One bad apple challenges our profession

Sept. 1, 2012
The lead story in this month’s Observatory department is one you have probably read about elsewhere: the appalling revelation that a medical technician who has worked in eight states allegedly infected a so-far-undetermined number of patients with hepatitis C via stolen syringes contaminated with his own blood. The first thing to say about this, of course, is that it is a significant human tragedy. Our sympathies go out to the people who were victimized, if the charges are true, by the rogue med tech David Kwiatkowski.

Secondarily, this is a major problem for the clinical laboratory profession in terms of public perception. Certainly, no reasonable member of the general public would read about Kwiatkowski and think he is representative of clinical laboratory professionals—but some people are not reasonable. Whenever a member of any profession behaves badly, there are some people who let that form their idea of the whole profession.

Medical laboratory professionals may be unusually vulnerable to bad publicity, in fact, because most do not have direct contact with the patients they serve. If a pharmacist or a physician had done something comparable to what Kwiatkowski has been accused of, people would think about the many ethical and admirable pharmacists and physicians they know, and put the one bad apple in context. But most patients have never met their med tech.

Also, some press coverage of this story has not been professional or helpful. One report, widely repeated, said that Kwiatkowski was found passed out from drug abuse on a bench in an employee locker room before he was fired from one of his jobs. This dramatic image naturally would lead readers to think, “Well, how did this guy get hired somewhere else?” It’s a fair question, but it’s based on an emotional reaction to bad journalism: the allegation may be true, but the writer could not possibly have confirmed it. The writer probably did not simply invent it (though stranger things have happened); more likely, some source provided it. But the writer should have named the source—and been very suspicious if the source had insisted on anonymity. Instead, the writer sacrificed journalistic integrity for the sake of a powerful mental picture.

Similarly, journalists love to use memorable descriptive phrases to make their stories more vivid: Thus, Kwiatkowski almost instantly became the “serial infector.” I think it showed disrespect to Kwiatkowski’s victims to give him a sensationalistic nickname.

Media coverage aside, though, the tragedy raises serious issues that are rightly being addressed by public watchdogs. For example, Elenore Casey Crane, co-founder of a group called The Patients Speak, is calling for a national registry to which hospitals and staffing agencies would be required to report issues of professional misconduct by medical technicians. Her group is also calling for national licensing of all medical technicians; licensing requirements now vary from state to state. Crane is capable of the occasional cheap shot: she has been quoted as saying, “Why does the guy who loads your car at Home Depot have drug testing and the men and women with you in the operating room do not?” But she raises good points.

In fact, the best way for clinical laboratorians, through their professional organizations, to respond to the challenge posed by Kwiatkowski’s alleged actions is to be proactive in proposing regulatory changes and other reforms that can minimize the chances of such things ever happening again. We should carefully consider and evaluate all proposals—not all suggestions are good ones, after all—but we should aggressively seek solutions. And we should go to the public with our ideas—rather than wait for them to come to us.

It will be interesting to see how this important story unfolds, and what crucial changes result from it. I have no doubt that we are up to the challenge.