One week before he started work at Temple University Hospital in April 2010, David Kwiatkowski had been fired and had tested positive for cocaine and marijuana, according to his prior employer, the Arizona Heart Hospital in Phoenix.
Yet, amid a crush of 850 replacements filling in for 1,500 striking nurses and techs at Temple, Kwiatkowski was able to pass a drug screening and get cleared for work.
How, exactly, did he pass the screening? Temple doesn’t know: Associate chief medical officer Marc Hurowitz says the staffing agency handled all that. Neither does the staffing agency, Ohio’s Advantage RN: Chief executive Matt Price tells City Paper that Temple organized the drug screening itself.
One thing seems clear, though: The hiring of Kwiatkowski, a radiology technician who had been also been fired from a hospital in Pittsburgh, was the product of a chaotic system that left room for error. Kwiatkowski, who worked at 13 hospitals in six years, has since been accused of infecting 31 people in New Hampshire with hepatitis C via syringes he contaminated in the process of stealing drugs. Testing at other hospitals has turned up more suspected infections, including at least two at a Kansas medical center where he began work mere weeks after leaving Temple.
The case highlights flaws both in the state monitoring system, which requires no registration of techs and doesn’t track disciplinary actions, and in the recruitment of strike-breaking health workers, through a $4 billion temp industry that’s triggered investigations around the country. Various health authorities have uncovered hundreds of instances of nurses working with suspended or revoked licenses, sometimes moving from state to state to sidestep sanctions. A 2010 study by the National Bureau of Economic Research found in-hospital mortality increased by 19.4 percent during nursing strikes.
And at the time of the Temple strike, the union, the Pennsylvania Association of Staff Nurses & Allied Professionals (PASNAP), raised concerns over the quality and screening of the replacements (“our preferred term is ‘scab,’” says Bill Cruice, executive director of PASNAP). Temple’s chief executive at the time, Sandy Gomberg, accused the union of trying to “frighten” the public.
But a union nurse who went through the orientation process with a different staffing agency that provided many of the replacements says there was reason to be frightened. “It was an extremely chaotic situation,” he says of the process, which took place at the Convention Center just before the strike began. “There was a lot of confusion. And if you didn’t have your credentials with you, there was a way they could push you through.”
Though Temple’s Hurowitz says the agencies used a “nationally reputable drug-testing process,” the nurse, who asked not to be named, says the drug testing was unlike anything he’d been through at prior posts, where each worker was sent into a secure bathroom with a temperature-sensitive cup and a toilet containing a dye indicating a urine sample was given. “It wasn’t anything like that. It was just, here’s a cup, go pee and leave it on the counter.” An unmonitored, multi-stall restroom was used, he says. Those administering the tests told him they were not regular drug-screeners, but other strike replacements. “There was plenty of room to compromise a sample. Anything could have been manipulated, the way they were handling it.”
Though the staffing agency administered the testing, he says, Temple was overseeing it. He saw Gomberg “there checking that everything was in place.”
The drug test was just the start: The nurse learned that none of his references were checked, and he met nurses without Pennsylvania licenses who got so far along in the process as to obtain hospital IDs.
As to what happened inside the hospital during the strike, union nurses don’t know — but they have an idea. At one point, Temple nurse and PASNAP president Patricia Eakin says, a patient walked out in her gown, “her IV hanging out of her arm, and came to the picket line. That would never happen in a normal situation.” The Pennsylvania Health Department logged several complaints during the strike, and took issue with the use of patient restraints in two cases.
Still, Hurowitz says Temple uses staffing agencies on an ongoing basis without issue. And Price says that, these days, agencies employ more background checks, including highly detailed state- and county-level checks.
But in a strike situation, they can’t do it all. “The background checks for strikes is typically different,” as is the handling of drug screens, “because of the compression of the credentialing period.”
Given all that, Cruice says that Kwiatkowski’s hiring — a week after he was allegedly found passed out in a hospital bathroom, a syringe of the narcotic fentanyl in the toilet — shouldn’t be a surprise. “How this particular guy was able to slide through the cracks is fairly typical of these agencies,” Cruice says. “We have here in this situation somebody who just happened to get caught.”