient-controlled drips (1+ / 0-)
        Recommended by:
        Cassandra Waites

        are actually the best way to go: they're designed to limit the dose a patient can receive in a certain period of time (so no overdoses).

        Plus, as an added benefit, letting patients direct their own pain medication generally leads to them needing less medication.

        We don't want our country back, we want our country FORWARD. --Eclectablog

        by Samer on Wed Dec 04, 2013 at 07:45:57 PM PST

        [ Parent ]

        •  Makes sense to me. (2+ / 0-)
          Recommended by:
          swampyankee, Samer

          Breakthrough pain is a lot harder to get rid of the more established it gets.

          I missed an ibuprofen dose for an aching ear last night and it was a full 45 minutes out of a 4-hour dose before the too-late-pill actually lessened the pain enough for me to sleep again.

          Problem is, if you're going by static 'every X hours' dosing, you have to peg the dosage to what won't allow breakthrough pain during the taper down leading into the next dose. And if you've got allowances built in for additional pain medication to deal with anything that breaks through but it requires calling a nurse, that's that much longer the pain has to get established and build.

          Give the patient control, and there's no need for the huge static doses after the first one AND the patient can nip anything that breaks through in the bud when it's merely at the annoying or distracting stage instead of the mind-consuming stage. You just have to have some static dose in place so that going to sleep for a few hours doesn't leave the patient with no pain medication until the pain wakes them up.

  •  There isn't a national database (3+ / 0-)

    of people who work in health-related fields and have a drug problem. He wasn't arrested for the earlier problems -- the one place where I might find fault with the hospitals, if they failed to report him to the police -- so would pass a criminal records check.

    I assume the various hospitals are facing civil liability (which only requires proof of negligence in hiring or supervision), and may have already settled numerous cases. But criminal liability? I doubt it.

  •  Many places of business have mandatory (1+ / 0-)
    Recommended by:
    elmo

    drug tests of employees. I would think that would be a fair screening test.

    I was a fan of a TV show where the surgeon had to undergo a blood test every time before he went into surgery to test for diabetes. I would think for a place of business that handles addictive drugs, a daily drug test prior to work would be acceptable. If you have residue from last night's party, you get the day off without pay.

  •  Radiology/Cardiovascular technician (0+ / 0-)

    He would have a licence which should have allowed this behavior to be reported to the State Board and would follow him where ever he went. There are procedures in place and the the failure was at the hospital level for not reporting his termination(s) for drug use and theft. There are many levels of caregivers in a hospital and any one of them in position with potential access to drugs should be subject to a much higher level of scrutiny.
    Take Registered Nurses for example, he/she can lose their licence for many reasons. In Missouri you can add non-payment of state taxes or even child support.

  •  SOP for medical field for years (0+ / 0-)

    admitting that you hired a "problem" professional could lay an institution open for all sorts of malpractice suits so usually the "problem" employee was usually allowed to resign and move on, sometimes even with glowing recommendations.  Irony here is that with advent of the Data Bank, whistleblowers found themselves as likely to be reported to the Bank, as the professionals who had displayed varying levels of problems.  The whole notion was to move the problem guy on down the line because his problems being made public could lead to all sorts of repercussions while destroying the career of the whistleblowers carried with it few repercussions, if any.

  •  Asdf (0+ / 0-)

    "Hospitals who..."

    Hospitals are people??

    Or only corporate hospitals??

    :D

    The best way to tell a Democrat from a Republican is to present someone requiring food and shelter. The Democrat will want them housed and fed, even if they be faking need. The Republican will gladly see them starve until all doubt is removed.

    by GayIthacan on Thu Dec 05, 2013 at 06:20:02 AM PST

  •  I want to know how a laboratory technician (1+ / 0-)
    Recommended by:
    Cassandra Waites

    is getting his hands on fentanyl syringes. Fentanyl is a C2 medication; C2 narcotics are the most regulated drugs that have medical use, and are typically only accessible by the pharmacist ( and maybe pharmacy technician under supervision) that fills the order, and the RN that administers the medication, and have be kept locked up in medication safes ( though I don't know what the specific state laws are in effect.) Seems to me that investigation into other staff members and/or hospital practices and procedures is necessary, because there is no reason that a lab technician should have been anywhere near these drugs.

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