While other health care workers have been prosecuted for diverting drugs and infecting patients, the Kwiatkowski case stands apart, said U.S. Attorney John Kacavas.
"Because of his employment as a traveler, working for agencies and being sent around the country to various states, it really has tentacles all over the country," he said. "Its scope is unprecedented and scary."
His court-appointed lawyer declined to comment at a court hearing this week.
Kwiatkowski, who is being held on federal drug charges, told authorities he did not steal or use drugs. He said he learned he had hepatitis C in May, but authorities say there is evidence that it was diagnosed as early as June 2010. Kacavas said nailing down that date is his top priority, but in the meantime, the uncertainty is further complicating efforts by hospitals to make recommendations about testing.
In Michigan, officials at Oakwood Annapolis Hospital in Wayne noted that there was no indication that Kwiatkowski had hepatitis C when he was employed there from January to September 2007, and that he passed at least two drug tests during that time. State health officials said they are still looking into other locations where Kwiatkowski worked and what steps, if any, they need to take.
Other states have moved ahead with notifying patients and offering free testing.
Twenty-five former patients at St. Francis Hospital in Poughkeepsie, N.Y., where Kwiatkowski worked for three months in late 2007 and early 2008, have been asked to get tested. In Kansas, state health officials are sending letters to about 460 patients who were treated at the cardiac catheterization lab at Hays Medical Center from May 24, 2010, to Sept. 22, 2010. The state also is setting up an informational website, and the hospital has set up a telephone hotline.
In Maryland, hundreds of patients are being contacted by the four hospitals where Kwiatkowski worked between May 2008 and March 2010. None of the four, which include The Johns Hopkins Hospital and a Veterans Affairs hospital in Baltimore, reported that Kwiatkowski was fired or that his behavior raised red flags.
That wasn't the case in Arizona. Kwiatkowski completed one stint at Maryvale Hospital from March to June 2009 without apparent incident but was fired 11 days into his second stint, at the Arizona Heart Hospital.
Barbara Yeninas, a spokeswoman for SpringBoard Healthcare Staffing and Search, said her agency reported Kwiatkowski's firing to a state regulatory board, as well as a national certification organization. Aubrey Godwin, director of the Arizona Radiology Regulatory Agency, said as the agency began investigating, Kwiatkowski surrendered his certification that allowed him to work in the state.
"His statement was that he didn't have enough resources to fight it," Godwin said.
Officials have identified 270 patients at Maryvale and fewer than 200 at the heart hospital who could have been exposed to Kwiatkowski.
At Houston Medical Center in Warner Robins, Ga., CEO Cary Martin the identification process hasn't been completed yet. Kwiatkowski worked in the cardiac cath lab there from October 2010 to March 2011 but did not have access to the hospital's medication system, he said.
Kwiatkowski didn't have direct access to Exeter Hospital's medication system, either, but investigators believe he was able to steal medication that other employees were in the process of preparing for patients and switch it with syringes he had filled with another liquid, possibly saline. Former co-workers reported that he sometimes came in on his days off and attended procedures he wasn't assigned to.
Testing originally was recommended only for patients who had been treated at Exeter's cardiac lab, but state officials have expanded the recommendation to include anyone who underwent surgery or was admitted to the intensive care unit because Kwiatkowski sometimes took patients to those areas. Clinics planned for this weekend and early next week were postponed Thursday due to logistical problems.
If convicted of the charges he currently faces—tampering with a consumer product and fraudulently obtaining a controlled drug—Kwiatkowski could get as many as 24 years in prison.