White Coats, Black Hat


How the Medical Establishment Let a Doctor Get Away With Murder

By James B. Stewart

Simon & Schuster 334pp $25

You've probably heard that the American Medical Assn. has recently been trying to form a union. Well, getting the public's sympathy for that may very well require buying up all available copies of James B. Stewart's new book, Blind Eye: How the Medical Establishment Let a Doctor Get Away With Murder, and locking them in a vault somewhere. After reading this volume, the last thing anybody would want to do is strengthen the bonds between doctors.

Blind Eye is a flat-out horrifying nonfiction profile of Michael Swango, a physician who Stewart says may well be the country's most prolific serial killer. He's currently in prison in the U.S., about a year into a 42-month sentence on the minor charge of providing false statements. But, says the author, an international scramble is under way to collect enough evidence to charge him with one or more of what the FBI believes may be at least 50 murders.

For nearly 20 years, Swango worked both as a paramedic and as a fully privileged physician in several U.S. states and in Africa. Wherever he went, Stewart charges, patients soon started dying inexplicably, often minutes after he left their rooms. The author accumulates evidence that Swango was a compulsive poisoner with little or no actual relationship with his victims and no apparent motive for doing them in.

That's bad enough. But even if this lack of motive helped Swango escape prosecution, plenty of clues seemed to suggest that he was a psychopath. His supervising physicians, the author suggests, were unwilling to face the facts.

Although a brilliant and outgoing honors student, Swango appeared to suffer a dramatic personality shift after a brief, mid-1970s stint in the Marine Corps. He obsessed openly about serial murDerers and violent death and assembled scrap books of horrible accidents. At Southern Illinois University School of Medicine, where he was admitted in 1979, his peers immediately found him strange and off-putting. They observed that he had a seeming contempt for patients, for their families, and for normal procedures. And, they said, many patients on whom he had just collected medical histories would suddenly become acutely ill and even die. This earned him the nickname "Double-O Swango," a play on James Bond's 007 designation. CollEagues joked that Swango seemed to have a "license to kill."

Swango narrowly escaped expulsion as a result of several procedural violations and other infractions, Stewart says. But soon the apparent pattern of deaths followed Swango to his residency at Ohio State University Medical Center. He was observed injecting something into a patient who immediately suffered paralysis and nearly died. But he was cleared in a cursory investigation in which Stewart says evidence was destroyed and patient testimony mischaracterized to squash the scandal.

Stewart displays the medical caste system at OSU and several other hospitals in stark relief: Physicians and hospital administrators repeatedly turned a deaf ear to the pleas and concerns of medical studEnts, nurses, patients, and paramedics who witnessed Swango's macabre behavior. The authorities were always inclined to write off the coNcerns as jealousy or unfounded gossip.

In 1985, after a team of paramedics showed that he was spiking their iced tea with arsenic, Swango was found guilty of five counts of aggravated battery and served two years of a five-year sentence. But for several years after his release, he got hospitals and ambulance companies to overlook his conviction and hire him. Eventually, Swango traveled to Africa to continue working with patients and to avoid mounting legal troubles. There, Stewart says, the killing continued.

Former Wall Street Journal editor and Pulitzer prize winner Stewart, Like Swango, is a native of Quincy, Ill. He never knew Swango but was alerted to the case and inspired to write about it by an old friend and local judge, Dennis Cashman, who had handled Swango's original poisoning trial in 1985. Cashman told Stewart: "There is an unwritten rule in the medical profession. Inept doctors do not get reported. Just get them out of town."

Stewart is an excellent writer and reporter. He employs court documents and hundreds of Interviews to meticulously document Swango's trail. Yet there are two shortcomings worth noting. Swango would not talk to Stewart--and that poses a problem: Swango's alleged motives remain a mystery, especially since Stewart never finds anyone to whom the doctor confessed.

Also, Stewart doesn't quite do justice to the larger issues. He discusses the flawed National Practitioner Data Bank, which is designed to prevent such characters as Swango from going undetected. But although he provides a few examples of other docs run amok, the extent of the problem of dangerous physicians isn't comprehensively considered or analyzed.

Still, this a brave and passionate book. Whether Swango is ever tried for murder, his poisoning conviction--not to mention the disturbing events that dogged his career--should have kept him from attending any more patient bedsides. Physicians may feel embattled on many fronts, but circling the wagons on matters of patient safety is intolerable.

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