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N.H. hep C cluster not the first: stealing syringes in hospitals & infecting patients with HCV
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Medical techs were suspected before
By Meg Heckman
concordmonitor.com
July 29, 2012
Using a charming personality and generic letters of recommendation, a surgical technician named David Wayne Thomas landed a job at a Texas outpatient clinic in the fall of 1991. Four years later, the Mid-Cities Surgi-Center, battered by expensive lawsuits and bad publicity, would close its doors after Thomas admitted stealing syringes full of narcotics and, in the process, infecting dozens of patients with hepatitis C.
The case was unprecedented. At the time, few people had even heard of hepatitis C, a blood-borne virus that can cause deadly liver damage. Scientists knew little about the disease and had never before encountered an outbreak linked to criminal acts by a health care worker. Understanding of the virus has improved in the last 20 years, but newspaper reports from the early 1990s tell a story eerily familiar to anyone following recent events at Exeter Hospital, where David Kwiatkowski is accused of stealing drugs and infecting at least 30 patients with hepatitis C.
Both men worked as surgical technicians at multiple hospitals. Both were accused of taking the powerful narcotic fentanyl. And both exhibited symptoms of drug addiction before their arrests. The Fort Worth Star-Telegram reported that Thomas was frequently absent from work and had been seen touching syringes.
According to the Associated Press, Kwiatkowski was fired from an Arizona hospital after he was found passed out in a locker room with needles. Both men also became the subject of civil lawsuits. The complaints against Thomas and his employers were eventually settled, often for millions of dollars each. Suits against Kwiatkowski are still being filed.
The cases in Texas and Exeter are two of six hepatitis C outbreaks public health officials have linked to drug diversion in the last 20 years. That's too small a sample to draw any scientific conclusions, but a review of court papers, medical journals and other public documents reveals trends: Four cases, including Exeter, involve technicians. All but one have multiple victims. Other commonalities include complex investigations by multiple agencies, public panic and suspects who, in hiding their addictions, became masters of deception.
Half of these cases have occurred in the last three years. Joseph Perz, a public health doctor with the Centers for Disease Control and Prevention, called the cluster of outbreaks "concerning," but said it's hard to say if drug tampering by hospital employees is on the rise.
"We might just as readily conclude that detection is improving," he said.
Court documents from the Thomas case are sparse, but a 1995 Star-Telegram story describes Thomas as "affable when he wasn't high" and the recipient of glowing recommendations from internships that helped him get hired by at least seven medical centers in Texas and Arizona. He was also a drug addict, the story said, with a history of small crimes. Thomas was fired from three other hospitals before arriving at the Mid-Cities Surgi-Center, once for lying about his criminal record, once for excessive absenteeism and once after he tested positive for drugs.
It's unclear if Thomas knew he had hepatitis C, but investigators said at least 3,300 patients at four clinics were exposed; 48 were infected. Thomas pleaded guilty and served part of an eight-year sentence before he was paroled. He and his employers were sued multiple times by the victims and their families. The terms of the settlements are private, but the Star-Telegram reported in 1996 that the total awards would likely top $100 million.
12 years on
Twelve years after the Thomas case, another Texas hospital became the epicenter of a hepatitis C outbreak. This time, it was the William Beaumont Army Medical Center, and the suspect was a civilian nurse anesthetist named Jon Dale Jones. The investigation began in 2004 and eventually stretched into Virginia and Washington, D.C., where Jones had also worked.
In all, 543 people were notified of possible exposure; 16 were believed to have been infected, although the number is hard to quantify because, according to court papers, investigators believe Jones was the source of two separate outbreaks involving two different strains of the virus.
One of the people involved in the investigation was Perz. He already had years of experience as an epidemiological investigator, but this was the first case he'd seen where a viral outbreak was linked to drug theft by a hospital employee.
"It opened my eyes," Perz said in a phone interview last week. "It's obviously a very challenging issue to deal with. Until more recent incidents, we and the health care community at large had limited knowledge of the potential magnitude as a patient safety threat."
Since his work at Beaumont, Perz has become an expert on viral outbreaks in clinical settings, researching how transmissions occur and advocating for better infection control standards. Usually, clusters of new hepatitis C infections are caused by improper use of syringes or sloppy sterilization techniques - problems that have been linked to 26 outbreaks since 1998.
Because poor infection control is more common, that's where public health investigators start their work, but they're also looking for signs of drug diversion. Hepatitis C is the most common blood-borne pathogen in the United States, so it's no surprise that it's likely to be transmitted when sterile procedures break down. The virus is also prevalent among people addicted to IV drugs and, sometimes, those people get their fixes at the hospitals where they work.
As soon as public health officials suspect drug theft, law enforcement agencies get involved. From that point on, there are two separate burdens of proof: epidemiological and criminal. Sometimes, it's possible to meet one but not the other. Such was the case at Beaumont.
After four years of work by the FBI, the CDC and other agencies, Jones pleaded guilty to one count of assault and one count of stealing a controlled substance and was sentenced to three years in prison. At his plea hearing, a prosecutor explained that public health officials were confident that Jones was the source of at least 16 infections, but had used a test the FDA had approved only for research purposes. As a result, much of the data would be inadmissible in court.
Instead, investigators focused on linking a single patient to Jones.
Sometimes, the science isn't strong enough to build any criminal case. In early 1996, a man became ill with acute hepatitis C seven weeks after lung surgery at an unnamed California hospital. He had no other risk factors, and public health officials soon began to suspect that an anesthesiologist infected the patient.
Using extensive blood tests and, in once case, a frozen tissue sample, investigators theorized that the anesthesiologist contracted the disease from a woman who underwent a hysterectomy and then transmitted the virus to the male patient during his surgery two months later. The anesthesiologist denied that he'd stolen drugs, but investigators were unable to find any other possible mode of transmission.
The research made for an interesting paper, which was published in the Archives of Internal Medicine in 2002, but investigators were never able to find a strong enough link to bring criminal charges.
Even when evidence is abundant, identifying the source of an outbreak can be a lengthy process. It took epidemiologists three years to find the source of the small but puzzling cluster hepatitis C infections at the Mayo Clinic in Jacksonville, Fla. Several patients with no risk factors for the virus had tested positive in 2007 and 2008, and doctors began to suspect a link to the clinic.
Many law enforcement documents related to the case have been sealed by a federal judge, but aspects of the public health inquiry are outlined in a paper published earlier this year in the Annals of Internal Medicine. Once investigators ruled out accidental transmission, they began to look for evidence of drug diversion. Using patient records, employee schedules and other documents, they mapped out when narcotics were dispensed and which employees were on duty.
Three of the infected patients, they discovered, had procedures in the interventional radiology unit, and all three had received fentanyl. Twenty-one employees had been on duty during all three procedures, but only one tested positive for hepatitis C.
Steven Beumel, a radiology technician, was arrested in 2010. He pleaded guilty to multiple charges this spring and could spend the rest of his life in federal prison. The CDC suspects that nearly 4,000 patients were put at risk by Beumel's actions; five - including one man who died from the virus - were infected.
Beumel told public health investigators that he started stealing hospital drugs in 2004. Although he would occasionally take full syringes intended for patients, he was more likely to scavenge through bins of used needles, looking for half-empty vials of fentanyl.
Luck changes
Lauren Lollini tried everything to avoid surgery for a stubborn kidney stone. She had a toddler, a busy job as a therapist and little time to spare. So it was a relief when her recovery went smoothly after she was discharged from the Rose Medical Center in Denver. Her luck changed six weeks later when she began to notice worrisome symptoms: fatigue, loss of appetite, congested lungs, dark urine. After a few trips to the doctor and a blood test, she learned that, somehow, she'd contracted hepatitis C.
Lollini would soon discover that she was one 19 people infected with the virus in 2008 and 2009 when surgical technician Kristen Parker stole narcotics at two Colorado medical centers. For almost six months, Parker took syringes full of fentanyl two or three times a day, leaving saline tainted with hepatitis C, court papers say.
When her supervisors at Rose grew suspicious, Parker left and went to work at another nearby medical center. In all, she exposed at least 6,000 people to the virus.
At first, Lollini was in shock. Then, she decided to speak up. When the story hit the news, Lollini was willing to talk to reporters. She became a regular at legal proceedings, fighting to make sure victims' voices were heard.
"Let's make people understand that this is happening to real people," she said in a phone interview last week. "I was at every motion, every hearing."
Lollini's immune system was strong enough to kill the virus, and her prognosis is good, but she's continued to advocate for patient safety. When she learned about the outbreak in Exeter, she cried.
"It's just a travesty," she said in a phone interview last week. "It keeps happening and it frustrates the hell out of me."
At her 2010 sentencing hearing, Parker testified about the motives behind her crimes.
"I know everyone is waiting for me to answer the million-dollar question, 'Why?' " she said in a court transcript. "There is no reason to sugarcoat it. I was a drug addict. I put getting my next fix above my career, my family, taking care of my son, and safety and well-being of my patients."
Parker described how, while living in New York, she lost custody of her son shortly after leaving his father. She became homeless and started using IV drugs, the leading cause of new hepatitis C infections in the United States.
"In just four months, I lost everything and became a junkie," she said.
Her parents persuaded her to come to Colorado to be closer to family, but she said it wasn't long before she found other ways to get high, including syringes intended for her patients.
Lollini was also at that hearing, and was one of several victims who testified.
"Let's be honest," she said. "Kristen Parker is not the only one to blame for what happened to me and dozens of other innocent victims. For someone to come in and after only a few days be able to steal narcotics without the knowledge of the hospital is unfathomable. . . . The system is definitely broken, and the sentencing of Kristen Parker is just the beginning in an attempt to fix it."
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