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Tech who infected patients with Hep-C came to Temple as a strike replacement
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Tech who infected patients with Hep-C came to Temple as a strike replacement
David Kwiatkowski, the radiology tech who's now infamous around the country for allegedly infecting at least 30 people with Hepatitis-C in the process of stealing intravenous drugs from the hospital where he worked, came to Temple University Hospital in April 2010 as one of 850 workers hurriedly imported by temporary staffing firms to cross picket lines during a strike. At the time, union leaders at the Pennsylvania Association of Staff Nurses and Allied Health Professionals (PASNAP) cried foul over the quality and training of the workers replacing them; Temple accused them of employing "scare tactics."
"How this particular guy was able to slide thorugh the cracks is fairly typical of these agencies," says Bill Cruice, executive director of PASNAP. "They're so focused on making a quick buck that inevitably they're going to cut corners in screening who they hire, because they're so desperate to get bodies who are willing to cross a picket line and travel to work in a tinted bus and deal with the anger of employees who are forced out on strike. The type of person who will cross a picket line to go to work in these kinds of conditions is frequently somebody who can't get work anywhere else. We have here in this situation somebody who just happened to get caught."
Just a week before Kwiatkowski arrived at Temple, he had reportedly been found passed out in a bathroom at Arizona Heart Hospital, where a worker claimed to have spotted him with a syringe of the narcotic Fentanyl. He was fired from that job, but found work at Temple just six days later.
How he could have passed a drug screen at that point is, by all accounts, something of a mystery. Temple's associate chief medical officer, Dr. Marc Hurowitz, told City Paper that Temple set forth the standards for the screening process, but that actual drug screens were handled by the various staffing agencies the hospital had tapped. "The screening process is absolutely directed by us, not by the agency. … At times, we allow them to gather that [candidate background] information and we review it and make the decision." He said that the staffing agency that hired Kwiatkowski, Advantage RN, had done the drug testing through a "nationally reputable drug testing process," adding, "the information we have and we relied on showed he had successfully passed the drug screen."
However, Matt Price, chief executive of Ohio-based Advantage RN, disputes that. He tells CP that Temple, in a strike situation, would have done all of the drug-testing itself. He says that the firm, which sent only about a dozen workers to fill in during the strike, was told to direct staffers to a single contact at a hotel near Temple, where the hospital took over, presumably either bringing in a lab technician or giving instruction to go to a lab nearby.
Hurowitz says Temple uses temporary staffers on an ongoing basis for a variety of reasons, and that they have the same qualifications as any other employee. But Patricia Eakin, president of PASNAP and a Temple University Hospital nurse, says that doesn't take into account the awareness of unique protocols and institutional knowledge they're lacking. She points out that in the days before staffing agencies, hospitals would merely reduce their patient load in the event of a strike.
More recently, temporary staffing agencies have been the subject of several damning investigations. A 2010 study by the National Bureau of Economic Research found that in-hospital mortality rises by 19.4 percent and readmission rates spike by 6.5 percent during a nursing strike. A Los Angeles Times and ProPublica investigation in 2009 found "dozens of instances in which staffing agencies skimped on background checks or ignored warnings from hospitals about sub-par nurses on their payrolls. Some hired nurses sight unseen, without even conducting an interview. As a result, fill-in nurses with documented histories of poor care have fallen asleep on the job, failed to perform critical tests or stolen drugs intended to ease patients' pain or anxiety."
During the Temple strike, nurses say they don't know everything that went on inside the hospital — but they have an idea. For one thing, Eakin says, a patient at one point walked out of the hospital in her gown, "her IV hanging out of her arm, and came to the picket line. That would never happen in a normal situation."
But Price says there wasn't much Advantage RN could have done in Kwiatkowski's case: it did national and social security background checks, called the two most recent references (Arizona Heart Hospital had been left off the list), and confirmed that he was on the national registry and that his Arizona license was still current. His previous firing, from a hospital in Pittsburgh, was "five or six references before" and hadn't been reported to the American Registry of Radiologic Technologists.
"The problem with national background checks, which used to be the norm in this industry, is they don't pick up all the incidents in somebody's background," Price says. He adds that different standards would be employed during a strike, "because of the compression of the credentialing period," than would be employed normally.
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