When it comes to discussion and analysis of drug diversion, David Kwiatkowski is the elephant in the room. More aptly, he is in a Florida federal prison cell.
A hepatis C virus (HCV) carrier, Kwiatkowski was sentenced to 39 years in prison in 2013 for infecting a string of victims with HCV as he diverted drugs from multiple hospitals in eight states. Tracking back through this trail of tears, federal officials with the Department of Health and Human Services (HHS) tallied 45 HCV-infected patients, two of whom died.1
Kwiatkowski’s modus operandi was to steal prepared fentanyl syringes intended for patients awaiting cardiac catheterizations, inject the drugs, and replace them with saline. The replaced syringes were contaminated with HCV from the cardiac medical technician’s blood.
“Kwiatkowski concealed his job history,” HHS officials wrote. “But regulations and procedures that differ from state to state, and even from institution to institution, enabled him to continue destroying lives. We know of only two instances when calls were made to law enforcement officials on suspicions that Kwiatkowski was stealing drugs. Both times, he left the state before any action was taken. Most hospitals didn’t call the police. They also didn’t communicate his job history to agencies and institutions to prevent his being hired again.”1
Kwiatkowski entered a plea for early release in 2021, citing his HCV infection and the risk of COVID-19 in prison. A district court judge in New Hampshire dismissed the plea out of hand, saying the crime committed was “extremely cruel and callous” and the perpetrator deserved no such mercy.2
In the years after this case, some states have tightened oversight over medical staffing agencies or discussed some version of granting immunity to those who report diverters. However, similar incidents — although on a smaller scale — have occurred since the landmark Kwiatkowski case. In 2022, a nurse who worked at a hospital in Winston-Salem, NC, was sentenced to 4.5 years in prison for drug tampering. No patients were infected with a bloodborne pathogen, but by stealing hydromorphone and replacing it with dummy syringes containing saline, the nurse knowingly left patients without any pain relief for subsequent procedures, the court ruled.3
The CDC investigated a 2017 outbreak of genetically similar HCV infections in 12 patients who were all linked to the same nurse. It was thought the nurse was HCV positive, but her viral titers were too low to draw a definitive conclusion. However, a patient not in the cluster was diagnosed with chronic HCV and could have infected the nurse before she infected the other 12 patients, the CDC theorized.
“It is possible that nurse A acquired the virus from the patient with chronic HCV infection during the Nov. 8 visit and was infectious during Nov. 22-Dec. 26, 2017, during which time at least 12 patients that she treated became infected,” the CDC concluded.4
That report underscores the challenge of determining routes of transmission and the behavior of individual pathogens with variable incubation periods. For example, HCV can appear relatively soon after an exposure as an acute infection or remain dormant for years.
“There is a ton of tampering going on,” says Kimberly New, JD, BSN, RN, principal consultant at Diversion Specialists. “I recently heard a facility say somebody tampered in the ER for eight months, but there was no patient harm. I don’t know how they can come to that conclusion. You are only going to find what you look for.”
REFERENCES
- Levinson DR, Broadhurst ET. Why aren’t doctors drug tested? The New York Times. March 12, 2014.
- Feely P. Judge rejects compassionate release request from man who infected 46 with hepatitis C. New Hampshire Union Leader. Jul 1, 2021.
- Hewlett M. Ex-nurse sentenced for ‘tampering’ with opioids at Winston-Salem hospital. She took drugs, replaced them with saline, investigators say. Winston-Salem Journal. Jun 2, 2022.
- Njuguna HN, Stinson D, Montgomery P, et al. Hepatitis C virus potentially transmitted by opioid drug diversion from a nurse — Washington, August 2017-March 2018. MMWR Morb Mortal Wkly Rep 2019;68:374-376.
When it comes to discussion and analysis of drug diversion, David Kwiatkowski is the elephant in the room. More aptly, he is in a Florida federal prison cell. A hepatis C virus carrier, Kwiatkowski was sentenced to 39 years in prison in 2013 for infecting a string of victims with HCV as he diverted drugs from multiple hospitals in eight states. Tracking back through this trail of tears, federal officials with the Department of Health and Human Services tallied 45 HCV-infected patients, two of whom died.
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