A shot in the dark

Is a hospital the perfect place for a doctor to kill -- and kill again?

By Dawn MacKeen
September 2, 1999 8:00PM (UTC)
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A hospital is an enticing environment for a serial killer. Death and illness are rampant,
injections routine; and patients are alone in rooms with those
who may later determine their cause of death. When a doctor turns on his Hippocratic Oath and harms, rather than heals, the crime can be nearly impossible to detect.

Authorities fear that worst-case scenario may have come to pass in the case of a physician named Michael Swango, who they believe killed dozens of patients by
injection while working at hospitals in the United States
and abroad between 1984 and 1997. After being convicted of
non-fatally poisoning his co-workers with arsenic in 1985 and
serving two years in prison, he was able to continue getting
jobs as a doctor, even after disclosing his record.


Within the last six months the bodies of three former patients, from a Long Island veterans hospital where Swango last worked in the States, have been exhumed; tests are being performed on two others. The FBI has found chemicals in two of the bodies that can be fatal in large enough quantities. Although Swango is doing time at a federal prison in Oregon for misrepresenting himself to get the job in Long Island (saying his previous conviction was for a barroom brawl instead of poisoning), he has never been charged with murder. Swango is eligible for a halfway house in January and is scheduled for release next summer.

In "Blind Eye: How the Medical Establishment Let a Doctor Get Away With Murder," a new book chronicling Swango's alleged crime spree, author James B. Stewart, a Pulitzer Prize-winning regular contributor to the New Yorker, places the blame on the hospital system, and what he says is its tendency to look the other way when one of its own is doing wrong -- even when there are eyewitnesses. "Blind Eye" is a chilling indictment of the time-honored system of physicians policing physicians, and it's a call for sweeping changes to install more safeguards in the medical profession. Salon Health & Body spoke with Stewart about the Swango case, the difficulty in detecting poisons in a person's body after death and the ease with which a physician can take a life.

In your book, you write that the hospital is the ideal setting for a serial killer. Why is that so?


It's probably the one setting, outside of a war zone, you can think of where death is a routine occurrence. The mere fact that someone dies is not likely to set off the warning bells that death does in almost every other setting. So I think that's the fundamental reason.

For a doctor, how easy is it to take a life?

I think, fortunately, almost all doctors want to heal. But what's terrifying is that it's a situation that -- should you get the aberrational personality -- it's very, very easy.


How are the families of victims dealing? At the time, did they find the deaths suspicious?

I think they're extremely upset. Years have passed in some of these cases but this has opened old wounds -- suddenly beginning to think that your loved one was a murder victim, it's extremely upsetting.


Most of these were patients who were on the road to recovery, or were never that sick to begin with and then, boom, they, die but the hospital kept reassuring them, saying, "No, no, no, there's nothing to be concerned about."

Which incident in this book, in terms of a patient, haunts you the most?

Rena Cooper, the woman at Ohio State who nearly died. She underwent a life-threatening seizure and paralysis. There were three eyewitnesses -- herself, her roommate and a student nurse who was in the room at the time. It wasn't enough for her to nearly die, but then they had to slander her on her patient record, suggesting that she had been paranoid because she thought a doctor tried to harm her. She eventually sued the hospital and because she really couldn't prove anything, she settled the case for $8,500.


Speaking of being liable, is that something hospitals are very afraid of, especially in the current legal climate?

Hospitals are terrified of liability. So when someone dies or when some other horrible thing happens to a patient, their first instinct is "How can we limit the damage to us?" That attitude makes the hospitals the almost unwitting collaborators with anybody who is committing a crime in a hospital, or in this case, Swango. Again, Ohio State is the most glaring example. They did this so-called internal investigation, which exonerated Swango, but guess what? It exonerated them too. They didn't then have to worry about patients suing them.

Are hospitals too concerned about the bottom line?


One of the things that shocked me is that in a series of meetings that were held at Ohio State to figure out what to do about these mysterious deaths, and in these long conversations, no one ever brought up the patients. I wonder if, at times, the patients are like commodities, moving through like a conveyor belt; maybe in the world of hospitals you become so inured to human suffering that you hardly notice the patients, but oh my God, the hierarchy of the hospital, its reputation and ability to get grants, that's all interesting. And the only time that patients really got talked about was when they were trying to keep the police out. [The hospital's staff] were saying we can't have that -- the patients are going to get upset if police are in here, but somehow the idea that a madman who is a physician roaming in there is OK.

How did Swango go about continually eluding his past, and finding jobs as a physician? Was it the fault of the system, or is he just a really smart, cunning man?

It's a combination of both. Everybody who knows him says that he is cunning, charming, smart, attractive, earnest -- fill in the adjective -- but the plain fact is that he was applying to hospitals for jobs as a physician when he was a convicted felon, and not just for tax fraud, but for poisoning co-workers in Illinois, and no one hiring him called the judicial authorities. I find that completely flabbergasting.

I know a lot of these incidents happened before 1990, when the National Practitioner Data Bank, which collects information on incompetent doctors, went into effect. But even after that, he was able to elude his past. Is the data bank now in the position to stop another doctor from doing something like this?


It went into effect while he was in jail, after poisoning people. So you would have thought if it ever was going to work, it should have kicked in when he started applying to hospital jobs. I think it is ineffective. And it is not in a position to stop another Swango.

The main problem with the [National Practitioner Data Bank] is that people are not obeying the law. Doctors and hospitals are not reporting people to the data bank and they are not checking with the data bank before hiring doctors as the law requires.

Why do you think this is happening?

First, there's no meaningful penalty for violating the law. Secondly, there are so many loopholes in this legislation as to who doesn't have to be reported, like interns or residents. Anybody who has ever been in the hospital knows that most of your time with a doctor is spent with an intern or resident. Now, they should be reported to the data bank the same way that any other physician is. Those two things, which are quite simple, would pretty much cure the problem.


As it is now, the only thing that is required to go into the data bank is if other doctors take disciplinary action against a physician. So in other words, in the case of Dr. Swango, if he is tried in a court of law and convicted of poisoning, that doesn't have to go into the data bank because those are not doctors who found him guilty. And I feel that any crime, any judgment against a doctor, should be lodged in the data bank. And then finally, open it to the public.

I also think the National Practitioners Data Bank should be open to foreign health services -- there ought to be some channels for foreign ministries of health to go through when asked to license a foreign physician

In your book, you wrote about the pitfalls of peer review process -- of doctors policing other doctors. Is that still happening, or has it changed?

Let me put it this way: I stumbled on this police investigation that was going on in the Ohio State hospitals related to some type of loan-sharking; it had nothing to do with medical care. They installed these hidden cameras in the hospital, and guess what the hidden cameras found? Doctors stealing drugs from the drug cart, substituting placebos for the patients, injecting themselves with narcotic drugs right there in the hospital, being completely intoxicated and heading off to surgery. So when the police saw this, they took the footage to the lawyer who was overseeing the hospital and guess what? The undercover operation got shut down, and the police were not allowed to report any of this for possible criminal prosecution. Instead, the hospital decided that the people on the tape would be encouraged to find counseling. I can't say that's the whole entire American hospital system, but this is a prestigious, highly regarded hospital. I suspect similar things go on everywhere. The peer review process is not working.


Do you think there are more Swangos?

Swango is an extreme psychopath; I think there's only one other physician serial killer who has cropped up this century. So we're talking about something that is extremely aberrational and rare. By no means am I saying that the medical profession is rife with murderers who are killing people instead of healing them, deliberately. The problems that I'm talking about in the data bank are probably dealing with issues of psychological impairment because of drug or alcoholic addiction, or other kinds of incompetence. It takes an extreme case to show how ineffective the data bank is because if it's not stopping someone like him, then who would it stop?

Also, the number of serial killers in America has skyrocketed since 1970 and the incidence in hospitals, based on anecdotal evidence, has also gone up dramatically. And the man who is now believed to be the most prolific serial killer this century, Donald Harvey, was a nurse's aide in Cincinnati. At the time he was arrested, he was suspected of a single murder. And then he confessed to 52; he got away with 51 and nobody was even suspicious, he did give some interviews and said it was just amazingly easy for him to commit murder in the hospital.

What do you think is one of the main things seemingly driving Swango?

Swango himself has never allowed himself to be examined by a psychiatrist. But all the clinical psychologists and psychiatrists I spoke to say he seems like almost a textbook case of a psychopath and, in the subcategory, an extreme narcissist. The father was largely absent, spending most of Michael's youth in Vietnam; and the mother doted on him. Plenty of people grow up in these circumstances and don't turn out to be serial killers, or criminals, but that family pattern is quite common to the handful of serial killers who have been examined and analyzed.

Was his going to medical school premeditated?

I think so, because his fascination with violent death predated his going to medical school. He went through an abrupt personality change in the middle of his college years. He had been a very talented musician, but in college, he was obsessed with accidents of all kinds. He found work as a paramedic, and would show up at car wrecks even when he wasn't on duty. He'd get incredibly excited over things like the McDonald's massacre; he said his fantasy was to witness an accident where a school bus collided with a tanker trailer and it exploded and the children's bodies would be hurled onto a barbed wire fence.

What was amazing was how many times in your book you document him saying these things to people. It's incredible that this didn't incite ordinary people, like his co-workers -- never mind the hospital -- to say, this guy might be really unstable, maybe we should bring it to someone's attention.

Yes, I totally agree. Now, people told me in these emergency settings that comments do get pretty raw and people develop a somewhat macabre sense of humor. But I can't believe that this was in the realm of things that people just are routinely saying in there. If so, then I'm even more worried about the hospital system than I would have been otherwise.

Describe some of the problems with investigating whether the patients under his care died from his hand or from natural causes. You write about how difficult it is to detect some poisons.

One of those substances that has been linked to Swango is a muscle relaxant called Anectine, which, when injected directly into an intravenous tube or into a patient, can cause seizure, paralysis and death -- and it leaves no identifiable trace. Another poison that was a particular fascination to Swango is called ricin, a derivative of the castor bean. Then there is the category of substances that kill if injected directly in sufficient quantities. Salt potassium, which is routinely found in the body, is an example of that, and completely fatal if injected directly.

Then there are substances that kill and do leave identifiable remains, like arsenic and nicotine, which Swango has been linked to. One very interesting thing is Swango obviously knows his poisons -- and knows what is not detectable -- and yet, he tended to use arsenic, which just about stays in your hair forever; nicotine also lingers in the body. So why would he use poisons that could be identified? A big part of his motivation is getting away with something incredibly daring and the thrill is probably greater to him if he goes right up to the edge and uses something that might be detectable and gets away with it.

I thought it was interesting that there were 16 people, according to your book, whom he poisoned, but didn't kill.

The poisonings do have some identifiable motive. In the case of the paramedics he poisoned, they had been teasing him; with his landlady and his girlfriends, they had in a couple of cases expressed some doubt about his innocence. His reaction was to poison, not fatally, but just to make them violently sick.

The interesting thing is the motives for what appeared to be the murders, he seemed to have chosen those victims at random.

Is there any possibility that he might not be guilty? He hasn't even been
charged yet, let alone convicted.

I went into this project with what I thought was an open mind; I thought
perhaps this is a bizarre, strange series of incidences. I personally became
convinced of his guilt when I was in Africa. There, I heard the same
stories except for a different time and place that I had heard in Ohio.
There were two victims there who nearly died but survived and they told the
same stories as Rena Cooper, the victim in Ohio who nearly died.
There's no way they could have colluded these stories; they didn't know
each other. I think the circumstantial evidence is extremely strong. In
any trial he is entitled to presumption of innocence, but that's a legal
requirement; I, or anyone else for that matter, am free to form my own
opinion based on the evidence I've uncovered and I do believe that he is
guilty, but I did not think that when I started my research.

Do you think that with your book, people are going to start reevaluating the whole data bank and close the loopholes?

I hope so; I can't imagine a story that would more vividly reveal what needs to be done than this. I passionately hope that it will lead to some reform in Washington. I would love to see the medical profession support me on this and get on what is the right side of this issue, and recognize that there's got to be a little more protection and regulation.

Dawn MacKeen

Dawn MacKeen is a former senior writer for Salon, and author of a forthcoming book about her grandfather’s survival of the Armenian Genocide, "The Hundred-Year Walk: An Armenian Odyssey" (Houghton Mifflin Harcourt, January 2016).

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