Medical technician gets 39 years for triggering hepatitis C outbreakBy KATHRYN MARCHOCKI
New Hampshire Union Leader
December 02. 2013 9:52PM
The case against David M. Kwiatkowski
Number of states in which he worked, 2003-2012: 8, in multiple hospitals
Hepatitis C diagnosis discovered: 2010 Number of patients he is known to have infected with hepatitis C: At least 45 (No way to determine precise number of those he exposed to virus): One at VA Medical Center, Baltimore, Md., in 2008; Six at Johns Hopkins Hospital in 2009; Six at Hays Medical Center in Kansas in 2010; 32 at Exeter Hospital in 2011-2012
Deaths: One known (Kansas) Cases Kwiatkowski pleaded guilty to Aug. 14: Seven of the NH cases plus the fatal Kansas case
Number of patients CDC recommended be tested for hepatitis C because of Kwiatkowski: More than 12,000 Number of Exeter Hospital patients tested: 3,753
Cost to New Hampshire to respond to public health crisis: $384,000
When Kwiatkowski began stealing pain killers intended for hospital patients: He admitted he began diverting drugs in 2002 when he and a co-worker stole vials of morphine from a Michigan emergency room.
What is hepatitis C: A viral, blood-borne illness most efficiently transmitted through contact with infected blood. It is potentially fatal. It is most commonly transmitted through needle-sharing by users of injectable drugs. It is occasionally spread sexually or through sharing personal items contaminated with infected blood (e.g. toothbrushes). There currently is no vaccine for Hepatitis C. A small percentage of those who become infected with the disease are able to “clear” the infection. Most (85 percent) develop chronic Hepatitis C. It can lead to chronic liver disease. There currently is no vaccine for Hepatitis C.
CONCORD — U.S. District Court Judge Joseph LaPlante on Monday sentenced former traveling medical technician David M. Kwiatkowski to 39 years in prison for infecting 45 patients with Hepatitis C — one of whom died — while he worked at hospitals in eight states — exposing what prosecutors call the medical community's "dirty little secret" of drug diversion among employees.
U.S. Attorneys John P. Kacavas of New Hampshire and Barry R. Grissom of Kansas said the sentence, which exceeds sentencing guidelines but is one year short of the 40-year term the government sought, sends a clear warning to anyone engaged in stealing narcotic painkillers from patients.
"Those who are contemplating drug diversion. Those who are engaged in drug diversion as we speak, should hear the message loud and clear: that 39 years (in prison) are in your future. It's a harsh sentence. We are grateful to Justice LaPlante for imposing it," Kacavas said after the hearing. He was flanked by federal, state and local law enforcers who led the 1 1/2-year criminal investigation.
Kwiatkowski, 34, infected at least 45 patients with hepatitis C by stealing syringes filled with the narcotic painkiller fentanyl intended for patient use, and injected himself with the narcotic. He then refilled the syringes with saline and put them back to be used on patients — even though he knew he had hepatitis C.
Kwiatkowski carried out his drug diversion scheme from 2003 to 2012 while working at hospitals in at least eight states. It was uncovered in May 2012 when an outbreak of hepatitis C occurred at Exeter Hospital while Kwiatkowski worked there.
The sentencing followed about 3 1/2 hours of statements from victims and their families, many of whom struggled through tears to describe the devastation the potentially fatal, blood-borne disease has wrought on them and their families.
"You may only be facing drug charges, but make no mistake, you are a serial killer," Kathleen Murray of Elmira, N.Y., told Kwiatkowski, showing him a picture of her mother, Lucy Starry, then 90, when she went to Johns Hopkins Hospital in Baltimore, Md., for heart surgery and became infected with hepatitis C.
The once-vibrant woman who maintained a "huge garden," lived alone and "could work circles around me" in her New York state home, now can barely walk across the kitchen, is weak, frail and in constant pain, said Murray and her sister, Peg Seaman of Millersville, Md.
"I had to come here today for mom — just to see firsthand what evil looks like. And you are evil," added Murray, a prison nurse who told the court her mother hopes Kwiatkowski "gets life."
Of the 45 known victims, 32 became infected while patients at Exeter Hospital; one was infected at the VA Medical Center and six others at Johns Hopkins Hospital, both located in Baltimore, Md.; six patients were infected at Hays Medical Center in Hays, Kansas. One of the Kansas patients — 89-year-old grandmother Eleanor Murphy — later died from complications.
Kwiatkowski was arrested July 19, 2012, and pleaded guilty last Aug. 14 to eight counts each of tampering with a consumer product and obtaining controlled substances by fraud in connection with seven of the New Hampshire cases and the fatal Kansas case.
His public defenders sought a 30-year prison sentence, saying Kwiatkowski had abused alcohol and narcotics since high school and his conduct was largely the result of his addictions, for which he did not get treatment.
Kwiatkowski, a husky, dark-haired man dressed in light olive prison scrubs, sat seemingly impassive between public defenders Jonathan R. Saxe and Bjorn Lange through most of the hearing — even as several victims angrily demanded answers or a show of remorse.
"You killed me. You don't have anything to say to me?" Donald Page, 50, pleaded, his face flushed and visibly shaking as he faced Kwiatkowski.
"You took my life," Page continued as Kwiatkowski stared ahead in silence. Page wept as his former wife, Joan, took his arm and escorted him back to his seat.
As the hearing drew to a close, Kwiatkowski stood and turned to face the more than 100 people who packed the courtroom.
"I have listened to you guys. I have read your statements. I agree with you. I do belong in prison," Kwiatkowski read aloud from a written statement.
"I know it's no excuse for what I've done (but) I never hurt anyone intentionally," Kwiatkowski added, blaming his conduct on his addictions to alcohol and narcotics. He apologized to the victims, their families and the health care institutions for which he worked.
Public health crisis
Kwiatkowski's conduct set off a national public health crisis prompting the Centers for Disease Control and Prevention to recommend 12,000 people be tested for hepatitis C. Assistant U.S. Attorney John J. Farley said Kwiatkowski's conduct resulted in the greatest number of victims reported in a drug diversion case. And, Farley added, his actions were particularly heinous because he could have stolen the narcotic syringes and replaced them with sterile ones. Yet Kwiatkowski chose to refill the tainted syringes and return them for patient use even though he knew he had hepatitis C at least since 2010.
"He is a monster," U.S. Attorney Grissom of Kansas said. "We not only have victims who now carry hepatitis C, but their victimization extends to their families, their loved one, even their communities."
In fact, one case of secondary infection has been reported in New Hampshire where a close relative of one of the victims contracted the disease.
While the convictions and sentencing close all criminal cases against Kwiatkowski, Kacavas said he has directed his staff to draft a policy paper that will highlight "systematic failures" in the medical care system that allowed Kwiatkowski to "exploit critical gaps" that enabled him to continue infecting others in multiple states.
"It has cast a harsh light on the dirty little secret of drug diversion in the medical setting and it has heightened public sentiment toward reform and management," Kacavas said.
The team that investigated and prosecuted Kwiatkowski's criminal case now will work on a white paper that will identify these gaps and systemic failures and possibly propose civil or administrative remedies, Kacavas said.
For instance, while "drug diversion is prevalent in the medical community, it is not reported to law enforcement as it should be," he said.
"However, it is a crime and had the crime been reported to law enforcement, this serial infector would not have reached Kansas, he wouldn't have reached Baltimore and he wouldn't have reached New Hampshire," Kacavas said.
In sentencing Kwiatkowski, LaPlante read aloud the 45 victims' names and thanked those who spoke in court.
"I don't know what to make of this crime," LaPlante continued. "The law doesn't view it as purposeful or knowing conduct. Just viewing it as reckless conduct or a crime of addiction just doesn't do it justice. There is a component to your conduct that goes beyond recklessness. There is a component of cruelty or sadistic or hostility or something about it," the judge continued.
Not only did Kwiatkowski deprive patients of medication by stealing their painkiller, but he chose to use tainted syringes rather than sterile ones, knowing the likelihood of spreading infection, the judge noted.
Explaining his reason for imposing one year less than the 40 years the government sought, LaPlante said this was a gesture he hoped Kwiatkowski would act upon while in prison.
"People do have a capacity for mercy. This isn't any generous helping of that. It's just a token," LaPlante explained. "As you spend the next 39 years of your life in prison, I hope you remember the one year you didn't get and remember and try to develop that capacity in yourself."
Kwiatkowski was ordered to be on three years of supervised release after his release from prison and to pay nearly $25,000 in restitution to two of his victims. The court requested Kwiatkowski be imprisoned close to Canton, Mich., where his family lives.