Some of you might remember this story from last year:
Evolution: Crime Fighting Machine
A hospital technician, David Kwiatkowski, has been accused of stealing pain medication (100 times as potent at morphine) and sterile needles from surgical patients. Not only did patients not get the pain medication they needed, Kwiatkowski also exposed them to Hepatitis C, which he knew he was infected with for several years.
The story was a good 'teachable moment' for how scientists can use evolutionary biology in a courtroom. Alas, none of that fun and interesting science was needed, as Kwiatkowski ultimately plead guilty to the charges against him, and will be serving 39 years in prison (warning, link goes to an article + annoying video).
Admitted to infected 49 people with a devastating disease (one of whom died), not including hypothesized hundreds, if not thousands of people: 39 years in prison.
That pisses me off.
But Kwiatkowski is, really, just a problem. A druggie addicted to Fentanyl instead of cocaine or meth. Druggies are a dime a dozen.
My question with this case, really, is "What have hospitals done to prevent the NEXT David Kwiatkowski?"
Because the stunts Kwiatkowski pulled, what he got caught doing before he was officially 'caught', those stunts have happened a million times over the course of history. When I was an undergrad, I did research for a professor who specialized in serial killers. People always focus on how, for example, the Angel of Death serial killers are so attractive, so charismatic, so charming. To an outside observer like myself, those looked like excuses for why normal people and hospital administrators covered up shit they should not have covered up. Again, to an outside observer, it looked like the individuals wanted this nutbar out of their work environment, and the hospitals wanted to keep word of them hiring a nutbar away from patients/investors/their bottom line.
The story following Kwiatkowski is not any different than the ones I read following Angels of Death physicians and nurses.
For example, the University of Pittsburgh Medical Center fired Kwiatkowski in May 2008 after an employee saw him take a fentanyl syringe from the operating room, and he was later found with three empty syringes on his person, according to the plea agreement.
Less than two weeks after that, Kwiatkowski got a job at the VA Medical Center in Baltimore. A patient who received care from him on May 27, 2008, at the Baltimore hospital later tested positive for the same strain of hepatitis C that Kwiatkowski has.
What is the excuse for why this man was allowed to go from hospital to hospital to hospital exposing people to Hep C? Where are people falling over themselves to call Kwiatkowski 'handsome and charismatic'?
Why is there no universal database to report people like Kwiatkowski so this doesnt happen again? Like I said, druggies are a dime a dozen, and if you think Kwiatkowski was the only one doing this shit (ignoring the people who read about his stunts on the news and how long he got away with it and think it is a FANTASTIC new way to score a hit), you are nuts.
So Kwiatkowski was caught. He is in jail. What has been done to prevent the next Kwiatkowski?
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My question is, is it at all unreasonable to require all healthcare employees to be screened for uncurable and transmissible diseases like Hepatitis C, then deny them employment if found positive?
When I was in med school in the '70s I had a friend who became a pediatrician. After she set up a practice near where we went to school, she hired a nurse who had left the teaching hospital. It turned out later that the doctors running the place were suspicious that she was responsible for some deaths, but couldn't prove it at the time. My friend was only aware of rumors, but did know the nurse personally and thought she seemed o.k., so she hired her. Turned out the nurse was a Munchausen type, and she deliberately induced crises in several kids in the office, until a young girl died and my friend and the police figured out what had happened.
The trouble in these cases is that it those in charge can suspect something is going on, but they can't prove it. If they take action against someone, and it turns out they have it wrong and the person is innocent, there is of course hell to pay in terms of lawsuits and bad publicity. If the person under suspicion decides go elsewhere, it must be awfully tempting to just let it become someone else's problem. Whoever hires medical people has to be willing to ask hard questions of the previous employer, and always consider that no matter how normal someone looks, there could be a problem lurking underneath.
Just in general employment laws do place a substantial burden of proof on demonstrating misconduct. This is generally a good thing in granting some level of equity between employee and employer. I share the frustration with the 'system' effectively protecting bad people, but would things be better if it became easier to blacklist people?
I don't really think that this is an issue of rumors or concern over "blacklisting". Kwiatkowski was caught stealing fentanyl and found to have several more empty syringes, and the citation for this is from a *plea agreement* over that case. If he plead guilty to stealing fentanyl, that is a matter of public record, and even if he hadn't been charged, there is nothing that would prevent Pitt from telling the VA Medical Center that Kwiatkowski had been fired because they caught him stealing drugs. That's not a suspicion or a rumor.
And yeah, this may be an extreme example, but even without a communicable disease, an addict can cause all sorts of problems. There's the issue of stealing drugs of course, as happened in this case, and also the problems that can happen when you have a tech who is intoxicated.
I'm sympathetic to the fact that drug addiction is a disease, but it also creates a danger for everyone around the addict. And for a healthcare facility that has a CSA license and regularly uses controlled substances as a regular (and legitimate) part of their practice, they really should have a responsibility to avoid hiring people who they know have substance abuse problems.
Honestly, I could see a good case for yanking that facility's CSA licensing, at the very least.
@Thanny: good luck with that. Health care workers where I live (BC) balk at the idea of wearing a mask if they haven't had a flu shot. Also, nurses at a certain hospital avoid MRSA+ patient care because gowning up is such a bother. :-(
With the new treatment(that will be out in about a year and a half without interferon for genotype 1) all these people will have a greater then 90% or better of being cured. They all haven't had it that long which is a big plus. So they will no longer have hp c and should have more money then they can spend in a life time from the law suits of every hospital that passed this dude around. With that said I wish I was one of those people.
Angelo, are you trolling or stupid?
Administrators want things to run smoothly and inexpensively. Fellow workers don't want to appear rats or jerks to their fellows. Everything is working against finding and exposing these evil bastards so somebody has to serve as internal affairs officer, and have no friends. It sucks, but there it is. Setting up systems that make abuse harder to execute without detection, but those come at the cost of efficiency and resources. All the pressure is on doing the work at lower costs or higher efficiency, and that just makes places for miscreants to hide.