OpEd Column: Why Aren't Doctors Drug Tested?

New York Times

By DANIEL R. LEVINSON and ERIKA T. BROADHURST

March 12, 2014

PEOPLE go to hospitals to get well. We all know that medical care involves risks, but what patients don't expect is that the doctors, nurses and other staff members charged with their care may deliberately cause them harm. As an important recent case demonstrates, that's exactly what can happen without stronger controls.

David Kwiatkowski was a medical technician and a prescription-drug addict who worked in more than a dozen hospitals in eight states. He stole the painkiller fentanyl that staff members had prepared for patients awaiting cardiac catheterizations. Mr. Kwiatkowski would take the prefilled fentanyl syringe, inject the drug into his own arm, refill the used syringe with saline, and replace it. Saline was not all he added to those contaminated syringes: Mr. Kwiatkowski has hepatitis C, a potentially fatal virus.

Over the course of a decade, he left a trail of 45 unexplained hepatitis C cases, including two deaths, before finally being arrested in New Hampshire. This past December, he was sentenced to 39 years in prison. Mr. Kwiatkowski's surviving victims live with the consequences of his crime as well: David Porter (who happens to be a retiree from our Boston office) had to have a leg amputation. Alden Sanborn suffered liver failure.

As the inspector general for the Department of Health and Human Services and a special agent who investigated the Kwiatkowski case, we believe that this case, and others like it, show that our hospitals are not protecting patients from drug tampering.

Mr. Kwiatkowski concealed his job history. 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 Mr. 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.

This case is not unique. In Denver, a former surgical technician, Kristen Diane Parker, was sentenced to 30 years in prison in 2010 after doing the same thing as Mr. Kwiatkowski: injecting herself with fentanyl and refilling the used syringes with saline or water. She infected over a dozen patients with hepatitis C. In Florida, Steven Beumel was sentenced to 30 years in prison in 2012 for similar actions that infected at least five people with hepatitis C. One victim underwent a liver transplant and later died.

Hospitals can do more to protect patients. Improved security, such as surveillance of drug storage areas, tighter chain of custody on drugs, and better tracking of controlled substances are obvious areas to target.

But we should go further. We believe hospitals should be required to perform random drug tests on all health care workers with access to drugs. The tests should be comprehensive enough to screen for fentanyl and other commonly abused drugs and must keep up with evolving drug abuse patterns.

This is hardly a radical suggestion. By federal law, many workers in transportation or other safety-sensitive areas are already subject to random drug tests. These include pilots, school bus drivers, truck drivers, flight attendants, train engineers, subway operators, ship captains and pipeline emergency response crews.

Another step is to require medical centers to call law enforcement agencies if they suspect a health care worker of stealing drugs. "These are federal crimes," said John P. Kacavas, the United States attorney who prosecuted Mr. Kwiatkowski in New Hampshire. "Medical providers are ill equipped to investigate these cases."

We should also treat addiction as the chronic disease that it is, and get addicted health care workers help. This could prevent some from breaking the law to feed their addiction. One effective model is known as physician health programs. These work for and with state agencies to recommend treatment and monitor recovery while helping physicians avoid professional and criminal penalties. One 2008 study of 802 doctors with a history of substance abuse who were monitored for five years showed that 65 percent remained free of drug or alcohol use.

But addicted health care workers need not be physicians to put patients at risk. All health care workers with access to drugs, including medical doctors, nurses, nurse practitioners, radiological technicians and surgical assistants, should be subject to mandatory drug testing.

Lucy Starry, one of Mr. Kwiatkowski's victims, suffered afterward from severe edema. She died earlier this month, and her death certificate lists hepatitis C as a contributing factor. Kathleen Murray, her daughter, has been a nurse herself for more than 30 years. "To me, the real crime is that for years he was never prosecuted," she said. "It tarnishes my profession. He never should have gotten as far as he did." Better prescription-drug protocols in hospitals could ensure that such a case doesn't happen again.

Daniel R. Levinson is the inspector general and Erika T. Broadhurst is a special agent for the Department of Health and Human Services.