The Hepatitis C “calamity” at Exeter Hospital might have been prevented had a hospital in another state taken action years ago, the state's top federal prosecutor says.

Four years before David Kwiatkowski was arrested here, an employee at that unidentified hospital caught him stealing a syringe of Fentanyl — the same powerful narcotic drug he's accused of abusing here, according to court records.

U.S. Attorney John Kacavas, whose office is prosecuting the former Exeter Hospital employee for allegedly infecting patients with hepatitis C through contaminated syringes, says “there's no question” the 2008 incident should have been reported to authorities.

“He was literally caught red-handed by a witness,” Kacavas said. “He should have been prosecuted, in my view.”

But there's no evidence that the 2008 incident was ever reported to police. “And it absolutely should have been,” Kacavas said. “Had it been reported to law enforcement authorities, perhaps this calamity would not have happened.”

Federal authorities arrested Kwiatkowski, 32, Thursday in connection with the hepatitis C outbreak at Exeter Hospital, which to date has infected 30 patients of the hospital's cardiac catheterization lab.

Authorities say Kwiatkowski, who worked as a medical technician in that lab from April 2011 until mid-May, exposed patients to the blood-borne virus through contaminated syringes.

In an affidavit filed in the New Hampshire case, Special Agent Marcie DiFede described the 2008 incident, when Kwiatkowski was working as a contract employee at an unidentified hospital:

“An employee in an operating room observed Kwiatkowski enter an operating room, lift his shirt, put a syringe in his pants, move his arms quickly near a medication ... (cart) and exit the room.

“A subsequent review of the narcotics in the room showed that a syringe containing Fentanyl was missing and that it had been replaced by a syringe containing a different liquid. ...

“Kwiatkowski, who was acting erratically and sweating, was confronted and agreed to be searched shortly after the incident. Three empty syringes bearing Fentanyl labels were found on his person. An empty morphine sulfate syringe and a needle were later found in his locker. A drug test found Fentanyl and opiates in Kwiatkowski's urine.”

It's unknown just how long Kwiatkowski has been infected with hepatitis C; he tested positive for the virus in June 2010, according to court records.

But as more details emerge about Kwiatkowski's alleged behavior here and in other states, attorneys representing some of the 30 patients infected at Exeter Hospital are asking whether the outbreak could have — indeed should have — been prevented.

Michael Rainboth, a Portsmouth attorney who is representing four patients in lawsuits against Exeter Hospital, believes the hospital involved in the 2008 incident has some culpability for what happened here. It “has some real answering to do as to why they didn't report this to the police,” he said. “Maybe he would have been arrested then, and my clients would never have been harmed.”

“What strikes me is that this guy was a walking advertisement for trouble, and nobody was doing anything about it,” said Mark Abramson, a Manchester malpractice attorney who has filed lawsuits against Exeter Hospital on behalf of 12 patients.

Revelations in the federal case against Kwiatkowski have made his clients even angrier than they already were, Abramson said.

Three clients told him they experienced “a lot of pain” during their procedures at the lab; now they believe Kwiatkowski was injecting himself with painkillers they were supposed to get, he said.

And one patient remembers the technician had an IV known as a “PICC line” in his arm that he said he needed because of a medical condition, Abramson said. “He was very talkative, very outgoing,” he said.

On Monday, Abramson will add Triage Staffing Inc., the Nebraska-based agency he says employed Kwiatkowski and assigned him to Exeter Hospital, to the lawsuits he previously filed in Rockingham County Superior Court.

Kwiatkowski worked as a temporary employee, known as a “traveler,” in cardiac catheterization labs in six states since 2007, according to the U.S. Attorney's Office.

Health departments in Michigan, Maryland and Georgia have told the New Hampshire Sunday News they are looking into whether Kwiatkowski might have exposed patients at hospitals in those states to hepatitis C.

The Johns Hopkins Hospital, one of four hospitals involved in the public health investigation in Maryland, announced Friday it has begun notifying 200 patients who may have been exposed to hepatitis C when Kwiatkowski worked there in 2009 and early 2010.

Kacavas said drug diversion by health care workers “may be the dirty little problem nobody wants to admit or deal with.”

“I think oftentimes in the health care arena, people view it as, 'Oh, this person needs help, needs treatment,' and I agree with that,” Kacavas said. “But there are legal consequences to doing that. And I think that this case is really one where we must illustrate that there are legal consequences to what you do.”

Domenic Paolini, a former cardiac surgeon who is now a malpractice attorney in Boston, said Friday he plans to file suit this week against Triage Staffing Inc. on behalf of Exeter Hospital patients.

Paolini said most “travelers” are “really good people” who just enjoy working in different hospitals and states. But he said, “There are also people who use this to stay under the radar. ”

“So when you're hiring somebody who is a traveler, you need to really do extra due diligence, and apparently that wasn't done.”

Kwiatkowski was arrested Thursday and charged before a magistrate who came to the undisclosed Massachusetts facility where he is hospitalized. James G. Reardon Jr., a court-appointed lawyer who was at the bedside hearing, said Kwiatkowski did not object to being returned to New Hampshire to face trial as soon as his medical condition allows.

Court records show Kwiatkowski was hospitalized on June 23 after a family member, concerned that he was suicidal and had a gun, called police, who found him at a hotel in Boxborough, Mass.

When a federal search warrant was executed for Kwiatkowski's vehicle, investigators found an empty syringe with a blue sticker labeled “Fentanyl” that matched the syringes used at Exeter's lab, authorities said.

Kwiatkowski has denied drug use and told investigators “he is scared of needles,” according to the FBI affidavit.

Kacavas said there's a limit to the justice that prosecution can bring in such a case. “It's never going to provide his victims with peace of mind. It's never going to provide them with physical security, because he's done something to them that can never be taken back.

“He's altered their lives both physically and mentally, and that we can't change,” he said. “It's a tragedy.”

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Shawne Wickham may be reached at swickham@unionleader.com.