A national problem
"This is a huge issue for the nation," says Jose Montero, MD, director of the New Hampshire Division of Public HealthServices who leads his agency's investigation of Exeter Hospital, where Kwiatkowski worked for more than a year. Montero has been looking into the mess for three months so far, and officials from the Centers for Medicare & Medicaid Services and several other federal agencies are investigating as well.
That there is no national requirement that all hospitals and states must report such individuals makes Montero so angry, he pauses the interview to apologize, "for getting on a soapbox." Instead of a uniform registry, there's a patchwork of state-by-state autonomy, he says.
"Each state has the capability to determine a lot of things that impact the population of that state," he continues. "But we are missing the point. Having different requirements for licensing in different states is too haphazard.
"When you look at the affidavits and the criminal information that has been disclosed out there, and how he was able to move from state to state...this just shouldn't have happened."
On July 19, the New Hampshire U.S. Attorney's Office charged Kwiatkowski with fraud and drug diversion related to the theft of syringes filled with the anesthesia drug fentanyl intended for cardiac catheterization patients and injecting them in himself. According to the indictment, Kwiatkowski would then replace "the drug in the syringe with another liquid (such as saline), which is then injected into the patient."