October 19, 2012

NH hospital at risk of losing Medicare funds over hepatitis C

Exeter Hospital says it has been trying to correct deficiencies identified in July by the Centers for Medicare and Medicaid Services.

Holly Ramer / The Associated Press

CONCORD, N.H. — Exeter Hospital said Friday it will correct serious problems discovered after a hepatitis C outbreak last spring in time to stop federal officials from cutting off its Medicare funding.

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Thirty-two people who were patients at Exeter Hospital have been diagnosed with the same strain of hepatitis C as a former medical worker prosecutors describe as a "serial infector."


The hospital has been trying to correct deficiencies identified in July by the Centers for Medicare and Medicaid Services. Among them are efforts to improve the hospital's policies on controlling infections and administering drugs.

But in a recent letter, the government said a follow-up survey found that problems remain and that it plans to terminate the hospital's Medicare funding on Dec. 28.

The agency's inspection was triggered by the case of David Kwiatkowski, a former cardiac catheterization lab worker who is accused of stealing drugs from the hospital and replacing them with tainted syringes that were later used on patients. Thirty-two people have been diagnosed with the same strain of hepatitis C he carries since the investigation began in May.

"CMS has determined that the deficiencies are of such a serious nature as to substantially limit the hospital's capacity to provide adequate care," the agency wrote in a letter to the hospital dated Oct. 11.

In a statement Friday, the hospital said it will continue to work to thoroughly address each of the agency's findings and that it already has taken steps to resolve many of them and is confident it will fix the rest in the next several weeks.

"We take quality and patient safety extremely seriously and will continue to make all necessary improvements to further improve the health system," CEO Kevin Callahan said.

The centers' full report won't be made public for 30 days or when CMS receives an acceptable plan of correction, whichever comes first, a CMS spokeswoman said. The letter sent to the hospital outlines four areas where Medicare conditions have not been met: infection control, patient's rights, the hospital's quality assessment and performance improvement program and its governing body.

In the July report, CMS said nurses at the cardiac lab left syringes unattended after removing medication from machines. The hospital has since implemented a policy that requires filled syringes to be placed in a locked drawer until needed.

Kwiatkowski, a traveling medical worker whom prosecutors describe as a "serial infector," was hired in Exeter in April 2011 after working in 18 hospitals in Arizona, Georgia, Kansas, Maryland, Michigan, New York and Pennsylvania.

He moved from hospital to hospital despite having been fired twice over allegations of drug use and theft. Thousands of patients in those states are being tested to see if they, too, were infected with hepatitis C, a sometimes life-threatening virus. A handful of patients in Kansas also have been found to carry the same strain Kwiatkowski carries.

"Hospitals across the country and the regulators who oversee them continue to learn from this tragic event that was created by an alleged criminal who circumvented some of the best systems and protocols at leading institutions across the nation," Callahan said.

Kwiatkowski, who has told authorities he did not steal or use drugs, has pleaded not guilty to illegally obtaining drugs and tampering with a consumer product. Prosecutors recently were given until Nov. 30 to indict him after saying they needed more time because investigators are still conducting interviews and performing scientific analysis in multiple states.

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