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David Kwiatkowski faces charges in outbreak
David Kwiatkowski, a former lab tech at Exeter Hospital, faces felony charges in a hepatitis C outbreak. The case may give momentum to legislation aimed at combating drug diversion.

Higher standards

Hepatitis C outbreak leads to calls for stricter employment standards, rules

By Maureen McKinney
Posted: December 22, 2012 - 12:01 am ET

Some hospitals may have to tighten employment and oversight standards for medical technicians as state and federal lawmakers push stricter rules after the multistate outbreak of hepatitis C traced to a traveling hospital worker.

“We just want to make sure that what happened here doesn't happen again,” said New Hampshire Rep. Tim Copeland (D-Stratham), referring to the case of David Kwiatkowski. The lab technician, infected with hepatitis C while employed at Exeter (N.H.) Hospital, allegedly diverted syringes of the pain medication Fentanyl for his own use, returning the contaminated syringes into circulation after refilling them with another solution.

Kwiatkowski, who worked at 18 hospitals in seven states over more than five years, moved easily from one job to another, despite reported drug-related incidents at several hospitals. On Dec. 3, he pleaded not guilty to 14 federal charges, including multiple counts of obtaining controlled substances by fraud and tampering with a consumer product.

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The case has prompted a closer look from legislators, some of whom are drafting bills aimed at combating drug diversion, improving communication among hospitals and preventing technicians from gaining new employment after a drug-related episode.

Copeland, for instance, is the sponsor of two such bills originally filed by Rep. Lee Quandt (R-Exeter), who lost his seat in the November election. The first would create a central board of registration for healthcare workers who are not already licensed or registered with the state. The registry would include information about founded allegations and whether a registrant's status was active, suspended or revoked, he said.

“(Human resource) departments at these hospitals couldn't speak honestly about this lab tech for fear of being sued,” Copeland said. “We can't change what HR does, but we can create a public document that will provide hospitals with some information.”

The second New Hampshire bill would institute a policy of random, at-work drug testing of hospital employees. Hospitals would rely on Social Security numbers for random testing, but employees who appear intoxicated could also be singled out. That bill has already met with some resistance from hospitals, who would be charged with paying for the tests, Copeland said.

Steve Ahnen, president of the New Hampshire Hospital Association, said the group has not taken a stance yet on drug testing, creation of a statewide registry or other solutions that have come up for discussion. The NHHA has formed a steering committee that includes clinicians, hospital officials, risk management professionals and leaders from the state's medical society and boards of medicine, pharmacy and nursing, with the goal of evaluating potential strategies and working alongside lawmakers, he said.

“We're not at a point to identify with any one perspective yet,” Ahnen said. “Whatever approach we take, we want to make sure it's feasible in the context of patient care and will have the effect that we want.”

Both bills are in “their infancy,” with many steps to go before passage is a possibility, Copeland said. Still, he predicts one or both of them could conceivably make it to the governor's desk in 2013.

“There's an obvious hole since this is just one of 50 states, but we're hoping the federal government will pick up on what we're doing and mirror it,” Copeland said. “Once the legislation is properly written and ready to go to committee, I'm going to forward it to our two senators and two congresswomen. They can see if it has any traction at the federal level.”

Exeter Hospital, New Hampshire
Exeter Hospital
One federal bill introduced in 2011 would set national certification and education standards for technicians involved in medical imaging or radiation procedures. Known as the Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy Act of 2011, or the CARE Act, the legislation would make Medicare reimbursement for such services contingent upon adherence to the standards.

Rep. John Barrow (D-Ga.), the bill's lead sponsor, said in an August interview with the Associated Press that the recent hepatitis C outbreak illustrates “what happens when you have incredibly important, sophisticated work being done by folks who don't have to be trained or certified or qualified to do it.”

Legislators pondering such action could look to Colorado, where in 2009 a surgical technician's theft of Fentanyl syringes also resulted in an outbreak of hepatitis C affecting more than 30 patients at Rose Medical Center, Denver. That technician, Kristen Parker, is now serving a 30-year prison sentence.

The case galvanized lawmakers and led to the passage in 2010 of two laws tightening requirements for surgical technicians. One requires surgical technicians and assistants to register with the Colorado Department of Regulatory Agencies. Employers must also verify that a new hire's registration is in good standing. Under a second law aimed at stemming drug diversion, hospitals have to report employee drug thefts to state officials.

“Our model made sense, but the horse was already out of the barn,” said Colorado State Sen. John Morse (D-Colorado Springs), a co-sponsor of the registration bill. “We did this too late to help the people affected by the outbreak. Our hope is that other states put protections in place before something happens.”

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