CONCORD — A 33-year-old medical technician who worked at Exeter Hospital has been arrested and charged with spreading hepatitis C to 30 patients through the use of stolen hospital drugs.

David Matthew Kwiatkowski is charged with obtaining controlled substances by fraud and tampering with a consumer product, U.S. Attorney John P. Kacavas said Thursday at a news conference in Concord.

Kwiatkowski, a traveling medical technician, has worked in at least seven hospitals since 2007, and federal authorities are trying to determine whether any other patients may have been exposed to the disease.

“Our investigation remains open and very much active, and I want to stress that we are closer to the beginning of our investigation than we are to the end of it,” Kacavas said.

Prosecutors say Kwiatkowski spread the virus by stealing syringes of the anesthesia drug fentanyl, injecting himself, and then filling them with a different liquid to conceal the theft. He allegedly passed the disease to patients by allowing the syringes to be reused.

He was arrested on Thursday morning at a hospital in Massachusetts, where he was receiving unspecified treatment. Kacavas declined to comment on his location, and said he will likely be remanded to the custody of New Hampshire authorities next week.

Earlier this week, investigators discovered that Kwiatkowski was allegedly involved in another case of so-called “drug diversion,” meaning the theft of hospital narcotics.

According to court documents, a hospital employer in another state said Kwiatkowski was spotted stealing a syringe of fentanyl from an operating room four years ago. Prosecutors say he was seen lifting his shirt and putting the syringe down his pants.

Kwiatkowski was searched after the procedure, and allegedly found to be carrying three empty syringes labeled as fentanyl. Prosecutors say a drug test administered after the 2008 incident detected fentanyl and opiates in his urine.

“With Kwiatkowski’s arrest today, this serial infector has been contained and the menace he posed to public health and safety has been removed,” Kacavas said.

Kwiatkowski is originally from Michigan, and he worked in the health care industry there for several years, according to an affidavit filed in federal court in New Hampshire Thursday by an FBI agent. He went on to work as a traveling technician in cardiac catheterization laboratories in at least six states since 2007.

Kwiatkowski was employed as a traveling medical technician in Exeter Hospital’s cardiac catheterization laboratory (CCL) in April 2011. He was brought on as a full staff member in October 2011, and worked in the CCL until May 2012, Kacavas said.

According to the affidavit, employees at Exeter Hospital were suspicious of Kwiatkowski’s behavior before an outbreak of hepatitis C was detected at the hospital this spring. He was allegedly observed leaving the CCL during procedures, sweating profusely, attending procedures on his off-days and “engaging in other suspicious behavior,” according to the U.S. attorney’s office.

One former co-worker who spoke with police remembered that Kwiatkowski appeared to be “on something.” Others claimed to have observed so-called “track marks” on his arms — physical signs of intravenous drug use.

During one instance, a supervisor declared Kwiatkowski unfit for work and sent him home early from a shift, according to information provided by Kacavas.

When federal authorities searched Kwiatkowski’s vehicle, they allegedly found an empty fentanyl syringe and several needles inside, despite the fact that he should not have had access to the drug as a technician, according to Kacavas.

He declined to describe the exact method prosecutors believe Kwiatkowski employed to obtain the drug while the investigation is ongoing.

Prosecutors say when Kwiatkowski was questioned regarding the hepatitis C outbreak, he insisted he only learned he was carrying the disease in May. However, investigators have allegedly uncovered evidence that Kwiatkowski has carried the disease since at least June 2010, Kacavas said.

Kwiatkowski was scheduled to appear in a Massachusetts courtroom on July 11 to face charges relating to an automobile accident, according to the affidavit. He failed to appear in court, and a warrant was issued for his arrest.

Then, on July 13, officers from the Marlborough, Mass., Police Department allegedly found Kwiatkowski intoxicated inside a hotel room. They believe he might have been attempting to harm himself. He was transported to a medical facility for treatment.

Since 2009, there have been at least two hepatitis C outbreaks that spurred criminal charges.

In one instance, a 26-year-old Colorado woman infected patients at two hospitals by stealing fentanyl off operating room carts and injecting herself with it.

However, the situation at Exeter Hospital encompasses more cases of hepatitis C than any other instance of hospital drug diversion on record, according to an official at the Centers for Disease Control and Prevention.

“I will tell you that I’m unaware of such a scheme with such reach,” Kacavas said Thursday. “There are certainly other cases around the country where diversion has occurred, and that diversion resulted in outbreaks ¿ such as this, but this one has the potential for very far-reaching implications.”

Kwiatkowski’s background

As part of their investigation, federal authorities have interviewed some of Kwiatkowski’s former colleagues at other hospitals.

Traveling technicians such as Kwiatkowski are hired to work at hospitals on a contract basis for a short time, often approximately 13 weeks, according to information provided in the affidavit.

Witnesses have painted a picture of Kwiatkowski as a man who often fabricated stories about himself: In one case, he claimed erroneously to have played baseball at the University of Michigan. In another instance, a witness said Kwiatkowski claimed his fiancée had died under tragic circumstances.

According to the affidavit, a former supervisor told police Kwiatkowski was fired for lying on his time sheets.

Multiple people also reported Kwiatkowski claimed to have cancer; investigators have found no evidence to support the claim.

On at least two occasions, needles were found inside a restroom at a hospital where Kwiatkowski was working while he was on duty, another former supervisor told police.

Behavior at Exeter Hospital

In June, police interviewed a range of employees and supervisors at Exeter Hospital, some of whom recalled Kwiatkowski’s behavior was “unusual,” according to the affidavit.

One woman recalled noticing one day that Kwiatkowski was sweaty and had bloodshot eyes. Believing he was “on something,” she notified the CCL director.

In a June 18, 2012, interview with investigators, the director acknowledged receiving the complaint. He said he called Kwiatkowski into his office and also observed the technician’s eyes were bloodshot.

According to the affidavit, Kwiatkowski told the director that his aunt had died and that he had been up since 3 a.m. crying. He was sent home “in light of his condition,” according to the affidavit.

Last month, Kwiatkowski’s parents were also interviewed by police. They indicated there have been no family deaths in the last three years, according to the affidavit.

Another Exeter Hospital employee who was interviewed last month said he remembered an incident in which he observed that Kwiatkowski had “a red face, red eyes, and white foam around his mouth” while he was on duty.

A third employee recalled that the family of an Exeter Hospital patient had found a syringe labeled “fentanyl” inside a public bathroom outside the CCL. The story has been corroborated by other employees, according to the affidavit.

One hospital remembered Kwiatkowski became “upset and claimed that the employee had accused him of stealing drugs” when the worker raised the issue in a conversation, according to the affidavit.

Another worker said Kwiatkowski would sometimes get “shaky and very sweaty,” and would sometimes rush out of the CCL when procedures concluded.

One Exeter Hospital employee claimed that Kwiatkowski often complained of abdominal pain, regularly vomited and frequently left to use the bathroom. The affidavit states abdominal cramps, vomiting and sweating are symptoms often associated with fentanyl withdrawal.

Investigating Kwiatkowski

On June 19, 2012, federal agents in Michigan interviewed Kwiatkowski’s parents. They said their son has issues with “alcohol, anger, and depression,” but said they did not believe he used illegal drugs.

The couple said their son suffers from Crohn’s disease, a bowel disorder, and took medications for the illness. They also indicated that Kwiatkowski was diagnosed with hepatitis C, and he became infected when he was pricked by a needle at work. They estimated Kwiatkowski was infected with the disease at least one year ago.

Kwiatkowski resided in Exeter while he was employed at the hospital, and investigators also interviewed a woman who previously lived with him. According to the affidavit, the woman claimed she found needles in Kwiatkowski’s laundry on several occasions. When she confronted him, Kwiatkowski told her the needles were related to cancer treatment he was receiving at Portsmouth Regional Hospital. She also told police she discovered a “blunt needle” under Kwiatkowski’s bed.

An investigator who was shown the needle said it resembles the needles used in the CCL at Exeter Hospital to draw medication.

A footnote in the affidavit states the woman who formerly lived with Kwiatkowski subsequently failed a lie-detector test.

The layout at Exeter Hospital

Based on their interviews with Exeter Hospital officials, prosecutors say Kwiatkowski should not have been granted access to drugs such as fentanyl, which are tightly controlled.

The CCL at Exeter Hospital contains two secured machines to dispense hospital narcotics, which are referred to as Pyxis machines. The first is kept in a secured room adjacent to the CCL recovery area. The second is inside the lab.

In order to access medications, nurses and other authorized individuals must enter a username and provide a fingerprint scan. Nurses will ordinarily remove vials of medication, such as fentanyl, at the start of a procedure and draw the drug into a syringe, which is then labeled.

During procedures, the physician and scrub technician — the position held by Kwiatkowski — are considered sterile, and are the only workers who come in contact with the patient’s body. The nurse who administers the medications usually stands aside, behind a screen.

At the conclusion of the procedure, the nurse is required to discard any unused drugs by tossing needles and syringes in a medical waste container. Based on these circumstances, prosecutors say Kwiatkowski would have no reason to possess a syringe containing fentanyl or a needle used in a CCL procedure.

Lead aprons raise suspicions

On June 15, investigators spoke with an Exeter Hospital CCL supervisor about the hepatitis C outbreak. The supervisor speculated one possible explanation for how Kwiatkowski could access vials of medication while a procedure is under way is by delivering aprons to colleagues.

The supervisor said Kwiatkowski would sometimes deliver lead aprons to workers inside the procedure room, even if he wasn’t assigned to work during the procedure. The supervisor said Kwiatkowski would set the lead aprons down on a table next to the Pyxis machine, often after nurses had already withdrawn medications. The supervisor speculated this could have provided Kwiatkowski with an opportunity to steal syringes of fentanyl and replace them with tainted syringes containing saline or another liquid, according to the affidavit.

“He noted that it was unusual for an employee to bring in lead aprons for other employees,” it states.

Police interview suspect

Kwiatkowski was interviewed by law enforcement officers on June 13, 2012. He allegedly told police he was recently informed by a doctor that he had tested positive for hepatitis C, and described the news as a “time bomb.” According to the affidavit, Kwiatkowski denied stealing any hospital drugs, and further stated he was allergic to fentanyl.

However, the investigation has uncovered Kwiatkowski received approximately 200 micrograms of fentanyl while undergoing a medical procedure on Dec. 11, 2011. The physician who operated on Kwiatkowski was interviewed on Wednesday, and told police that she saw no evidence of an allergic reaction to the drug.

The investigation into Kwiatkowski’s activities took a turn on June 23, when one of his family members called the Exeter Police Department. According to the affidavit, the family member reported Kwiatkowski had a gun and was potentially suicidal.

Police in Boxborough, Mass., located Kwiatkowski at a hotel there. They searched his room and found no weapons, but allegedly discovered prescription bottles and clothing. Kwiatkowski agreed to be transported to a hospital for evaluation.

Sometime thereafter, police executed a federal search warrant on Kwiatkowski’s vehicle. Inside, they allegedly found an empty syringe labeled with a blue sticker that read “fentanyl,” which “appears to be consistent with the stickers used to label syringes at the Exeter Hospital CCL,” according to the affidavit.

On July 2, Kwiatkowski was interviewed again by law enforcement officers. He allegedly admitted he had “lied to a lot of people” and “fabricated my life.” He denied being an intravenous drug user, and said the syringe allegedly found in his car was not his, and suggested it had been planted there by a co-worker.

Kwiatkowski allegedly terminated the interview when he was informed police had gathered evidence that he was aware before May 2012 of his hepatitis C diagnosis.

Investigators highlight February operation

In the affidavit, federal investigators provide a detailed account of Kwiatkowski’s involvement with a Feb. 25, 2012, procedure in which a patient was infected with hepatitis C.

According to interviews with Exeter Hospital workers, Kwiatkowski showed up for the Saturday procedure even though he wasn’t on call. Supervisors remembered telling Kwiatkowski he could go home, but he stayed for the length of two procedures that day.

A physician told police Kwiatkowski entered and exited the CCL during the procedure. After reviewing records from the operation, the physician told police the amount of fentanyl used on the patient “seemed high,” according to the affidavit.

Based on medical records, during the second procedure, a nurse withdrew 100 micrograms of fentanyl from the Pyxis machine at 7:12 p.m. Card access records show Kwiatkowski entered the CCL approximately eight minutes later, then apparently left the room and entered again at 7:29 p.m., before the patient received the first dose of fentanyl.

At 7:56 p.m., the nurse withdrew another 100 micrograms of fentanyl from the machine. Kwiatkowski was then logged as entering the room at 8:06 p.m., and the patient’s procedure concluded about four minutes later.

“Based upon the medical and epidemiological information, the witness statements, my conversations with other law enforcement officers, and my training experience, I believe that Kwiatkowski tampered with the medications that were intended for this patient and diverted the medication for his personal use,” FBI Special Agent Marcie DiFede wrote in the affidavit.

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©2012 the Foster’s Daily Democrat (Dover, N.H.)

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