Anesthesiologist DEA Investigation Lawyer

Last Updated on: 13th December 2025, 08:52 pm

Anesthesiologist DEA Investigation Lawyer: 39 Years for the Hepatitis C Outbreak, 45 Patients Infected, and Why Anesthesia Providers Have 3X the Addiction Rate of Other Physicians

David Kwiatkowski received 39 years in federal prison for infecting 45 patients with hepatitis C across eight states. He wasn’t dealing drugs on the street. He was a traveling radiology technician who diverted fentanyl from patient syringes, injected himself, then refilled the syringes with saline and returned them to patient care areas. His blood contaminated the syringes. Those syringes were used on patients. Forty-five people contracted hepatitis C. One died. Thirty-nine years. For drug diversion that created a multi-state infection outbreak – because hospitals wouldn’t share information about his diversion history due to liability concerns, and he moved freely from facility to facility.

Anesthesiologists make up only 4.2% of all physicians but represent 11.4% of physicians in addiction treatment programs – nearly three times their representation in the profession. The addiction rate among anesthesia providers exceeds 15%. One in ten CRNAs becomes addicted during their career. The same access that makes anesthesiologists effective at their jobs – immediate proximity to the most powerful controlled substances in medicine – is what destroys them when addiction develops. The median time from first fentanyl use to detection is only four months, but by then, tolerance has developed to the point where a single injection of 1,000 micrograms of fentanyl may be required just to relieve withdrawal symptoms.

The DEA doesn’t distinguish between street drug dealers and medical professionals who divert controlled substances. If you’re an anesthesiologist or CRNA facing investigation for diversion, the penalties are identical to what pill mill operators face. Jaime Guerrero, a Kentucky anesthesiologist, received more than 8 years for unlawful distribution of controlled substances – including distribution that caused a patient’s death. Rosetta Valerie Cannata, a former anesthesiologist in Florida, faces up to 20 years per count for pain clinic distribution conspiracy. The medical license provides no protection. The specialty provides no insulation. Federal prison is identical regardless of whether you diverted for personal use or ran a distribution operation.

39 Years for Hepatitis Transmission

Heres what happened in the Kwiatkowski case that led to one of the longest sentences in healthcare diversion history. Kwiatkowski was a traveling radiology technician who moved between hospitals in multiple states. He was addicted to fentanyl. His method of diversion was particuarly dangerous – he would remove syringes containing residual fentanyl from sharps containers, or he would draw up fentanyl from patient syringes, inject himself, then refill the syringe with saline and return it to the patient care area.

The problem was that Kwiatkowski had hepatitis C. When he injected himself and returned contaminated syringes to patient use, his blood contaminated those syringes. Patients recieved medication from syringes that had been used on an HCV-infected provider. Forty-five patients across eight states contracted hepatitis C from Kwiatkowskis diversion. One patient died.

Heres the system failure that made it worse. Kwiatkowski had been caught diverting at previous facilities. But liability concerns kept administrators from sharing that information with other hospitals. He would get terminated from one facility, then move to another facility that had no idea about his history. The hospitals were more worried about being sued for defamation then they were about warning other facilities that this provider was diverting controlled substances. There liability concerns protected Kwiatkowski while his diversion infected patients across eight states.

The sentence – 39 years – reflects the severity of what prosecutors characterized as tampering with a consumer product resulting in death and serious bodily injury. Thats not a diversion charge. Thats a product tampering charge. The same statute that applies to people who poison food products. Kwiatkowskis diversion transformed from a controlled substance violation into something that sounded like terrorism becuase of the patient harm that resulted.

The 3X Addiction Risk

Anesthesiologists are uniquely vulnerable to addiction. The statistics are stark:

• Anesthesia providers make up 4.2% of all physicians but 11.4% of physicians in treatment programs – 2.7 times there representation in the profession
• More then 15% of anesthesia providers develop addiction during there careers
• Among CRNAs specifically, 9.8% divert drugs for self-administration

Heres why the specialty creates this vulnerability. Anesthesiologists have immediate, constant access to the most powerful controlled substances in medicine. Fentanyl, sufentanil, remifentanil, propofol, ketamine – these medications are part of daily practice. The ease of access combines with high-stress working conditions, long hours, and the psychological burden of managing patient life and death.

The irony is profound. The profession dedicated to managing patient pain is the profession most vulnerable to pain medication addiction. The skills that make anesthesiologists valuable – there expertise in controlled substance pharmacology, there access to medication, there understanding of dosing – are exactly the skills that enable addiction when it develops.

Think about what that means for anesthesiologists facing investigation. The DEA knows these statistics. Prosecutors know these statistics. When an anesthesiologist faces diversion allegations, there facing investigators who understand that the specialty itself creates addiction risk. Thats not an excuse that helps at sentencing. Its context that explains why investigations into anesthesiology practices are particuarly thorough.

4 Months From First Use to Detection

The median time from first fentanyl use to detection is only four months. Thats not much time. But within those four months, tolerance develops rapidly. What begins as experimental use becomes physical dependence. A provider who started diverting small amounts may need 1,000 micrograms of fentanyl – a massive dose – just to relieve withdrawal symptoms by the time detection occurs.

Heres the consequence cascade that happens in those four months:

• First use leads to tolerance
• Tolerance requires escalating doses
• Escalating doses require more frequent diversion
• More frequent diversion creates detectable patterns
• Detection triggers investigation

By the time your caught, your not facing allegations about one or two diverted doses – your facing allegations about a pattern of diversion that spans months and involves quantities that look like distribution rather then personal use.

The detection methods have become sophisticated. Automated dispensing cabinets track every withdrawal. Waste documentation is audited. Discrepancies between what was withdrawn and what was documented as administered trigger alerts. If the amount of controlled substance you withdrew from the cabinet dosent match the amount documented in patient records, that discrepancy becomes investigation evidence. The technology has basicly eliminated the possibility of undetected long-term diversion – the systems catch patterns that human oversight would miss.

The Peplinski case from 2024 illustrates how detection works. Roman Peplinski, an anesthesiologist at Lakewood Medical Center in Missouri, was caught when personnel reported that three vials of fentanyl in an automated dispensing cabinet showed signs of tampering. He had misrepresented that fentanyl was for a patient who had actualy been discharged earlier that day. The system caught the discrepancy – the patient wasnt in the hospital when Peplinski claimed to be treating them. That single documentation inconsistency triggered the investigation that ended his career. He faces up to four years in federal prison for obtaining a controlled substance through misrepresentation, fraud, forgery, deception, or subterfuge.

Heres what many anesthesiologists dont understand about detection timelines. The four-month median means half are caught sooner and half are caught later. But the investigation may have been running before you knew it existed. The discrepancies that triggered the investigation may have been accumulating for weeks before anyone confronted you. By the time you learn your under investigation, the evidence has already been gathered. The pattern has already been documented. The case is already substantially built.

When Diversion Kills Patients

The Kwiatkowski case demonstrates the most extreme consequence of diversion – patient death through infection transmission. But patient harm from diversion takes multiple forms:

• Patients may recieve saline instead of pain medication during procedures
• Patients may recieve contaminated medication
• Patients may be treated by providers who are impaired during there care

The 2024 Seattle Childrens Hospital case illustrates this reality. A resident anesthesiologist, Voegel-Podadera, diverted fentanyl, remifentanil, sufentanil, hydromorphone, and other controlled substances while treating children. On December 27, 2024, he treated three minor patients. The attending physician observed him drawing up excessive amounts of fentanyl that wouldnt be needed for the scheduled procedures. He was practicing medicine while under the influence of controlled substances – while treating children.

Think about what that means. Childrens whose parents trusted that there anesthesiologist was competent and sober. Children undergoing procedures with a provider who was impaired by the same medications he was supposed to be administering to them. The investigation revealed he had been diverting while treating children – tampered with and diverted controlled substances ordered for three specific children.

The federal charges in that case arent just about diversion. There about practicing while impaired. About tampering with medications designated for pediatric patients. About the breach of trust that occurs when a provider prioritizes there addiction over patient safety. The charges reflect the harm – not just the diversion itself, but what the diversion meant for the patients who depended on that provider.

Hospital Liability and the Moving Target

The system failure in the Kwiatkowski case reveals how hospital liability concerns enable continued diversion. Kwiatkowski was terminated from multiple facilities for suspected diversion. But those facilities didnt report his termination circumstances to other hospitals. Liability concerns – fear of being sued for defamation – kept administrators from sharing information that could have prevented the outbreak.

Heres the hidden connection that enables serial diverters. Hospitals are reluctant to provide detailed information about why a provider was terminated. They confirm employment dates. They confirm whether the person is eligible for rehire. But they dont say “we terminated this person becuase we caught them diverting fentanyl.” That information, shared, might have prevented 45 hepatitis C infections. It wasnt shared becuase the hospital was more concerned about there legal exposure then about patient safety at the next facility.

The traveling healthcare worker model makes this worse. Providers who move between facilities – locum tenens, traveling nurses, contract anesthesiologists – may have diversion histories at previous facilities that there current employer never learns about. The system that enables healthcare flexibility also enables diversion mobility. A provider terminated for suspected diversion in one state can be working in another state within weeks, with no record following them.

The DEA has responded by increasing focus on organizations rather then just individuals. The agency’s diversion control budget increased 9% in 2016 specificaly to target organizational failures:

• Catholic Medical Center paid $300,000 in 2024 to resolve allegations that there failure to keep accurate controlled substance records enabled a CRNA to steal hundreds of fentanyl doses over an entire year
• Massachusetts General Hospital paid $2.3 million in 2015 for similar failures – discrepancies of 20,000 pills, missing inventories, nurses who diverted for years without detection

The MGH settlement reveals how extensive organizational failures can become. Twenty thousand pills unaccounted for. Hundreds of missing drug records. Multiple nurses diverting over many years without detection. The investigation found that the hospital had completly failed to implement appropriate monitoring systems. The $2.3 million settlement was the largest of its kind at the time – a signal that the DEA was taking organizational accountability seriousely.

Heres what that shift means for anesthesiologists. If your diversion is detected, your employer may also face investigation. The DEA wants to know how the diversion happened, why it wasnt detected sooner, and whether organizational failures enabled the diversion to continue. Your case becomes part of a larger investigation into the facility. And the facility has every incentive to cooperate with investigators – potentially at your expense.

The Relapse Reality

For anesthesia providers who survive the initial addiction episode – who are detected, treated, and potentially return to practice – the relapse statistics are grim. The cumulative incidence of relapse is 43%. Over 30 years, nearly half of anesthesia providers with substance use disorder will relapse at least once.

Heres the inversion that makes anesthesia addiction particuarly deadly. First relapse may present as death in 13-19% of cases when opioids are involved. No warning. No second chance at treatment. Just death. Anesthesia providers are “found dead on a regular basis from overdose and suicide.” The literature uses that exact phrase. Found dead on a regular basis.

When fentanyl is the drug of choice – and fentanyl is the most commonly abused drug among anesthesia providers – the risk of relapse nearly doubles compared to other substances. The tolerance that developed during the initial addiction period is gone after treatment. A provider who returns to fentanyl use at previously tolerated doses may overdose becuase there tolerance has reset. The dose that used to provide relief is now a lethal dose.

Propofol presents its own dangers. More then a third of reported propofol abuse cases end in death. And heres the irony – propofol isnt even classified as a controlled substance by the DEA, despite its clear abuse and dependence potential. Access is easier then access to Schedule II drugs like fentanyl. The regulatory framework hasnt caught up to the clinical reality that propofol kills healthcare workers who abuse it at alarming rates.

Heres the consequence cascade for anesthesiologists facing investigation. If you complete treatment and attempt to return to practice, you face ongoing monitoring, random testing, and restrictions on controlled substance access. Many facilities wont hire recovered addicts for anesthesia positions becuase of the relapse risk. Even if you avoid criminal prosecution, your career in anesthesia may be over. And if you relapse, the statistics suggest a significant chance that relapse kills you before anyone can intervene.

What Actually Protects Anesthesiologists

If your an anesthesiologist or CRNA facing DEA investigation for diversion, what actualy protects you?

First: Understand that diversion detection is highly sophisticated. Automated dispensing systems track every withdrawal. Waste documentation is audited. Discrepancies trigger investigation. The four-month median from first use to detection reflects how quickly these systems identify patterns. If your under investigation, substantial evidence has probly already been gathered.

Second: Patient harm transforms diversion charges into something much worse. Kwiatkowskis 39 years came from product tampering charges, not just diversion charges. If patients were harmed by your diversion – through infection, through recieving saline instead of medication, through being treated by an impaired provider – the charges will reflect that harm.

Third: Hospital organizational failures may be investigated alongside your case. The DEA now targets facilities as well as individuals. Your employer has incentive to cooperate with investigators and may provide information that strengthens the case against you. The facility that enabled your diversion may protect itself by helping prosecute you.

Fourth: The traveling healthcare worker model creates multi-jurisdictional exposure. If you diverted at multiple facilities, you may face investigation in multiple jurisdictions. Each facility becomes a seperate set of allegations. The pattern across facilities becomes evidence of ongoing criminal activity rather then isolated incidents.

Fifth: Relapse risk affects sentencing and career prospects. Even if you avoid prosecution and complete treatment, the 43% relapse rate means ongoing restrictions and monitoring. Many facilities wont employ recovered addicts in anesthesia positions. Your career in the specialty may be over regardless of legal outcomes.

Sixth: Get counsel immediately upon any investigation contact. By the time anesthesiologists learn there under investigation, evidence has typically been gathered for weeks or months. The discrepancies have been documented. The pattern has been established. Legal strategy implemented early can shape wheather your facing Kwiatkowskis 39 years or a treatment-focused resolution that preserves some career options.

Thats the reality of DEA defense for anesthesiologists. A specialty with 3X the addiction rate of other physician specialties. Were the very access that makes you effective enables the addiction that destroys careers. Were diversion that begins as personal use can result in patient deaths and 39-year sentences. And were the system failures that enable diversion – hospital liability concerns, traveling worker mobility, inadequate tracking – dont protect you when prosecution comes. What protects you isnt assuming that medical credentials insulate you from drug trafficking consequences. What protects you is understanding that the DEA treats anesthesia diversion like any other controlled substance crime – and that patient harm transforms diversion into charges that carry decades in federal prison.

The anesthesiologists who navigated investigations successfuly werent necessarly those who diverted less. They were those who understood the legal landscape early, who engaged counsel before making statements that could be used against them, who recognized that addiction is a disease but diversion is a crime – and that the distinction matters enormusly when federal prosecutors are involved. The difference between treatment and prison often comes down to how the case is handled in its earliest stages, before patterns are characterized and before cooperation becomes self-incrimination. The four-month detection window means time is already short. Legal response must be immediate. Waiting eventualy becomes the decision that transforms a potentially manageable situation into federal prosecution.