Officials with Maryland's Department of Health and Mental Hygiene have launched a sweeping review of procedures and protocols in the state for licensing radiographers like Kwiatkowski and for overseeing staffing agencies that place traveling technicians in area hospitals. It is also reviewing aspects of the medical system that could allow practitioners with drug abuse issues to go unnoticed.

"We have a review team that is looking into vulnerabilities that are related to the situation," said Dr. Lucy Wilson, the agency's chief of surveillance, infection prevention and outbreak response.

Currently, the agency's Office of Health Care Quality regulates temporary agency placements of nurses but not placements of technicians like Kwiatkowski, officials said. Accredited hospitals have hiring standards and contracts with staffing agencies that require certain employee background reviews, but those reviews might not catch every red flag about a practicing technician in other states.

The Maryland Board of Physicians requires radiographers to be licensed — Kwiatkowski held a license for most of his time in Maryland — but does not require "medical technicians" to be licensed, said Carole Catalfo, the board's executive director.

Some states require neither radiographers nor technicians to be licensed, and the work history of such medical employees, especially those who move from state to state, is much more difficult to vet, Catalfo said.

A full report from the state health department review team is expected to be completed, with recommendations for reforms, by early next year. The department's epidemiological staff is reviewing and monitoring the testing of patients exposed to Kwiatkowski in Maryland.

"That's sort of a lengthy process and it involves samples going down to the Centers for Disease Control for testing, and so far there are no results," Wilson said.

There is also little information available about Kwiatkowski. Who he is — and how he was able to secure placements in so many hospitals despite his alleged drug addiction — is unclear.

David Matthew Kwiatkowski was raised in Michigan. He was admitted to Madonna University, a Catholic university in Livonia, Mich., in 1998 and graduated in 2005 with a bachelor of science degree in allied health administration, according to a school spokeswoman. He then began taking on temporary technician jobs.

According to federal court documents, he would enter secured surgical labs and steal syringes full of fentanyl after they had been removed by nurses from locked compartments before surgeries.

At times, he would do so despite not being properly "scrubbed in" and not being on the team scheduled to perform the surgery, the documents say. He likely replaced the needles with syringes he had previously used and refilled with saline, the documents say.

The continuing investigation has sparked a number of lawsuits related to Kwiatkowski and the hospitals where he worked. In one, an infected patient in Kansas alleges that Kwiatkowski was caught stealing drugs at UPMC Presbyterian in Pittsburgh, but the issue was not reported to authorities by the hospital or by Maxim Staffing Solutions Inc., the Columbia, Md.-based staffing agency that placed him. A second, class-action lawsuit has been filed as well.

Officials with UPMC did not return multiple requests for comment. Heather Chilcot, Maxim's director of strategic communications, said the agency is taking the cases seriously but could not comment on ongoing investigations.

Kwiatkowski's federally appointed attorneys, Bjorn Lange and Jonathan Saxe, said they and Kwiatkowski would not be available to comment to the news media "now or in the near future."

Kwiatkowski is being held as prosecutors and his attorneys continue investigations into his actions over the past few years, according to federal documents.

By the time he was found at the hotel outside Boston, he had already been interviewed by federal investigators, and allegedly told them he'd "lied to a lot of people" and "fabricated [his] life," court documents say. His parents, back home in Michigan, had told investigators they were unaware of any illegal drug use by their son, but that he had "issues with alcohol, anger and depression."

Questioned by the same investigators about dozens of patients infected with hepatitis C at Exeter Hospital, Kwiatkowski allegedly responded, "You know, I'm more concerned about myself, my own well-being."

Six days after the hotel incident, on July 19, he was arrested on federal charges of "acquiring a controlled substance by misrepresentation, fraud, forgery, deception or subterfuge" and of tampering with a consumer product with "reckless disregard for the risk that another person will be placed in danger of death or bodily injury."

The affidavit filed in the case by DiFede, the FBI agent, recounts conversations investigators had with Kwiatkowski's former co-workers, including those at the cardiac catheterization lab at Exeter. They described how Kwiatkowski might have been able to steal, use and replace needles that were then reused on patients.

In the Exeter lab, controlled substances, including vials of fentanyl, are kept in what is known as a Pyxis machine, which scans fingerprints and dispenses drugs to authorized personnel only. Kwiatkowski was not authorized to access the medications.