Not only were Exeter Hospital's patients who underwent cardiac catheterization procedures infected with hepatitis C through syringes allegedly first used by an infected employee, but some patients may have also suffered during their procedures because they didn't get enough of the anesthetic drug, fentanyl.
"In some cases they may have required additional dosages, and in some cases, it may mean that some patients suffered unnecessary pain as a consequence of not receiving their prescribed dose," New Hampshire U.S. Attorney John P. Kacavas told HealthLeaders Media.
Kacavas spoke Thursday just after his office announced it has indicted David Matthew Kwiatkowski, 33, a former lab technician at Exeter Hospital, on seven counts of obtaining controlled substances by fraud. Reports have labeled him a "serial infector" because at least 32 catheterization patients have tested positive for a genetic sequence of hepatitis C virus that is virtually identical to Kwiatkowski's.
Kacavas acknowledges that it was possible that Exeter's physicians, nurses, or others who worked with Kwiatkowski suspected or knew that their patients were not getting correct dosages of fentanyl, and that they may have observed patients exhibiting symptoms of agitation during their procedures. He also acknowledges that he is investigating whether anyone else at Exeter Hospital knew of a trend or an anomaly indicating that prescription medications had stopped working as they were supposed to and reported it, and what happened to those reports.
"While these charges have been laid against the defendant," Kacavas says, "it is just a point in time in the legal continuum. We are continuing to investigate this case, and there is no individual or no entity that we are excluding as a potential target of our investigation. ...You can draw the inference from that, we're looking at everything."
The U.S. Attorney's Office has interviewed "the large majority of victims in this case," he says, and "although the patients don't have a great recollection of whether or not fentanyl had its intended effect at the time of their procedure, what we're doing is using medical records to show how many micrograms of fentanyl were administered, say, to this particular patient on this particular date."
He acknowledges that medical records show some patients exhibited symptoms indicating that they got a lower dose of fentanyl, saying, "in some instances, yes."
He adds, "What we have to do is take what the doctor tells us what's supposed to happen in theory, and compare it to what actually happened on an objective paper record, and draw our conclusions that way. There were instances in which the patients did not receive the prescribed dose of fentanyl and there were manifestations of that."
A statement from the Department of Justice for the District of New Hampshire on Thursday said "Kwiatkowski allegedly caused over 30 individuals in New Hampshire and elsewhere to become infected with Hepatitis C, a blood-borne virus that can cause serious damage to the liver."
Kacavas says that during the trial, he will introduce evidence that Kwiatkowski "diverted fentanyl in some quantity by stealing the syringe, and injecting himself, and either filling the syringe in whole with saline or mixing it with residue or some quantity of fentanyl."
Kwiatkowski, who was arrested July 19 and whose Exeter employment was terminated in May or June, remains detained in the Strafford County House of Corrections in Dover, NH, pending trial, for which a date has not been set.
If convicted, Kwiatkowski faces up to 10 years in prison for each count of tampering with a consumer product and up to four years in prison for each count of obtaining controlled substances by fraud, with each offense punishable with a fine of $250,000 and a term of supervised release following imprisonment.
Exeter Hospital has failed three state/federal inspection surveys stemming from the episode, which was discovered in May when numerous patients showed up with unexplained acute infections with hepatitis C. According to the latest inspection report released Wednesday, numerous infection control issues remain.
If not corrected by the time state and federal officials conduct a follow-up inspection, Exeter could lose its ability to receive reimbursement for Medicare and Medicaid patients, which would be a significant loss of revenue.
According to the U.S. Attorney's Office indictment, Kwiatkowski was employed as a healthcare worker in Michigan, and in 2007 became a "traveling healthcare technician, employed in various states including New York, Pennsylvania, Maryland, Arizona, Kansas, Georgia, and New Hampshire."