How the Medical Establishment Let a Doctor Get Away with Murder

By James B. Stewart

Simon and Schuster. 334 pp. $25

Reviewed by Abraham Verghese

Books about murderers are always of interest, perhaps because we subconsciously recognize that the kernel for such evil lies dormant in many a heart. If there is anything reassuring about James B. Stewart's gripping new book, it is that only a psychopath will identify with Michael Swango, the killer he describes. Psychopaths are narcissistic, antisocial persons who lack a capacity for empathy, who can carry out criminal, perverted or amoral behavior while being fully aware of the consequences, and perfectly able to distinguish right from wrong.

Stewart, who in his book Den of Thieves told the story of Michael Milken and Ivan Boesky, turns his attention in Blind Eye to Michael Swango, doctor, poisoner and possibly the most successful serial killer in modern times. What makes this tale so chilling is that Swango is due to be released in July of 2000, sooner if he demonstrates "good behavior." And, if past experience is any guide, this superficially charming fellow with the All-American looks will resume the practice of medicine and his specialty of poisoning people.

Swango got off to an auspicious start: He was a National Merit Scholar finalist and valedictorian in high school. After a stint in the Marines, he entered medical school, where his classmates saw him as a bumbling, weird but viciously competitive student. Concerns that he was fabricating his histories and physicals without examining the patients delayed his graduation by a year.

Somehow he landed a prestigious neurosurgical residency at Ohio State University, but it was soon clear that he was ill-suited to that specialty. His fascination with Nazis and the Holocaust did not endear him to anyone. It was at OSU that a nurse noted the death of a patient shortly after Swango had been in the room, ostensibly trying to clear an intravenous line. The next day he was seen to be fiddling with the intravenous tubing of an elderly lady. When he left, the patient's roommate noticed that she had turned blue and summoned help. The patient survived. Swango denied being in the room. It is at this point in the story that we encounter the strange reluctance of the medical establishment to stop Swango -- the blind eye.

The nurses took the problem to the hospital and university top brass. After a cursory investigation that simply cast doubt on the nurses' story, it was concluded that nothing was awry. However OSU did not renew Swango's contract. Still, several OSU doctors wrote him letters of recommendation in his application for an Ohio license.

Swango went to work as a medic with an ambulance crew in his hometown of Quincy. His coworkers there often became violently ill, and when a sample of tea that Swango had tampered with was found to contain heavy metals, he was arrested. His apartment turned out to contain an arsenal of poisons. Back at OSU, a new internal investigation chaired by a law professor chastised the medical school for not acting on "facts which should have signaled the need for a more thorough inquiry. . . .There were numerous witnesses who were never interviewed. . . . We still find it astounding that no permanent record was kept detailing the occurrence . . ." At the criminal trial Swango was found guilty and given five years. The judge said, "It's clearly obvious to me that every man, woman and child in this community or anywhere else that you might go is in jeopardy as long as you are a free person."

But free Swango was by 1987. He wangled a residency in internal medicine at the University of South Dakota in 1992, by misstating the nature of his crime in Illinois and because inquiries with the licensing authorities of Ohio and Illinois revealed only that his license had been suspended for "disciplinary" reasons. Swango's stint at South Dakota ended when "The Justice Files" aired a segment on him. Incredibly, by 1993 he was a resident in psychiatry at the State University of New York at Stony Brook. Once again, he misrepresented his past, and inquiries with OSU made no mention of his now notorious history in Ohio. Patients at the Northport VA hospital under his care began to die unexpectedly. Just when his superiors got wind of his past, so did the Long Island tabloid Newsday, which put him on its front page. Swango, facing fraud charges for deceiving the VA, fled to a mission hospital in Zimbabwe, where many more deaths ensued. Facing the likelihood of arrest, he found a job as a physician in Saudi Arabia but had to return to America for a visa. When he landed in Chicago in June of 1997, he was arrested. By this time the FBI suspected him in at least 60 murders, in addition to numerous instances of non-fatal poisonings. He pleaded guilty to the fraud charges and was sentenced to 42 months. The FBI has exhumed bodies, but much of the evidence is cold, and it is entirely possible that Swango will soon be a free man.

Blind Eye is a true thriller, but it is also an indictment of protectionism within the medical profession. Despite the existence of a data bank on incompetent physicians to which hospitals are supposed to report and to check with prior to hiring, a study by the Department of Health and Human Services revealed that compliance with this requirement is poor. The American Medical Association, Stewart tells us, when "offered an opportunity to comment on the HHS study, attacked the methodology and the conclusions and continued to wage its rearguard action against any federal monitoring or reporting on incompetent or criminal physicians." If physicians cannot or will not police themselves, it seems certain that the public will take on that role, subjecting doctors to close scrutiny, and perhaps creating their own data bank. The elderly lady in Ohio whose attempted poisoning first brought Swango to the attention of his peers settled her suit against OSU hospital for a paltry $8,500. She expressed the public's sentiment well in a letter to the courts: "I did not know that life was so cheap in the eyes of some people."

Abraham Verghese, a professor of medicine at Texas Tech University, is the author of "The Tennis Partner: A Story of Friendship" and "My Own Country: A Doctor's Story."