Decade after hepatitis outbreak, medical registry might end

A decade after New Hampshire stopped a traveling medical technician who had been stealing drugs and infecting patients with hepatitis C, the Legislature might eliminate a registration system aimed at preventing similar misconduct

The medical technician who drew blood from New Hampshire Rep. Peter Schmidt after he broke his leg in February was registered with the state, thanks to a 2014 law enacted after a traveling medical technician infected dozens of people with hepatitis C.

But by the time Schmidt was back on his feet, colleagues had hijacked his bill aimed at improving the registry. House lawmakers passed a bill last month eliminating the registration requirement altogether, and Schmidt is now urging senators to reject it.

“Please do not pass this, this is a terrible idea,” Schmidt said. “I think we need to continue to register these medical technicians, otherwise we are opening ourselves up to a potential repeat of the Exeter experience.”

New Hampshire created the Board of Registration for Medical Technicians in response to David Kwiatkowski, who is serving 39 years in prison for stealing painkillers and replacing them with saline-filled syringes tainted with his blood.

At the time, officials hoped the board would become a model for other states, but that hasn’t happened. And those who want to ditch it say it creates unnecessary bureaucracy at a time when health care facilities are struggling to hire workers.

“The actions of one bad actor, however heinous, are not reason to require thousands of technicians to register and pay fees,” said Rep. Carol McGuire, R-Epsom, when the House passed the bill last month.

But Linda Ficken, a Kansas woman who contracted hepatitis C from Kwiatkowski in 2011, said she believes any medical worker with access to drugs should be registered and should undergo frequent drug testing.

“Every time I go into the hospital, I can’t help but wonder, is this a repeat?” she said. “Cured or not, the thoughts and anxiety are still there.”

Despite being fired numerous times over drug allegations, Kwiatkowski had worked in 18 hospitals in seven states before being hired in at Exeter Hospital in New Hampshire. After his arrest in 2012, 46 people in four states were diagnosed with the same strain of the hepatitis C virus he carries, including one who died in Kansas.

The case highlighted the fact that medical technicians aren’t as closely regulated as nurses or doctors, whose misconduct and discipline are tracked via a nationwide database. While some states require certain technicians to be licensed, four of the states where he worked didn’t license any of them at the time of his arrest, including New Hampshire.

The registry New Hampshire eventually created applies to all health care workers who are not otherwise already licensed or registered and have access to both patients and drugs. Hospitals are required to report disciplinary actions to the board, which also investigates complaints and takes disciplinary action.

The board has struggled to maintain a quorum, however, and hasn’t met in more than a year, said Lindsey Courtney, director of the Office of Professional Licensure and Certification.

“We’re greatly concerned the state is not meeting its obligation to protect the public,” she said at a public hearing.

Courtney, who isn’t taking a position on eliminating the board, supported Schmidt’s original proposal to convert it to an advisory panel that would make recommendations to her office. There are currently 1,691 registered technicians, and although complaints are rare, the board has taken action in a handful of cases each year.

Schmidt said his goal was to shift some of the administrative burden from the board to the larger agency. He hopes the Senate will either kill the amended bill or return to his original idea.

While hospitals are on the front lines of preventing and responding to drug diversion, partnering with public health, licensing and law enforcement agencies is essential, said Dr. Matthew Crist, a medical officer with the Centers for Disease Control and Prevention.

He said the CDC isn’t aware of outbreaks in recent years related to drug diversion and is cautiously optimistic given that health care facilities have improved security around controlled drugs, and many state licensing agencies have taken steps to improve communication across state lines.

In the decade before Kwiatkowski’s arrests, similar hepatitis C outbreaks had been traced to other hospital technicians in Texas, Colorado and Florida, and CDC officials said at the time that the Kwiatkowski case highlighted a problem that was a growing concern across the public health system.

Even though other states didn’t follow New Hampshire’s lead, the registry likely has deterred people like Kwiatkowski from coming to the state in the first place, said state Sen. Tom Sherman, D-Rye, who led the bipartisan effort to create the board.

Sherman, a gastroenterologist who is running for governor, played a key role in discovering Kwiatkowski’s misconduct when he and his colleagues noticed a cluster of hepatitis C cases among their patients and realized they all had been treated in Exeter Hospital’s cardiac catherization lab. He’s now urging his fellow senators to consider “the price of doing an experiment to see what happens if we get rid of the board.”

“People died because of that outbreak,” he said. “This was a very carefully thought-out solution that has worked. To take it away now means we just don’t learn from history.”