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Hospitals and the staffing agencies that routinely help them fill jobs are supposed to share responsibility for verifying that workers have proper licensing and good reputations. But four of the states where Kwiatkowski worked over the full course of his career _ New Hampshire, Georgia, Pennsylvania and Michigan _ don’t even license radiology workers.

The institutions that allowed Kwiatkowski to keep working offered a variety of excuses and explanations as to how he slipped by various background checks and managed to get licensed in other states.

University of Pittsburgh Medical Center spokeswoman Gloria Kreps said that when he was accused of stealing fentanyl, officials did not contact police because they did not believe they had enough evidence. “We noticed unusual behavior, caught him with a syringe, but did not witness him in the act of committing a crime,” she said.

They didn’t alert the national credentialing organization, she said, because they felt that was the responsibility of Maxim Staffing Solutions, the agency that had placed him. Officials at the staffing agency’s parent company did not return calls for comment.

Matt Price, chief executive of Advantage RN, the staffing agency that got Kwiatkowski the position in Philadelphia, said his stint in Phoenix was so short that it was easy for him to hide that he ever worked there.

And because of the need to find strike-replacement workers fast, Temple asked the company to verify only the last two jobs held by each applicant. So even though Kwiatkowski listed his Pittsburgh job on his resume, no one called the hospital for a reference.

In Kansas, which in 2010 became the last state to license Kwiatkowski, the Board of Healing Arts verified his education, national certification and other state licenses, but not his work history, said the agency’s lawyer, Kelli Stevens.

In the section of his application detailing previous jobs, he left out nine hospitals, including the two that fired him for suspected drug abuse. He answered “no” to a long list of questions about misconduct, saying he had never been disciplined or used illegal drugs.

He also asked the state to waive its requirement that he send a photocopy of his American Registry of Radiologic Technologists identification card. He claimed that his wallet had recently been stolen and complained in a rambling email about having trouble getting a school he attended to send proof of his degree.

Cook, the spokesman for the American Registry of Radiologic Technologists, said Kwiatkowski’s case underscores the need for a national database of disciplinary actions.

The agency has about 315,000 technicians registered with it. It handles about 3,000 complaints per year. Last year, it issued 222 public sanctions for misconduct that ranged from criminal convictions to failure to follow professional standards.

“If ARRT had more access to information held by state agencies, employers and others, we believe this number would be higher,” Cook said.

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Things finally began to unravel for Kwiatkowski in New Hampshire, where a temporary stint at Exeter Hospital starting in April 2011 turned into a permanent job in a cardiac catheterization lab. A co-worker complained that she saw Kwiatkowski acting strangely and sweating, with bloodshot eyes. He was sent home after saying his aunt had died.

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