Criminal - The Red Flag

Episode Date: November 5, 2021

In 2006, a man named William Ramsey went to the Mayo Clinic in Jacksonville, Florida for a life-saving liver transplant. It was a success, and so when his health started to decline after the procedure, doctors couldn't figure out why. Say hello on Twitter, Facebook and Instagram. Sign up for our occasional newsletter, The Accomplice. Follow the show and review us on Apple Podcasts: iTunes.com/CriminalShow. We also make This is Love and Phoebe Reads a Mystery. Artwork by Julienne Alexander. Check out our online shop.  Episode transcripts are posted on our website. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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and leads him to a dark secret about his own family. Check out Ghost Story, a series essential pick, completely ad-free on Apple Podcasts. Botox Cosmetic, Adabotulinum Toxin A, FDA approved for over 20 years. So, talk to your specialist to see if Botox Cosmetic is right for you. For full prescribing information, including boxed warning, visit BotoxCosmetic.com or call 877-351-0300. Remember to ask for Botox Cosmetic by name. To see for yourself and learn more, visit BotoxCosmetic.com. That's BotoxCosmetic.com. There was the first patient, and his name was William Edward Ramsey. And Mr. Ramsey was a

Methodist minister who was at the Mayo Clinic for a liver transplant. This is Assistant United States Attorney Frank Talbot. Before that, he had been evaluated for a liver transplant by a hospital out in California. He actually lived in Las Vegas with his wife. That's where they retired. And he'd been to a hospital in California that told him that the condition of his liver was essentially too bad, that he wouldn't be a candidate for a transplant. So really, he had been sent home just really to wait to die. And a friend suggested that he reach out to Mayo Clinic in Jacksonville because maybe they would be a little more aggressive in trying to do a liver transplant. And that's what happened. And Mayo Clinic agreed to put him on the transplant

list, and that was in 2006. And so Mr. Ramsey and his wife moved to Jacksonville to wait on a transplant. And that came in September, and it was a huge success. It was a very difficult transplant procedure, but it was a success. After his liver transplant, his health started to deteriorate and the doctors couldn't figure out why. They finally tested him in January of 2007 and to their surprise, he had hepatitis C that he did not have before his liver transplant. Part of the transplant process, of course, is lots of testing. And he had been tested for hepatitis C several times along the way before his liver transplant. And he had a genetic liver condition and did not have hepatitis C. So Mr. Ramsey became the red flag. Because Mr. Ramsey did not have this disease when he went into surgery.

That's correct. They knew absolutely that he didn't have it. Had he had hepatitis C, that would have changed the course of his treatment entirely. But it wasn't until after he got his new liver that the hepatitis C was discovered. Tell me a little bit about hepatitis C because there are a number of different types of hepatitis. Is that right, hepatitis A? Is hepatitis C the most serious? How is it transmitted, and why is not as, they can be serious, but they're much more easily treatable than hepatitis C. Hepatitis C is a blood-borne virus.

And so the only way to contract it is blood to blood, blood-borne pathogen. It's an RNA organism. So it's extremely, extremely small, smaller than the wavelength of light. You can only see it under an electron microscope, and it wasn't really discovered entirely. I mean, people had been dealing with hepatitis C for centuries in all likelihood, but it wasn't until the early 70s that doctors were able to actually diagnose and name it. And then it really wasn't until around the early 90s that we started to screen for hepatitis C in the blood bank. And there were several people that had contracted hepatitis C prior to that through ordinary treatment blood transfusions. So it is a very serious virus. About 20% of the population can clear it on their own, but typically that's people that are healthy. Someone in Mr. Ramsey's position who had just received a new liver and was on suppressive drugs to keep his body from rejecting

the liver, him being exposed to hepatitis C was horrible in terms of his ability to have his body accept the new liver and then in terms of the hepatitis C impacting him. Hepatitis C, over time, will destroy the liver. It is a virus that attacks the liver. An epidemiologist at the Jacksonville Mayo Clinic named Dr. Walter Hellinger began an investigation to try and find out exactly how William Ramsey had contracted hepatitis C. They must have thought that the hepatitis C came from his newly transplanted liver or something, right? Well, they went looking, and Dr. Hellinger, the epidemiologist, that was his first job was to go back and look to see where the liver came.

So you're right. They looked at the donor who had donated the liver, obviously no longer alive. The donor did not have hepatitis C. The liver had been tested before his surgery, and it was free of hepatitis C. They focused very heavily on the liver transplant unit, and what they were looking for was perhaps another patient who had been treated in the liver transplant unit had given the hepatitis C to Mr. Ramsey. They took blood samples from patients who they knew already had hepatitis C. And then the CDC got involved in the investigation. Every time they would find a patient with hepatitis C as a potential source for Mr. Ramsey's hepatitis C, they would send that sample to the CDC in Atlanta. The CDC in Atlanta is able to conduct genetic testing of the virus.

And so they are able to tell Dr. Hellinger either, yes, this is a potential source of the hepatitis C of Mr. Ramsey, or no, it's a different strain. And so when they did all of that, they still were not able to find how Mr. Ramsey got his hepatitis C. Now, at the same time, they're also testing the healthcare providers in the liver transplant unit to see if perhaps one of the providers themselves has hepatitis C and is inadvertently transmitting it to the patients. And there was no one that had hepatitis C, so there was no provider-to-patient transfer. So the new liver was fine. They couldn't find any patient-to-patient transfer,

and they couldn't find any provider-to-patient transfer. It didn't make sense. And then it happened again. I'm Phoebe Judge. This is Criminal. In January 2008, a year after William Ramsey tested positive for hepatitis C, another man named Rick Hildebrandt also tested positive. He was at the Jacksonville Mayo Clinic preparing for a liver transplant. He did not previously have the virus. When they sent Mr. Hildebrandt's blood sample to the CDC, they discovered that it was a strain match to Mr. Ramsey's have infected Mr. Hildebrandt, Mr. Hildebrandt may have infected Mr. Ramsey, or there's an unknown source of the hepatitis C.

And what Dr. Hellinger was able to determine is that these two men could not have infected each other. So he was still looking for the source of now two patients' hepatitis C, and both these patients were both liver transplant patients, so they were both seen heavily in the liver transplant unit. And then a third patient tested positive. But he wasn't in the liver transplant unit. He was at the Mayo Clinic for a cancer treatment that involved transplanting stem cells. So this patient, who happened to be an attorney from Georgia, was down at Mayo Clinic

for this procedure. He tested negative for hepatitis C, and then he had the stem cell replacement. When he went through the stem cell replacement, his immune system is essentially destroyed and then he gets very, very sick. And they determined that this patient has hepatitis C and he did not have it before. And again, it was a strain match to the other two patients. And these patients could, there's no way that these patients would have come in contact with each other.

That's correct. They again looked to see was there any overlap, and there wasn't. But what became very significant about this third patient is that instead of two patients in the liver transplant unit, we now have a third patient that's never been to the liver transplant unit. But now that we have, and the way I describe this is we now have a triangle. With these three patients, we draw a, and we look in that triangle for where these three patients overlapped at Mayo Clinic. Because at this point, Dr. Hellinger is really shifting his focus to provider-to-patient transmission. he's dealing with three different infections of hepatitis C that have spanned almost two years, he believes he's not looking for a patient, but he's looking for a provider. So when they draw the triangle, that's when they find that all three of these patients

had been treated in the interventional radiology department at Mayo Clinic. That was their common overlap in the Mayo Clinic. So what they did is, and it's one of the, I suppose, the advantages of having very detailed medical records, is that the Mayo Clinic was able to go back and look to see when these three patients went through interventional radiology, and they were able to tell who was working on those days that these three patients went through. They obviously weren't, they didn't go through on the same day, they were years apart, but they were able to see which employees were there. And there were 21 employees that overlapped with these three patients.

So you've got 21 employees. Do you just ask them, are you positive for hepatitis C? What did they do? That's exactly what Mayo Clinic did. They went to each of the 21 employees and told them why they wanted to get their blood sample, and they asked all 21 of the employees to voluntarily give them a blood sample. 20 of the employees did.

One of the employees withheld. Who was that employee? That employee was Stephen Bumel. So what, of the 20 employees that were tested, did any of them test positive for hepatitis C? They did not. All 20 were negative. When they found out that all 20 were negative, Mayo Clinic went back to Stephen Bumel, perhaps a little more insistently this time, and asked him if he would provide a blood sample. And on April 20, 2010, Stephen Bumail submitted to a blood sample, and that sample tested positive for hepatitis C. Apple Podcasts. Each month, Apple Podcasts highlights one series worth your attention, and they call these series essentials. This month, they recommend Wondery's Ghost Story,

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to give you a primer on how to integrate AI into your life. So tune into AI Basics, How and When to Use AI, a special series from Pivot sponsored by AWS, wherever you get your podcasts. After Stephen Bumel's blood sample tested positive for hepatitis C, Dr. Hellinger and investigators still had to figure out whether he was actually the source of the three patients' infections. The first step is that sample had to be sent to the CDC in Atlanta, and it was. And it was genetically tested, and it was a strain match to the three patients. So Dr. Hellinger was of the opinion that he had found his source of hepatitis C, but of course the CDC confirmed that with the genetic testing of the virus. Then they had to determine where was the point of infection. Obviously, as we talked about, hepatitis C is very small. You can't see it, and it is a blood-borne pathogen. So they had to

determine how did the hepatitis C in Stephen Bumel's bloodstream get into the bloodstream of the patients. After multiple interviews, Stephen Bumel told investigators how it might have happened. Stephen Bumel worked as a radiologic technician. His work involved preparing patients for procedures in the interventional radiology department, gathering the necessary supplies, making sure the interventional radiology department, gathering the necessary supplies, making sure the procedure rooms were sterile, and disposing of used needles and syringes. Those discarded syringes sometimes contained small leftover amounts of fentanyl, a synthetic opioid that can be 100 times more potent than morphine

and 50 times more potent than heroin. It's prescribed to patients in severe pain and is highly addictive. Stephen Bumel told investigators that he would replace the needles on the discarded syringes and inject himself with the fentanyl that remained in them. And then, he said, at some point he began to look for full syringes. Before each procedure that required fentanyl for the patient's IV, a nurse would fill a syringe with the drug, label it fentanyl, and place it on the patient's cart.

Stephen Bumel said that he would then take the syringe from the cart, replace the needle with a different one, and use it to inject himself. Then he would put the original needle back on the empty syringe, fill it with saline, and put it back on the cart before the nurse noticed. And he would do that at just a slight of hand, while typically the nurse might be distracted doing something else in the procedure room in interventional radiology and that's when he would make his slight of hand swap.

And any healthcare provider knows that they never reuse any part of a syringe, obviously not the needle, but not the syringe itself. The plastic syringe can easily become contaminated with blood when it is injected into a patient. And so what was happening is Stephen Bumel was injecting a fentanyl syringe into his vein, a little bit of his blood was getting backflowed into the syringe, contaminating it. And then when he refilled the syringe with saline and then dropped it, did the sleight of hand swap, then the patients were first of all not getting fentanyl,

but they were getting saline that was laced with Stephen B. Mel's hepatitis C. I mean, there's so many horrifying things about that. But I mean, the first, the most immediate is that these are people who are undergoing what seem to be pretty serious and painful procedures, and they're not getting pain medication. They're basically getting water. That's correct. And one of the things that we discovered as we went through the investigation was that during the procedures, the patients would typically receive not only fentanyl, or of course, in this case, a lot of patients were receiving saline

and not fentanyl, but they were also receiving Versed, it's a benzodiazepine, which has an amnesia quality to it. So, as we interviewed several of the doctors and the nurses over the course of this investigation, we did discover, we couldn't pin it down directly, but there were reports of patients, not our victim patients, but of other patients over the years that seemingly had not had any pain medication. And on at least one occasion, we had a doctor who remembered arguing with a nurse that the nurse is saying, I've given this patient too much fentanyl already. And the doctor ironically said, it seems like you're giving him water. And so there were some reports of that that we discovered during the course of our

investigation. But when we talked to the victims, they had no memory of the procedure in interventional radiology. And that was not surprising because they had all received Versed, which again acts as an amnesic, which is good. They have no memory of the pain that they endured. In August 2010, after more than three years of investigation, the Jacksonville Mayo Clinic fired Stephen Bumel and reported him to the police. According to his arrest report, Bumel acknowledged to the police he was addicted to fentanyl

and admitted that he had taken drugs from the hospital. The FBI, Florida State investigators, and a special agent with the Food and Drug Administration got involved in the criminal investigation. So we had kind of a team of investigators, and the first question was, did Stephen Bumell know he had hepatitis C before he was doing this at the Mayo Clinic? And so we went back trying to find medical records on Stephen Bumail, and we really found none. He just didn't go to the doctor ever. So that was a dead end.

We weren't able to prove anything there. And then we went back and went to look at his employment records. Stephen Bumel had worked at Memorial Hospital in Jacksonville from 1992 until 2004, before he started working for the Mayo Clinic. And when investigators looked at his records, they noticed something. He had been observed by a nurse at Memorial Hospital, and he was rummaging through a sharps container in the medical waste. So they sent him into a two-year drug treatment program, and it was while he was in that drug treatment program that

he left Memorial Hospital toward the end of 2004. And in October of 2004 is when he started working at the Mayo Clinic. Tell me about confidentiality rules that would have limited what Mayo Clinic knew about Stephen Bumail's past history drug issues. You'd imagine that that's something you'd want to know with someone who's going to be so close to controlled narcotics. That's correct. And there were confidentiality rules that prevented the Memorial Hospital administration from disclosing that information to anyone, including to the Mayo Clinic. When Mayo Clinic hired Stephen Bumill, and probably fairly standard for most jobs these days, especially in the medical field, they asked him about any prior drug history, whether he had any addictions, and they included alcohol as well. And he answered on that

application that he did not have any past issues with drug addiction? Well, at the time he's answering that question, he's actually actively in a drug treatment program. So Mayo Clinic never knew. According to court documents, during Stephen Bumel's time in the drug treatment program, he was specifically informed about the risk of exposure to hepatitis C from injections. His drug monitoring and counseling didn't end until April 2007, at least seven months after he first began injecting himself with fentanyl from the Mayo Clinic. A 2014 Mayo Clinic study using CDC data from all over the country found that over a period of 10 years,

nearly 30,000 patients were determined to have been potentially exposed to hepatitis C because of health care providers stealing drugs. One radiology technician named David Kwiatkowski managed to work at 19 hospitals in eight states, even though there were indications that he was using fentanyl intended for patients at many of those hospitals. In 2007, one month after he was hired at University of Michigan Hospital, vials of narcotics started disappearing from operating rooms. Two months later, he was seen leaving a room quickly, right before a nurse noticed that a syringe of fentanyl

that had just been left on the counter in that room was gone. During the police investigation, David Kwiatkowski refused to submit to a lie detector test and quit. From there, he went on to work for a series of hospitals as a temp, and none of them knew why he had left the University of Michigan. No charges had been filed, no one had alerted the National Registry of Radiology Technicians, and the hospital's policy when receiving inquiries from any potential employer was only to confirm the dates of his employment. It was reported that the hospital had been advised against disclosing anything else

for fear of being sued for defamation. In 2008, a co-worker at a hospital in Pittsburgh saw David Kwiatkowski slip a syringe into his pants. Not long after, three empty syringes with a fentanyl label were found in his pockets. After he failed the drug test, he was fired. The hospital told the staffing agency why he was fired, but didn't call the police. The staffing agency didn't notify the police either, and no one informed the National Registry of Radiology Technicians. He kept getting hired at different hospitals.

In 2010, David Kwiatkowski was found almost unconscious in the men's bathroom at Arizona Heart Hospital with an empty syringe labeled fentanyl floating in the toilet next to him. But he had inadvertently injected himself with a different drug altogether, a paralytic. The syringe had been mislabeled. The colleague who found him later reported that when he came to, he said,

I'm going to jail. But when hospital staff questioned him the next day, he told them he'd taken the fentanyl syringe to help with some abdominal pain and denied any history of intravenous drug use. The hospital did not press charges, and none were filed. He was reported to the Registry of Radiology Technicians, but they ended their investigation because, they said, David Kwiatkowski gave them a plausible explanation for what had happened. When he was reported to the Arizona Regulatory Board, he surrendered his license to practice in Arizona and moved on to other states. After working in Pennsylvania, Kansas, and Georgia, David Kwiatkowski got a job in New Hampshire.

His co-workers reported that he would sometimes sweat through his scrubs and was acting strange. Sometimes he ran to the bathroom in the middle of a procedure. And then, about a year after he was hired, in May 2012, several patients who had gone through the lab where he'd worked tested positive for hepatitis C. The strain was traced back to David Kwiatkowski. He was arrested and charged with multiple counts of obtaining controlled substances by fraud and tampering with a consumer product.

He pled guilty to all the charges and was sentenced to 39 years in prison. David Kwiatkowski is believed to have infected at least 46 people across four states. I'll see you next time. New year, new me? How about same year, new me? You just need a different approach. According to Noom, losing weight has less to do with discipline and more to do with psychology. Noom is the weight loss management program that focuses on the science behind food cravings and building sustainable eating habits. Noom wants to help you stay focused on what's important to you with their psychology and biology-based approach. Noom takes into account your unique biological factors, which also affect weight loss success. The program can also help you understand

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Learn more at klaviyo.com slash bfcm. During Stephen Bumel's six years of employment at the Jacksonville Mayo Clinic, investigators estimated that he potentially exposed 6,132 patients to hepatitis C. The Mayo Clinic began sending out letters. One woman who received the certified letter warning her that she may have been exposed told a reporter, I have never felt more safe than I was at the Mayo Clinic. For this to happen, I think is horrible. Thousands of people submitted blood samples, collected at their home, the Mayo Clinic, or another testing site. Thankfully, they discovered that there were

only two additional victims of Stephen Bumail that we didn't previously know about. Is it true, though, that a number of people who they would have reached out to had already died? Well, that is true, and we will never know what impact occurred there. The other thing that we'll never really know is how many patients were able to clear the virus. Like I said before, the doctors have told me that about 20% of individuals can clear hepatitis C on their own. And so we'll never really know what the total universe of victims really was. But for purposes of our prosecution, we identified five victims beyond a reasonable doubt, and in Stephen Bumel's indictment, those five victims were named specifically as his victims. One of the interesting dynamics of this case is that Stephen

Bumel, we think a lot in terms of criminal cases and I'm sure you have a lot of programs where people talk about DNA evidence and someone leaves their either they take the victim's DNA with them or they leave their own DNA at a crime scene. But this was such a unique situation where the only real evidence that Stephen B. O'Mell left at the crime scene was a virus that he had inside his own body. And then that virus was the fingerprint, if you will, that remained in these victims. But other than that virus, we would have no way of linking Stephen Bumel to this crime. In May 2011, Stephen Bumel was indicted by a federal grand jury on five counts of tampering with a consumer product, resulting in death or

serious bodily injury and five counts of obtaining a controlled substance by fraud. A year later, one week before the trial was scheduled to begin, Stephen Pumel pled guilty to all counts. He pled guilty and he pled without a plea agreement. It was a straight-up guilty plea and that meant that there was no agreement as to what sentence he would receive. That would be entirely up to Judge Howard who sentenced him. He was sentenced to 30 years in federal prison. What did he say? Did he say anything? Was he apologetic? He was apologetic,

and his family, his mother spoke, sister spoke at his sentencing. The victims' family members spoke. We had one of the victims, the attorney from Georgia, actually came to court and spoke about what he had suffered, and it was horrendous what he had gone through and really continued to go through battling the virus. I think one of the most powerful witnesses at sentencing was Mr. Ramsey's wife and the story she told about her husband and what he had gone through. The suffering was almost beyond description. Remember, he had gone through the liver transplant in September of 2006, but then when he went through interventional radiology after the transplant, that's when he got the hepatitis C. And it really, it took away really his second chance at life.

And the doctors would later describe to me that it was a constant battle to try to help Mr. Ramsey overcome the hepatitis C, that they just kept losing ground. No matter what they did, it was, they just couldn't gain any ground on the virus. And so, beginning in early 2007, for the next three years, the doctors at Mayo Clinic tried to save his life. And one of the dates that I've already mentioned but was very significant in the case was that date of April 20, 2010. Two things happened on that date. Mr. Ramsey was discharged from Mayo Clinic to go to home hospice. That was the day that he said goodbye to the staff at Mayo Clinic, and they said goodbye to him, and he went home to wait to die. That was the same day

that Bumail finally gave his blood sample, which would eventually solve the case. William Ramsey died from complications of hepatitis C in June of 2010. He never learned how he had contracted the virus. © transcript Emily Beynon by Johnny Vince Evans. Engineering by Russ Henry. Special thanks to Lily Clark. Julian Alexander makes original illustrations for each episode of Criminal. You can see them at thisiscriminal.com. We're on Facebook and Twitter at Criminal Show. Criminal is recorded in the studios of North Carolina Public Radio, WUNC.

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