Last week Michael Swango confessed in New York federal court to a killing spree that spanned his career as a physician. He admitted to four murders and four attempted murders, pleaded guilty to five felonies and was sentenced to life in prison without possibility of parole.

Scores of suspicious deaths of his patients remain officially unresolved. No mercy killings these. Prosecutors introduced chilling evidence of the former doctor's state of mind: notebook entries in Swango's handwriting such as "I love it: the sweet, close, husky smell of indoor homicide."

Sobbing relatives of Swango's victims spoke of their grief and anger--and not just at Swango, who seemed unmoved and offered no apologies or regrets. Nearly all of the survivors mentioned their outrage at a medical profession and hospital system that let a Swango continue to practice--even after he was investigated for murder at the Ohio State Hospitals in 1984 and was convicted of poisoning coworkers at a hospital in Illinois in 1985, eight years before his murders in New York.

Medical school residency programs hired Swango after he told them he was a convicted felon. After concluding their murder investigation and dismissing him from their program, doctors at Ohio State wrote glowing reviews on his behalf.

Swango's medical career continued in Illinois, in Virginia, in South Dakota, in New York and finally in the African nation of Zimbabwe. He was en route to yet another job, this time at a hospital in Saudi Arabia, when he was arrested at O'Hare airport in 1997.

After Swango's past was discovered, usually by local media, and Swango was hurriedly dismissed amid public outcries, hospitals conducted failed internal investigations and rushed to reassure the public. The Veterans Hopsital at Northport, Long Island, announced in 1993, one week after Swango was dismissed,, that had been "no suspicious illnesses or deaths" there. This is the same hospital where Swango has now confessed to murdering three patients and sending another into a coma.

Perhaps the most egregious behavior by doctors and hospital officials was at Ohio State, which officially exonerated Swango and wrote into one of his victims' medical records that she was "paranoid" for claiming a doctor had tried to kill her. She miraculously survived, and Swango has now admitted injecting a paralyzing drug into her IV line.

Swango has also confessed to murdering a 19-year-old gymnast who was a patient at Ohio State, and will plead guilty to murder in Ohio later this month. Yet police say Ohio State was not cooperative with their investigation.

There is no simple explanation of how a Swango could have gotten away with so sinister a career for so long. Fear of litigation, scandal and potential liability often seemed more important to other doctors and hospital officials than patient safety. The fraternity of doctors often rallied around Swango, forming a "white wall of silence" that makes the police "blue wall" seem porous by comparison.

The culture of the medical profession will not change because of one case. But remedies to protect the public seem relatively simple.

The National Practitioner Data Bank was established during the Reagan administration to monitor incompetent physicians and prevent them from being hired. Unfortunately, it has been an abject failure, as the Swango case makes clear. As best I can tell (with minor exceptions, the data bank is accessible only to other doctors and hospital officials), Swango's name never appeared in the data bank.

According to a Department of Health and Human Services report, 75 percent of all hospitals in the United States never have reported an adverse action against any physician, as mandated by law. This is hardly surprising, since the law contains no meaningful penalty for failure to comply and has been met with unrelenting hostility from organized medicine.

Opening the data bank to public scrutiny, increasing penalties for noncompliance and expanding the scope of its coverage to include information about criminal convictions would go far to restore the trust patients should be able to have in their doctors.

I have tremendous admiration for doctors and other members of the health care professions, and I have heard from many who genuinely care about patient welfare, security and trust. They are as baffled as I am by organized medicine's opposition.

On Thursday, Rep. Thomas J. Bliley Jr. (R-Va.), chairman of the House Commerce Committee, introduced a bill called "the patient protection act" to reform the data bank by making its information available to the public and by expanding its coverage to include felony convictions. Hearings are scheduled for the week of Sept. 18. I hope it will attract wide bipartisan support.

Swango, as a doctor and suspected serial killer, is obviously an extreme aberration. But data show that serial killings in general, and in hospitals in particular, have increased exponentially in this country since 1970. This isn't a time for finger-pointing, but for taking the steps necessary to make certain that future Swangos never find their way into the nation's hospitals.

The writer is author of "Blind Eye: The Terrifying Story of a Doctor Who Got Away with Murder."