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Friday, August 23, 2012 – Below is an update from Exeter Hospital concerning the status of hepatitis C cases and testing:

Exeter Hospital is continuing to work closely with the New Hampshire Division of Public Health Services (DPHS) to assist the state in the hepatitis C investigation and its subsequent recommended testing. Although the state has emphasized there is no current evidence to suggest additional employee involvement, in an abundance of caution and in accordance with the state’s request, Exeter Hospital has begun to notify approximately 500 employees and affiliated clinicians that the state has recommended they be tested for hepatitis C.

Over the next two weeks Exeter Hospital will be coordinating the employee and affiliated clinician testing. As in the patient testing, samples will be sent to the NH DPHS lab for processing.

The most recent testing of Exeter Hospital patients involved people who were treated in the Main Operating Room (excluding the Outpatient Surgery Center) and the Intensive Care Unit between April 1, 2011 and May 25, 2012. From this group, the hospital has not been notified of any new positive test results connected to the hepatitis C outbreak being investigated.

Exeter Hospital will continue to share information about this outbreak and the ongoing testing as it becomes available. We encourage anyone looking for the most recent updates to visit our dedicated hepatitis C page at exeterhospital.com/hepatitis-c-information or via Facebook and Twitter - @ExeterHospital.

Friday, August 17, 2012 – Below is an update from Exeter Hospital concerning the status of hepatitis C testing:

• As a result of Exeter Hospital’s testing clinics over the past four days and its last two weeks of testing, the hospital has now completed 1,002 screenings for identified patients in the expanded testing group—those who were treated in the Main Operating Room (excluding the Outpatient Surgery Center) and the Intensive Care Unit at the hospital during the state specified timeframe of April 1, 2011 to May 25, 2012.

• In total, more than 2,000 Exeter Hospital patients have now had their blood drawn at the hospital run clinics and forwarded for testing by the state’s lab to assist with the investigation and most importantly, to provide peace of mind for those who were obviously concerned they might have been impacted by actions of the alleged serial infector Mr. Kwiatkowski.

• Although we have now completed our scheduled round of testing clinics at Exeter Hospital, the state is still continuing to offer testing at its own clinic:

Manchester Health Department:
August 17, 1:00 – 5:00 p.m.
August 18, 8:00 – 12:00 p.m.

• We have not been notified of any new positive strains that are directly connected to the outbreak. As the state has previously said, it is likely that positive cases not connected to this outbreak will be identified as a result of testing thousands of patients in the community. According to the Centers for Disease Control and Prevention (CDC), an estimated 1.8% of the general population has the hepatitis C virus, many of whom are not aware of it. We encourage everyone who is diagnosed at any time with hepatitis C to speak with their primary care physicians immediately about their treatment options.

• Yesterday the CDC confirmed its recommendation with the general public that all “baby boomers” should get tested for the hepatitis C virus. Baby boomers account for approximately two-thirds of the estimated 3.2 million infections in the U.S. For more information on the CDC’s recommendation, please visit www.cdc.gov.

• Exeter Hospital will continue to share information about this outbreak and the ongoing testing as it becomes available. We encourage anyone looking for the most recent updates to visit our dedicated hepatitis C page at exeterhospital.com/hepatitis-c-information or via Facebook and Twitter-@ExeterHospital

Thursday, August 16, 2012– Yesterday, the New Hampshire Division of Public Health Services
(DPHS) announced that they are recommending that Exeter Hospital test additional employees for hepatitis C in response to questions raised about the most recent patient to be connected to our outbreak. This newly identified patient (patient 33) had a procedure in our Cardiac Catheterization Unit just prior to Mr. Kwiatkowski‘s start date as a “traveler” or temporary employee there. However, there was an overlap in this patient’s admission with Mr. Kwiatkowski’s first week of employment.

We have not yet moved forward with implementing the state’s initial request because there are still important questions about how this newly announced case became linked to Mr. Kwiatkowski. Dr. Sharon Alroy-Preis, the state’s epidemiologist, addressed this uncertainty yesterday when she said publicly, “We don’t have any evidence at this moment to indicate other staff were involved (in drug diversion).”

Before exploring the idea of expanded employee testing, we believe that all possible routes of transmission for this case both inside and outside the hospital should be considered and thoroughly investigated. We do not support the idea of government driven broad based testing of employees without first having specific evidence concerning why that testing is appropriate on a case by case basis and there is strong legal support for it. We are confident that we can work with the state on a more targeted, rational approach that is consistent with state and federal laws, respects both patient and employee privacy rights, and does not create unnecessary anxiety or concern in the general public. Over the next few days we will be developing a voluntary testing notification and lab draw process for a limited group of staff who provided direct care to patient 33.

Since the moment we proactively informed the state about this outbreak we have done everything reasonable and prudent to support this investigation. It is our patients who were harmed by Mr. Kwiatkowski’s alleged actions and we are eager to participate in any and all aspects of a focused investigation into the source and method of these terrible infections. Obviously Exeter Hospital and the state both have to balance those needs with the requirements of existing state and federal laws and protections regarding both patient and employee privacy.

Exeter Hospital will continue to provide regular information about the progress of the hepatitis C investigation as appropriate via our website, Facebook and Twitter accounts.

Wednesday, August 15, 2012 – Below is an update from Exeter Hospital concerning the status of hepatitis C cases and testing:

- The New Hampshire Division of Public Health Services (DPHS) has informed Exeter Hospital that one additional patient who had previously tested positive for hepatitis C has been linked to the same strain of the virus associated with the recent outbreak at Exeter Hospital. This patient who had invasive procedures in our Cardiac Catheterization Unit had previously tested positive for hepatitis C during our earlier screenings. We have not been informed by the state of any new hepatitis C cases related to the recent expanded round of testing that began approximately two weeks ago. As the DPHS has previously stated, the likelihood of finding any new cases is very small. The total number of related hepatitis C cases now stands at 33, which includes alleged infector Mr. Kwiatkowski.

- Exeter Hospital has completed screenings or scheduled appointments for 973 of the identified patients who were treated in the Main Operating Room (excluding the Outpatient Surgery Center) and the Intensive Care Unit at the hospital during the state’s specified timeframe of April 1, 2011 to May 25, 2012.

- In addition to the state’s testing sites, there are still two testing clinics being offered through Exeter Hospital this week on Wednesday, August 15, 7:00 a.m. – 6:00 p.m. and Thursday, August 16, 7:00 a.m. – 12:00 p.m. Identified patients who still need to be tested and would like to be tested through Exeter Hospital are asked to call the hospital’s Information and Referral Center at 603-580-6124 to schedule an appointment. Our staff is available Monday through Friday, 8:30 a.m. – 5:00 p.m. to assist with scheduling appointments.

- Exeter Hospital will continue to share information about this outbreak and the ongoing testing as it becomes available. We encourage anyone looking for the most recent updates to visit our dedicated hepatitis C page at exeterhospital.com/hepatitis-c-information or via Facebook and Twitter - @ExeterHospital.

Tuesday, August 14, 2012 – Below is a statement from Exeter Hospital in response to the Associated Press’ story titled, “Med Tech’s Arrest Shows Flaws in a System,” published today.

Before Exeter Hospital hired David Kwiatkowski, he had a national criminal background check, a sanctions check in a federal database, and a drug screening. In addition, two previous hospital mployers gave him outstanding reviews, one calling him “invaluable.”

It is incredible that the history now being exposed through investigations was not available to numerous hospital employers including Exeter Hospital. There needs to be mandatory disclosure by healthcare providers of problems with former employees who could pose a risk to patient safety. Hospitals that share this information should be protected from employment lawsuits. And there needs to be a national registry system covering all workers providing patient care.

We stand by our patients as they manage the health consequences of this man's conduct. Our hearts go out to the patients in New Hampshire and other states who have been affected, as well as their families. It is important to take nationwide action to prevent tragic situations like this from ever happening again.

Friday, August 10, 2012 – Below is an update from Exeter Hospital concerning the status of hepatitis C testing:

As of 9:00 a.m. today, Exeter Hospital has completed screenings or scheduled appointments for 715 of the identified patients who were treated in the Main Operating Room (excluding the Outpatient Surgery Center) and the Intensive Care Unit at the hospital during the state’s specified timeframe of April 1, 2011 to May 25, 2012.
Exeter Hospital is now able to offer a hepatitis C antibody test at the August clinics that will offer patients the ability to receive their results in approximately 24 hours.
Due to the high volume of patient calls we continue to receive, Exeter Hospital will be expanding its testing clinics for an additional day. In addition to offering onsite testing on August 13, 14 & 15 from 7:00 a.m. – 6:00 p.m., Exeter Hospital is now scheduling appointments for August 16 from 7:00 a.m. – 12:00 p.m.
12:00 p.m. Patients who would like to be tested through Exeter Hospital are asked to call the hospital’s Information and Referral Center at 603-580-6124 to schedule an appointment. Our staff is available to assist with scheduling appointments Monday through Friday, 8:30 am – 5:00 pm.
Debra Vasapolli, director of Community Relations and Development at Exeter Hospital, stated, “The care of our patients remains our primary focus. Throughout the last several weeks our Call Center staff and clinicians have directly communicated with thousands of patients and concerned community members. We continue to support the efforts of the New Hampshire Division of Public Health Services and we are doing everything we can to support our patients throughout this process, including maintaining their privacy.”
Exeter Hospital will continue to share information about this outbreak and the ongoing testing as it becomes available. We encourage anyone looking for the most recent updates to visit our dedicated hepatitis C page at exeterhospital.com/hepatitis-c-information or via Facebook and Twitter - @ExeterHospital.

Firday, August 10, 2012 - Exeter Hospital Statement Regarding CMS Survey The Centers for Medicare and Medicaid Services (CMS) conducted an unscheduled survey on June 6, 2012 following the public announcement of hepatitis C infections at Exeter Hospital, an outbreak that was caused by alleged criminal activity.

Following that inspection, the hospital participated in a full survey by CMS on July 10-13. A team of six inspectors reviewed every aspect of patient care at Exeter Hospital. At the conclusion of the inspection, CMS announced no additional significant findings to those reported in the June spot survey.

As outlined in Exeter Hospital’s August 8, 2012 Corrective Action Plan to CMS that became public on August 9 prior to its formal acceptance by CMS, the hospital has thoroughly addressed each finding.

For example, the medication preparation process described in the Cardiac Catheterization Lab was designed to enable prompt access to pain medication in connection with lifesaving treatment. All healthcare providers expect that medical personnel with access to the treatment area are there solely to help deliver that life-saving treatment and pain control. Individuals with criminal intent undermine this expectation. Exeter Hospital uses state-of-the-art technology to safeguard pain medication. However, based on Exeter Hospital’s investigation that uncovered alleged drug diversion by an ex-employee after dispensing from our secure system, the hospital modified the pain medication preparation process several weeks ago. As of June 12, once filled, syringes are locked up by a nurse until the moment they are needed and only then are they unlocked. This may add a few seconds of additional time to the treatment process, but makes pain medication even more secure in the Cardiac Catheterization Lab.

We have posted the report in its entirety on our web page at ExeterHospital.com. We encourage anyone who is interested in learning more to review the full report.

Tuesday, August 7, 2012 – Below is an update from Exeter Hospital concerning the status of hepatitis C cases:

• The New Hampshire Division of Public Health Services (DPHS) has informed Exeter Hospital that one additional patient has tested positive for hepatitis C who received care in the Cardiac Catheterization Unit during alleged infector Mr. Kwiatkowski’s employment at Exeter Hospital. This patient had previously tested positive for hepatitis C during our earlier screenings and has now been linked to
the same strain of the hepatitis C virus associated with the recent outbreak at Exeter Hospital.

• Exeter Hospital continues to schedule appointments for identified patients who were treated in the Main Operating Room (excluding the Outpatient Surgery Center) and the Intensive Care Unit at Exeter Hospital during the state’s specified timeframe of April 1, 2011 to May 25, 2012. Exeter Hospital is offering onsite confidential testing to these identified patients on August 13, 14 & 15 from 7:00
am – 6:00 pm at the Exeter Healthcare Building. We have already tested more than 250 patients since the state announced the expansion of testing two weeks ago and we have scheduled an additional 206 appointments since opening our scheduling for next week’s testing. Patients who would like to be tested through the hospital are asked to call the hospital’s Information and Referral Center at
603-580-6124 to schedule an appointment. Our staff is available to assist with scheduling appointments Monday through Friday, 8:30 am – 5:00 pm.

Thursday, August 3, 2012 – The NH Division of Public Health Services (DPHS) today announced its revised planning of scheduled regional testing clinics for identified patients who were treated in the Main Operating Room (excluding the Outpatient Surgery Center) and the Intensive Care Unit at Exeter Hospital during the specified timeframe of April 1, 2011 to May 25, 2012.

Officials from the DPHS have consistently referred to the screening as very low risk and are conducting the testing out of an abundance of caution. The DPHS will be notifying all identified patients with a letter next week that includes testing clinic details and scheduling information. In support of the state’s patient outreach process, Exeter Hospital provided the DPHS with the list of those individuals identified early last week. The total number of people who the state is recommending receive testing is approximately 3,300.

Exeter Hospital will be offering confidential and convenient onsite testing at no charge for identified patients at the Exeter Healthcare Building on August 13, 14 & 15 from 7:00 am – 6:00 pm. Identified patients who choose to be tested through Exeter Hospital are asked to call the hospital’s Information and Referral Center at 603-580-6124 to schedule an appointment.

The state will be managing the coordination and scheduling for the following testing clinics:

August 10 & 11: Cooperative Middle School, Stratham, NH
August 14 & 15: Timberlane Regional High School, Plaistow, NH
August 16: Rochester Middle School, Rochester, NH
August 16, 17 & 18: Manchester Health Department, Manchester, NH

Identified patients who seek testing in any of these locations are asked to contact the DPHS to schedule an appointment at 603-271-4496 or visit www.dhhs.nh.gov for more information.

Exeter Hospital will continue to work with the DPHS and other officials to ensure those affected by this situation have access to the resources and information they need.

We will continue to share appropriate information as it becomes available. We encourage anyone looking for the most recent updates to visit our dedicated hepatitis C page at exeterhospital.com/hepatitis-c-information or via Facebook and Twitter - @ExeterHospital.

Thursday, July 26, 2012 – Below is an update from Exeter Hospital concerning hepatitis C and the state’s testing clinic.

Exeter Hospital would like to clarify information that is being circulated publicly concerning the expansion of testing and the outreach process. The testing scheduled for July 28th through July 31st is being led by the NH Division of Public Health Services (DPHS). The hospital is not involved with the logistics or patient notification process. Unlike previous testing held at Exeter Hospital, the hospital is not sending out notifications to patients related to the state coordinated testing. The state is managing the clinic site and conducting all patient notification.

In support of the state’s patient outreach process to patients on Tuesday, July 24th, Exeter Hospital provided the state with the initial list of those individuals identified as having been treated in the Main Operating Room (excluding the Outpatient Surgery Center) and the Intensive Care Unit during the specified timeframe of April 1, 2011 to May 25, 2012. For information about the state’s testing clinics, patients should contact the DPHS at 603-271-4496.

Exeter Hospital will continue to share information about this outbreak and associated testing as it becomes available. We encourage anyone looking for the most recent updates to visit our dedicated hepatitis C page at exeterhospital.com/hepatitis-c-information or via Facebook and Twitter - @ExeterHospital.

Wednesday, July 25, 2012 – Below is an update from Exeter Hospital about the status of hepatitis C and related matters.

Late Tuesday, July 24, Exeter Hospital provided the NH Division of Public Health Services (DPHS), in support of the state’s patient outreach process, the initial list of those individuals identified as having been treated in the Main Operating Room (excluding Outpatient Surgery center) and the Intensive Care Unit of Exeter Hospital during the specified timeframe of April 1, 2011 to May 25, 2012. The rough list sent to the state included approximately 4,800 names. Based on our review, once duplicates and patients who have already been tested are removed, the total number of patients that fit the state’s
recommendation for testing will decrease to approximately 3,400.

Unlike previous testing that was managed by Exeter Hospital, the testing starting this weekend will be conducted by the DPHS. We are joining the state in encouraging patients who had a procedure in our Main Operating Room, or who were patients of our Intensive Care Unit between April 1, 2011 and May 25, 2012 to be tested at the DPHS’ clinics this weekend. For information about the state’s testing clinics, patients should contact the DPHS at 603-271-4496.

Tuesday, July 24, 2012 – The New Hampshire Division of Public Health Services (DPHS) announced today that they will be offering expanded testing for patients who received care in the main Operating Room (excluding outpatient surgery center) and Intensive Care Unit areas of Exeter Hospital from April 2011 to May 2012, the timeframe that former employee David Kwiatkowski worked at the hospital. The OR and ICU are two areas that Kwiatkowski visited occasionally as part of his routine duties to transport patients but was not involved with procedures or patient care. Unlike previous testing
that was managed by Exeter Hospital, this testing will be conducted by the DPHS and will be announcing details later today.

Exeter Hospital learned about the state’s plans to announce this expanded testing late on Monday. As a result, we unfortunately have limited information to share with our patients at this time. We encourage individuals with questions about the DPHS testing to contact the state directly at 603-271-4496.

As the DPHS continually emphasized to Exeter Hospital on Monday, there is an extremely small chance that anyone will be found to have been infected with a hepatitis C strain that is genetically linked to Kwiatkowski outside of the Cardiac Catheterization Unit where he worked on a daily basis. However, as we continue to learn about Kwiatkowski’s history in other states from the ongoing criminal investigation, and out of an abundance of caution, Exeter Hospital supports the DPHS’ decision to offer
expanded testing to patients treated in these two other areas even though Kwiatkowski had no formal role supporting procedures in those areas. Nancy Braese, DO, President of the Exeter Hospital Medical Staff stated, “As health care providers, our focus is first and foremost on our patients’ care and safety. We would rather that thousands of our patients be tested by the state even if they all turn up negative than to miss one patient who might have been infected by this alleged criminal.”

It is important to stress that this expanded public testing will likely identify previously undiagnosed cases of hepatitis C that are unrelated to this outbreak. According to the US Centers for Disease Control and Prevention (CDC) an estimated 1.8% of the entire US population has hepatitis C. Regardless of whether any positive cases are linked back to this outbreak, Exeter Hospital is prepared to offer coordinated care and support for all infected individuals. We encourage everyone who is diagnosed at any time with hepatitis C to speak with their primary care physician immediately about their treatment options. As has been discussed previously, although a very serious disease, hepatitis C is treatable and the options for very effective treatment are increasing.

Although we agree with the state that it is unlikely the additional testing in these two hospital areas will result in any new linked cases of hepatitis C, Exeter Hospital recognizes the inconvenience, anxiety and concern raised by this expansion of testing will cause for all of those patients involved and their families. Although our identification and speedy reporting of this threat to the appropriate state officials lead to the arrest of Kwiatkowski, we are saddened that those who reportedly discovered Kwiatkowski’s
alleged drug diversion activities at other hospitals apparently failed to report them to law enforcement officials. This inaction allegedly resulted in Kwiatkowski being able to secure employment in other hospitals around the country, including Exeter Hospital, resulting in this hepatitis C outbreak that has touched thousands of individuals across the NH seacoast and beyond.

Friday, July 20, 2012 - Following the public disclosure of an affidavit yesterday in the case of a former Exeter Hospital employee who allegedly diverted drugs for his own use, the hospital would like to provide further context on several issues, as well as a statement from the physician who oversees the Cardiac Catheterization Unit.

Observations of Staff in the Cardiac Catheterization Unit

The affidavit references a few instances where employees reported symptoms such as bloodshot eyes in connection with Kwiatkowski. However, we have no report that any employee suspected him of diverting medication from the hospital.

In every case, concerns raised by hospital staff were evaluated, in one instance including the involvement of the hospital's human resources team. In each of these few instances, Kwiatkowski provided plausible explanations related either to medical issues he had previously made claims about, or to family crises.

Thomas Wharton, MD, FACC, medical director of the Cardiac Catheterization Unit at Exeter Hospital, now views Kwiatkowski as “the ultimate con artist and an extremely good cardiac technologist who pulled the wool over everyone’s eyes.”

Of the isolated incidents that fellow Cardiac Catheterization Unit employees began reporting in the spring, Dr. Wharton said, “David had stories for everything that pulled at your heart strings and we had no reason to disbelieve him. David claimed to have several important medical conditions, and we had no reason to challenge this. The day he reportedly arrived to work with red eyes he told us his aunt had died the night before and he had been up all night crying.”

Exeter Hospital did not have the legal right to investigate Kwiatkowski's medical claims, and did not have the right to access certain of the medical records that law enforcement officials have now reviewed. In hindsight, with this additional information, a picture has emerged that is different from the one hospital employees had in real time.

Access to Medications in the Cardiac Catheterization Unit

Medication vials are accessed from a locked machine that has extensive security measures to prevent unauthorized access.

Cardiovascular technicians such as Kwiatkowski are not enabled to use the machine, but they do have access to the lab area itself to participate in, prepare, or observe procedures in accordance with their roles as employees.

Medication storage and handling procedures at the Exeter Hospital Cardiac Catheterization Unit are regularly reviewed and we continuously improve the security of medications used for procedures. Since this tragic development, we have has consulted with outside experts to strengthen security in this area.

Pre-Employment Screening and Testing

Kwiatkowski began working at Exeter Hospital in April of 2011 as a temporary employee, otherwise known as a “traveler.” Pre-employment drug testing and a national criminal background check were conducted by the staffing agency in advance of his placement at Exeter Hospital. References reflecting the highest level of performance were provided by his two previous employers one of whom said “David has been invaluable in helping us get our lab up and running.” Prior to being hired into a regular full-time position as a Cardiovascular Tech in the Cardiac Catheterization Unit in October of 2011, Exeter Hospital performed an additional state criminal background check, completed another sanction check (a federal government clearance check designed to identify fraud and licensure issues) and the hospital’s Staff Health Services evaluated Kwiatkowski. All of these required employment checks resulted in no raised concerns. Kwiatkowski holds the required The American Registry of Radiologic Technologies (ARRT) certification for the Cardiovascular Tech position; he also holds a bachelor’s degree although none is required for this job.

Thursday, July 19, 2012– At 2:00 pm today the US Attorney’s Office announced they have arrested David Matthew Kwiatkowski for his involvement in the hepatitis C outbreak at Exeter Hospital.

David Kwiatkowski began working at Exeter Hospital in April of 2011 as a temporary employee, otherwise known as a “traveler.” As with all travelers at Exeter Hospital, pre-employment drug testing and standard and criminal background checks were performed. He was hired into a regular full-time position as a Cardiovascular Tech in our Cardiac Catheterization Lab in October of 2011, where he worked until he was placed on leave at the onset of the investigation in May, and then was later terminated.

We understand there is a great deal of public interest in this situation; however, as this remains an ongoing criminal investigation, we are unable to comment on any of the details related to the case. In addition to being a former employee, David Kwiatkowski has also been a patient of Exeter Hospital which further limits our ability to comment more specifically.

The indictment is a critical milestone in this incredibly difficult and painful situation. It is the result of extraordinarily thorough and complex investigations on the part of Exeter Hospital and numerous state and federal agencies. Exeter Hospital has done everything it can to support these ongoing investigations including providing some of the specific information about Kwiatkowski’s suspicious actions noted in the US Attorney’s press release. We want to thank the dedicated experts from each of these agencies who helped with this tragic matter.

“It is deeply disturbing that the alleged callous acts of one individual can have such an impact on so many innocent lives. As a result of his alleged actions, people in our community, who in many cases are the friends and neighbors of the 2,300 people who work here, now face the challenge of a potentially chronic disease,” said Kevin Callahan, president and CEO of Exeter Hospital. Exeter Hospital also recognizes the disruption this has created for over 1,100 individuals who have had their lives unnecessarily interrupted by the required testing.

Callahan noted; “Even in the middle of this crisis, our 2,300 employees and affiliated medical staff have continued to selflessly care for thousands of people who have continued to seek treatment at the hospital over the last several months.”

The events of the past several months have demonstrated that no healthcare organization can rest in its pursuit of the highest possible quality and safety for its patients. Even the best systems and nationally accepted protocols can be corrupted by actions driven by illegal intent.

Thursday, July 12, 2012 – Below is an update from Exeter Hospital concerning the status of hepatitis C cases:

The New Hampshire Division of Public Health Services has informed Exeter Hospital that four additional patients have tested positive for the same strain of the hepatitis C virus associated with the recent outbreak, bringing the total cases to 31, including 30 patients and one employee.

Exeter Hospital has now completed blood draws for over 1,000 of the identified patients and is nearing the completion of testing with approximately 45 identified patients remaining to be tested under the state’s current protocol. Our staff continues to actively reach out to these identified patients and is doing everything they can to contact them and schedule an appointment as quickly as possible. If an
identified patient has been contacted by the hospital for testing and has not scheduled an appointment, they are asked to please call our Information and Referral Center at 580-6124.

We remain focused on supporting identified patients and their families, along with all patients who have required testing. Our dedicated clinical response team continues to offer all resources necessary to guide patients through the medical process from assessment through treatment.

We will continue to share information with the general public as it becomes available via media alerts; our website, www.exeterhospital.com; as well as our Facebook page and Twitter account (Twitter-@ExeterHospital).

Monday, July 2, 2012 – Below is an update from Exeter Hospital concerning the status of hepatitis C cases:

♦ Exeter Hospital has been informed by the New Hampshire Division of Public
Health Services that six additional patients have tested positive for the same strain
of the hepatitis c virus associated with the recent outbreak, bringing the total cases
to 27, including 26 patients and one employee.

♦ We are concerned for the patients and their families. Our primary focus remains
on identifying all patients who may have been affected as quickly as possible so
we can help them begin their treatment. We are continuing to do everything we
can to ensure all patients who have tested positive have access to appropriate
treatment, with no barriers to their care. As part of these efforts, our dedicated
response team of experienced clinicians and support personnel continues to be
available to provide comprehensive treatment and care management. We continue
to focus on supporting these patients and their families, along with all patients
who have required testing for the virus.

♦ Exeter Hospital is nearing the completion of testing with less than 100 identified
patients remaining to be tested. We remain focused on completing the testing
process as quickly as possible and we are actively reaching out to work with each
identified patient who requires testing. If an identified patient has been contacted
by the hospital for testing and has not scheduled an appointment, they are asked to
please call our Information and Referral Center at 580-6124.

♦ We will continue to share information with the general public as it becomes
available via media alerts; our website, www.exeterhospital.com; as well as our
Facebook page and Twitter account (Twitter-@ExeterHospital).

Wednesday, June 27, 2012 – Below are updates from Exeter Hospital about the status of hepatitis C cases and related matters.

♦ After several days of not having any new identified patients with hepatitis C that
match the cases at Exeter Hospital, the state’s Division of Public Health Services
has informed the hospital that an additional patient has been identified. The total
number of related hepatitis C cases now stands at 21, including 20 patients and
one employee.

♦ Exeter Hospital is continuing to do everything it can to help support the identified
patients and has established a clinical response team to care for these patients. The
team is comprised of specialists in the treatment of hepatitis C as well as
physicians and support personnel whose assistance may be needed in the
comprehensive care of these patients. Last week clinicians from the response team
began reaching out to experts outside of the hospital, including Dr. Raymond
Chung of Massachusetts General Hospital who spoke at last night’s forum, to
discuss incorporating their expertise into the clinic. The hospital has also added a
dedicated nurse practitioner to provide care management services to patients
associated with the outbreak, regardless if they receive care at Exeter Hospital or
elsewhere.

♦ Exeter Hospital remains focused on supporting all of our patients and their
families who required testing during this difficult time and has now completed the
blood draws or scheduled appointments for over 1,000 of the identified patients
who had an invasive procedure at the Cardiac Catheterization Unit and its
dedicated recovery area between October 1, 2010 and May 25, 2012. The hospital
has also contacted all patients who were identified by the state as needing a one
month follow-up test due to the recent timing in the Cardiac Catheterization Unit
and its dedicated recovery area, and have begun scheduling appointments for
these patients.

♦ The Cardiac Catheterization Unit continues to see all elective and emergent
patients, and on Saturday, June 23, staff at the unit provided critical, life-saving
services to an individual within the Seacoast community who experienced a
sudden heart attack. The national standard for a response time is to have treatment
completed within 90 minutes of arrival at the hospital to ensure the least possible
damage to heart muscle. Saturday’s procedure took only 37 minutes.
Exeter Hospital will continue to share more information as it becomes available via
media alerts, website – exeterhospital.com, Facebook and Twitter - @ExeterHospital.

Wednesday, June 20, 2012 – As we continue to update you on the status of testing and outreach efforts related to the hepatitis C cases, Exeter Hospital remains focused on supporting all patients and their families who have been impacted, and continues to do everything it can to help move the testing process along as quickly as possible.

Below are important updates:

♦ Exeter Hospital has now completed the blood draws or scheduled appointments
for 982 of the identified patients who received care at the Cardiac Catheôﾀﾁﾗôﾀﾁﾈrization
Lab between October 1, 2010 and May 25, 2012. We are nearing the completion
of testing with approximately 120 patients who still need to be tested. We are
continuing to schedule appointments and reach out to identified patients who we
believe still need to be tested.

♦ The hospital has scheduled appointments or completed blood draws for all of the
patients who needed to be retested because the state was unable to process their
original blood draws. One patient elected to be tested elsewhere.

♦ Exeter Hospital has established a dedicated clinical response team to treat all
patients who have been diagnosed with hepatitis C. The clinic is being lead by
Dr. Thomas Sherman and Dr. Hillary Tompkins of Core Gastroenterology, who
are now actively caring for more than half of the identified patients who tested
positive with the virus. We expect a new dedicated care manager to be added to
the clinic within the next several days. The additional care management will be
provided to all of the identified hepatitis C patients related to the Cardiac
Catherization Lab at no charge.

♦ The Cardiac Catheterization Lab, which reopened for full routine operations on
Tuesday, June 5 with approval from the experts at the state Division of Public
Health Services, continues to see all elective and emergent patients. Last night
staff at the Cardiac Catheterization Lab performed a critical, life saving procedure
on an individual who experienced a sudden heart attack while visiting friends and
family in the area. The national standard for a response time is to have treatment
completed within 90 minutes of arrival at the hospital to ensure there is the least
possible damage to heart muscle. Last night’s procedure only took 54 minutes.
Exeter Hospital’s historic average response time is less than 70 minutes. The
dedicated staff of the Cardiac Catheterization Lab is continuing to provide critical,
life-saving services to residents of the Seacoast community and has saved
hundreds of individuals over the last several years.

Tuesday, June 19, 2012 – Exeter Hospital has now completed screenings or scheduled appointments for 976 of the identified patients who received care at the Cardiac Catherization Lab between October 1, 2010 and May 25, 2012. We are nearing the completion of testing with approximately 120 patients who still need to be tested.

“Exeter Hospital’s Call Center staff and employees from other areas of the hospital have done their best to schedule screenings as quickly as possible and help support patients throughout this process,” said Claudette Lavigne, manager of Exeter Hospital’s Call Center. “Our staff and the hospital take tremendous pride in supporting and assisting our patients each day. We recognize the stress this has had on our patients and we are working as quickly as possible to complete the outreach and testing process.”

Clinical representatives from the hospital have placed calls to 763 of the patients who have been tested to date to follow-up with them and assist with any questions. In the vast majority of the calls patients have been positive and supportive of our outreach efforts, nd we appreciate their support. Although there are some patients who are very upset, we are following-up directly with these patients to address their concerns and apologize for any inconvenience or additional anxiety or stress this may have caused them. These outreach calls will continue to occur as we complete our testing. While the past few weeks have been significantly challenging for our community, many patients have shared their support of the hospital and have been appreciative of being contacted quickly to schedule their screening.

Exeter Hospital continues to collect new samples from the 24 patients whose hepatitis C
tests were unable to be processed by the state. Sixteen of these patients have already had
their screenings or scheduled appointments. The hospital is doing everything it can to
move this process along as quickly as possible, while supporting the patients and their
families along the way.

Monday, June 18, 2012 – Exeter Hospital has begun collecting new blood samples from the 24 patients whose hepatitis C tests were unable to be processed by the state. The samples were drawn on the scheduled testing dates of Thursday, June 7th and Friday, June 8th, and were picked up from Exeter on Saturday, June 9th by the state’s courier. The state claims they did not receive the samples until Monday, which was too late for them to process.

The hospital is committed to determining, together with the state, why these samples were not processed within the required 72 hour timeframe, even though they were picked up from Exeter Hospital on Saturday by the state’s courier.

In an effort to avoid any future challenges with samples being processed over the weekend, the hospital will no longer collect samples for hepatitis C testing related to this outbreak on Fridays. This is to ensure that samples drawn by the hospital and delivered to the state’s courier will be processed within the required 72 hour timeframe.

The hospital recognizes that these patients are under significant stress. It is very unfortunate these patients have to come in for a second test because their blood samples were unable to be processed. We know the state is working diligently to respond as quickly as possible during this outbreak. Nevertheless, by working together we hope to ensure that no one has to go through this stressful process again.

Exeter Hospital will do everything it can to move to process these redraws as quickly as possible while supporting the patients and their families along the way.

Friday, June 15, 2012 – The New Hampshire Division of Public Health Services (DPHS) is hosting an open forum tonight at 6 p.m. at the Exeter High School in Exeter, NH. This meeting is intended for epidemiological experts at the DPHS to update the public on their investigation and answer questions about their findings.

Exeter Hospital does not have a formal role in the state’s proceedings tonight and in deference to the state’s request to keep the focus of the meeting on their efforts, Exeter Hospital will not be making any presentations or be taking any direct questions. It is possible that Exeter Hospital employees may attend the meeting on their own; however, they will not be in a position to comment on behalf of the hospital.

Exeter Hospital will respond appropriately, based on our current circumstances, to questions raised at the forum either via the media or other public avenues. Our ability to comment is somewhat limited by the initiation of an investigation by the New Hampshire Attorney General’s office, but we will continue to provide the public with as much information as we can.

Exeter Hospital has initiated a patient follow-up communication initiative that has already directly reached more than 600 individuals who were tested as a result of the Hepatitis C investigation. To provide the public with a comprehensive view of how we are responding, we have also posted online an extended video interview of both Exeter Hospital president and CEO Kevin Callahan and Chief of Medicine Dr. Rick Hollister. The interview can be viewed at www.exeterhospital.com. In addition we have posted our full set of public statements and important educational links for the public to access.

Thursday, June 14, 2012 – The Attorney General’s Office has now formally announced that it has launched an investigation into the facts and circumstances surrounding the hepatitis C cases at Exeter Hospital. Exeter Hospital welcomes this investigation, and is planning to cooperate with the Attorney General’s Office as we continue our own investigation into the possible cause.

With the initiation of this investigation, Exeter Hospital intends to refrain from providing any additional public comments specifically related to these hepatitis C cases or the ongoing investigations. We will continue to provide updates on our efforts to reach out to and test all potentially affected patients who were treated in our Cardiac Catherization Lab between October 1, 2010 and May 25, 2012.

As of 4:00 p.m. today, we have now contacted all identified patients by phone, including the 316 newly identified patients who received care at the Cardiac Catherization Lab between October 1, 2010 and March 31, 2011. We are continuing to schedule appointments and a letter to all of the newly identified patients has also mailed today.

We will continue to share appropriate information as it becomes available.

Wednesday, June 13, 2012 – The New Hampshire Division of Public Health Services (DPHS) has informed Exeter Hospital that six additional patients have tested positive for hepatitis C and are genetically linked to the previous 14 cases, bringing the total to 20.

We understand that the state has notified each of the six new patients. The common connection for these patients, at Exeter Hospital, remains the Cardiac Catheterization Lab. As a result of these new identified cases, Exeter Hospital will expand its testing to include patients who received care at the Cardiac Catherization Lab or its recovery unit between October 1, 2010 and March 31, 2011, and will begin notifying patients beginning on Thursday, June 14 via phone and mail. Patients will be booked into scheduled drawing appointments beginning Monday, June 18. We will make every effort to make this testing process as convenient and comfortable as possible. We are continuing to work with the state to explore ways to expedite the process of getting test results back to our patients as quickly as possible. As part of that effort, the DPHS informed Exeter Hospital that it began making phone calls to all patients Thursday afternoon once its testing was complete and will continue to inform patients of test results via phone moving forward.

Although the investigation into these cases and their ultimate source is still ongoing, the DPHS determined that Exeter Hospital’s Cardiac Catheterization Lab was safe to resume full and normal operations starting on Tuesday, June 5, following the elimination of all potential ongoing infection risks. Exeter Hospital continues to collaborate with and support the investigation by the state’s experts.

As this investigation continues to evolve, we will continue to share information as it becomes available

Saturday, June 9, 2012 - One week after beginning the screening process for identified patients related to the hepatitis C investigation, Exeter Hospital has now reached out via telephone and letter to the 879 identified patients who were treated at the hospital’s Cardiac Catheterization Lab and its recovery unit from April 1, 2011 through May 25, 2012.

Late Friday afternoon, the experts at the state’s Division of Public Health Services (DPHS) informed the hospital that four additional patients have tested positive for hepatitis C and are genetically linked to the previous 10 cases, bringing the total to 14. This number includes the original four patients who have been genetically linked to the virus. Each of the 14 patients has been notified. The common connection for those patients at Exeter Hospital remains the Cardiac Catheterization Lab. Patients are continuing to come in for testing. It is likely even without any further expansions of the screening period that testing will continue at least throughout next week.

Although the investigation into these cases and their ultimate source is still ongoing, the DPHS determined that Exeter Hospital’s Cardiac Catheterization Lab was safe to resume full and normal operations starting on Tuesday, June 5th, following a thorough investigation of all potential ongoing infection risks. Exeter Hospital continues to collaborate with and support the investigation by the state’s experts.

The DPHS has also informed the hospital that as of Thursday afternoon, 422 or 97.2% of the blood samples they have completed testing on have been confirmed as negative by the state’s laboratory, meaning they show no signs of hepatitis C.

The DPHS has informed the hospital they have begun to mail test results to primary care physicians as of the afternoon of Thursday, June 7. This is an ongoing process, and as previously explained, it is likely to take 7-10 days from the time a patient’s blood is drawn for the primary care physician to receive information about negative test results. Patients drawn last Thursday and Friday should begin to receive information about their results over the next few days. Physicians from Exeter Hospital have called all of the related primary care physicians involved to let them know that test results for their patients are forthcoming. The state has also reached out to these physicians through their routine communication outreach efforts.

Although we know that patients are becoming increasingly anxious to know their results, the DPHS has told Exeter Hospital they are not able to share any of the negative results with the hospital and therefore, we are not in a position to be able to share them with patients. We are continuing to work collaboratively with the state on identifying ways to speed up the notification process.

Exeter Hospital’s Call Center continues to take phone calls and schedule appointments for identified patients at their earliest convenience. Staff members from the Call Center are prepared to take calls Monday through Friday, 7:00 a.m. to 7:00 p.m., and Saturday, 7:00 a.m. to 12:00pm, and can be reached at (603) 580-6124. The drawing station is taking appointments scheduled through the Call Center Monday through Friday, 8:00 a.m. to 6:00 p.m. and Saturday, 7:00 a.m. to 12:00 p.m.

The investigation continues to evolve and we will continue to share appropriate information as it becomes available.

Wednesday, June 6, 2012 – The New Hampshire Division of Public Health Services (DPHS) has announced the first round of test results related to testing of patients who had been treated at Exeter Hospital’s Cath Lab from August 1, 2011 to May 25, 2012, thus far. Through the first round of testing, the NH Public Health Labs (PHL) has identified an additional 6 patients who match the original strain of hepatitis C, bringing the total number of related cases to 10. All 6 patients will be notified by the state. The first four cases identified last week include 4 patients, one of whom is an employee of the hospital.

Because of these new results, Exeter Hospital is expanding our initial recommendations to test patients for hepatitis C, who received care at the Cath Lab and its recovery room to include those who were treated between April 1, 2011 and August 1, 2011.

Exeter Hospital has been expeditious in its outreach efforts to notify patients who now fit these criteria for testing and has already notified all new patients identified by phone, and a letter is being mailed today. The hospital’s medical staff is proactively reaching out to patients as soon as test results are made known to them by the state, and Exeter Hospital has sent close to 500 samples to the state for testing. The hospital began scheduling appointments for newly identified patients today and we are working as hard as we can to get the tests done as quickly as possible. Test results will be sent directly to the patient’s primary care physician from the DPHS within 7-10 days.

Exeter Hospital and the DPHS continue to work in close collaboration. Following an extensive review of the hospital’s staffing, procedures and practices as well as the length of our voluntary suspension of operations in the catheterization lab, the DPHS determined that the Cardiac Cath Lab and its recovery unit is safe to provide care and to proceed with normal operations. The Cath Lab returned to normal operations on Tuesday, June 5th at 8:00 a.m.

The hospital’s call center is available to assist patients with scheduling appointments Monday through Friday 7:00 a.m. to 7:00 p.m. and Saturday, 7:00 a.m. to 12:00pm, and can be reached at (603) 580-6124.

Exeter Hospital will continue to share more information with the media and the public as it becomes available. If there are any questions, individuals are encouraged to call the New Hampshire Division of Public Health at (603) 271-4496 or Exeter Hospital’s Information and Referral Center at (603) 580-6124.

Monday, June 4, 2012 – Dr. Jose Montero, the Director of the State Division of Public Health Services released this afternoon that one of the infected individuals involved in the investigation of hepatitis C at Exeter Hospital is an employee of the hospital.

While accurate, it is also true that all four, including the employee, are our patients and therefore we are prohibited from sharing information about any of them that could personally identify them or reveal personal health care information.

The State Division of Public Health Services has now cleared Exeter Hospital’s Cardiac Catheterization Lab to reopen for full and normal operations. The lab is scheduled to open at 8am on Tuesday June 5th.

Exeter Hospital will continue to work collaboratively with the experts from the state to determine the shared origin of these four cases.

As shared previously by both the Hospital and the state, hepatitis C is becoming more prevalent in the community. National standards for hospitals require us to treat all patients and employees that have direct patient contact as if they represent a possible infection risk necessitating the use of universal precautions. Exeter Hospital follows all national standards for preventing the spread of infectious disease.

At this time Exeter Hospital has either completed screening or scheduled screening for approximately 500 of the 651 individuals identified in the six month testing window around the identified cases. All 651individuals have been sent a letter notifying them about the screening and all have received a personal telephone call from representatives at the hospital.

Friday, June 1, 2012 – Exeter Hospital Reopens Cardiac Cath Lab
After thoroughly examining Exeter Hospital’s Cardiac Cath Lab, the New Hampshire Department of Public Health has informed Exeter Hospital that the Cardiac Cath Lab is safe to resume operations on an emergency services basis. We believe it is vitally important to share that the Cardiac Cath Lab has reopened as of 4:00 p.m. on Friday for emergency care and is expected to return to normal operations early next week.

We continue to work closely with the New Hampshire Division of Public Health and we are doing our very best to accommodate and to support our patients during this process. We have contacted and sent a letter to all of the patients identified for testing and as of 4:00 p.m. today, approximately 400 patients have been screened or have made an appointment. We will continue to take phone calls and schedule appointments with all of the identified patients until they are tested.

This is an evolving situation and we will continue to share more information as it becomes available. If there are any questions, individuals are encouraged to call the New Hampshire Division of Public Health at (603) 271-4496 or Exeter Hospital’s Information and Referral Center at (603) 580-6124.

May 31, 2012 – Exeter Hospital and the New Hampshire Division of Public Health Services Form a Joint Investigation Related to Four Individuals Recently Diagnosed with hepatitis C
Exeter Hospital has identified four individuals who were recently diagnosed with hepatitis C. Due to common elements in their clinical history, Exeter Hospital reported the cases to the New Hampshire Division of Public Health Services to seek their assistance.

Testing by the Division of Public Health Services has confirmed that all four cases share an identical strain, which means they were infected by the same source. We are currently working with the experts at Public Health to investigate and determine the source of the infection. The common place of connection for the infected individuals at Exeter Hospital appears to involve the Cardiac Cath Lab. Exeter Hospital voluntarily suspended operations in the Cardiac Cath Lab on Friday May 25th pending the completion of appropriate testing. We anticipate that it will be cleared to resume operations shortly.

As part of the investigation, together with the Division of Public Health Services, we are in the process of proactively reaching out via phone and letters to all patients who received care in the Cardiac Cath Lab since August 1, 2011 to recommend they return for hepatitis C testing.

Exeter Hospital is providing this confidential testing at no charge for these patients and to make the screening as convenient as possible, we have arranged for multiple dates and times. Test results will take 7-10 days and results will be sent directly to the patient’s primary care physician. Together with Public Health, we are doing our very best to make this process as accommodating and supportive as possible for patients.

We have established a dedicated phone line through Exeter Hospital’s Information and Referral Center to assist patients and schedule tests. The Referral Center has also extended its hours to 7:00am through 7:00pm Monday through Friday.

We will continue to work closely with the New Hampshire Division of Public Health and if there are any questions, individuals are encouraged to call them at (603) 271-4496. Further information and updates will be released as they become available.

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