Blind Eye: How the Medical Establishment Let a Doctor Get Away with Murder James B Stewart, Simon and Schuster, $17.50, pp 334 There is ample precedent for physicians flouting the Hippocratic admonition, “First, do no harm,” and, directly or indirectly, accounting for multiple deaths. Dr Joseph Mengele's handiwork has been much documented; more vicariously, Dr Joseph Guillotin's invention did away with a fair number of folk, as did Dr Richard Gatling's gun, which fired 350 shots a minute.
But Dr Michael Swango, the subject of this meticulously researched and highly readable book, was a fully fledged psychopath who killed for the sheer thrill of it. And even though as many as 60 fatal poisonings could be attributed to him, his charm and glib persuasiveness allowed him to move on with impunity from one medical institution to another. As a medical student at Southern Illinois University, he became known as “Double-0 Swango, licensed to kill” after 5 patients under his care died mysteriously.
At each hospital, the huge cloud of suspicion that enveloped Swango was wafted away by physicians and administrators fearful of litigation and sullied reputations. Even today, he's serving a jail term not for murder but for possession of narcotics and fraud and could be at large again soon.
That a blind eye could have been turned to Swango's persona and record is remarkable and somewhat chilling. He was fascinated by Nazism, the Holocaust, and serial and mass killers such as Jim Jones, the charismatic leader of the People's Temple, whose thousand-odd followers he persuaded to commit mass suicide in 1978. Swango kept a scrapbook of pictures of gory car crashes and collected an arsenal of weapons and an assortment of poisons in his apartments.
The cover up was worst at Ohio State University, the prestigious medical school where Swango was admitted to an internship. Despite a number of suspicious deaths reported by nurses who had seen Swango enter the patients' rooms with a syringe, the administration dismissed the concerns as gossip and overreaction. Fearful of the public relations damage and possible loss of funding, they closed ranks and later refused any cooperation with Pulitzer Prize winning author Stewart. In 1986, Swango's license to practice medicine was suspended when he went to prison for attempting to poison his coworkers, yet when he was released in 1987, he was able to enter a residency in internal medicine in South Dakota. Even though his past caught up with him there, he went on to secure a psychiatric residency in New York state, before fleeing to Zimbabwe, where he was again suspected of poisoning patients and again dismissed. Incredibly, he moved on to practice in Zambia, where he was suspected and fired once again.
Stewart's is a cautionary tale calling for urgent and stringent legislation and improved reporting mechanisms so that checks on rogue physicians won't continue to be thwarted by fear of litigation and bad press, and by a closing of ranks and a suspension of belief by fellow doctors.
This article was originally published in the BMJ 2000;320:809