Federal health agency investigating Exeter Hospital infection control procedures

By Chelsea Conaboy, Globe Staff

The Centers for Medicare & Medicaid Services is investigating the infection control procedures at a New Hampshire hospital where, federal prosecutors say, a worker caused an outbreak of hepatitis C.

David Kwiatkowski, a former medical technician at Exeter Hospital, was arrested last week and accused of infecting at least 30 patients with hepatitis C by stealing a powerful anesthetic prepared for use on patients and replacing it with dirty syringes.

In a letter to the hospital, the federal agency that oversees Medicare, the national health program for the elderly and disabled, said it was authorizing New Hampshire health officials to conduct a full review after inspectors responding to a complaint on June 6 found serious deficiencies in the hospital’s infection control. The letter, dated June 20 and provided to the Globe Wednesday through a records request, did not include details.

“These deficiencies have been determined to be of such a serious nature as to substantially limit your hospital’s capacity to render adequate care and prevent it from being in compliance with all the [conditions for participation in Medicare] for hospitals,” the letter read.

In order to be eligible to receive Medicare payments from the federal government, hospitals must have regular inspections by a state or private agency that has what is often called “deeming authority” -- or the power to determine that the hospital complies with federal standards.

Many hospitals pay The Joint Commission, the nation’s largest and oldest hospital accreditation organization, to do those inspections. Exeter Hospital had accreditation through the commission but withdrew it in April, though it would have lasted through March 2014, said Bret Coons, spokesman for the organization.

The hospital instead obtained accreditation in March through a separate organization, known as DNV Healthcare, part of Det Norske Veritas, an international risk-management firm.

In an e-mail last week, hospital spokeswoman Debra Vasapolli said the decision to change to DNV accreditation “was based upon our continuous pursuit of quality improvement and patient safety measures.”

The June letter from the federal agency effectively transferred inspection authority from DNV to New Hampshire officials while the investigation is completed.

A fuller survey was done on July 13, CMS spokeswoman Helen Mulligan said, but the results have not yet been processed and sent to the hospital. The results could be released to the public releasable 30 days after they are delivered to the hospital or when the hospital files a plan of correction, whichever comes first.

Mulligan said Exeter Hospital may continue to participate in Medicare during the investigation, which does not affect its relationship with private insurers.