Poisoning is the most intelligent -- as well as the most cowardly -- form of murder, because it's nearly impossible to prove. That helps explain the FBI's troubles in the notorious case of Michael Swango, who is suspected of having fatally poisoned some 60 people between 1984 and 1997 as an intern or resident at a number of hospitals and health-care establishments. In "Blind Eye," journalist James B. Stewart ("Blood Sport," "Den of Thieves") painstakingly recounts Swango's life and crimes in a clipped, matter-of-fact tone. Stewart discovers signs of psychosis (e.g., notebooks with newspaper clippings about train wrecks and car crashes) in Swango's childhood in Quincy, Ill., and traces the way they blossomed into an avocation.
Swango's poisonous ways began at the Ohio State University Hospitals in Columbus. Three witnesses saw the young intern inject a substance into a patient's IV moments before she suffered a life-threatening seizure. Swango gave conflicting accounts of the incident, but the senior doctor assigned to investigate took his word over that of the witnesses (none of whom were doctors), and the hospital dropped the matter. After completing his internship, Swango spent the summer of 1984 in Quincy working at an EMF unit, where he often bought doughnuts and drinks for his co-workers. When a number of paramedics came down with violent flu-like symptoms, they had a glass of iced tea tested; it contained arsenic. The evidence was strong enough to convict Swango of battery.
After his release from jail in August 1987, his life became curiously repetitive: He'd secure a residency by falsifying records; mysterious deaths that were circumstantially traceable to him would follow; hospital officials would become concerned but do little; they'd learn about his past, usually through the media, and revoke his privileges; and Swango would find another hospital willing to hire him. This pattern held even after an FBI investigation forced him to seek work at a clinic in Zimbabwe. En route to a job in Saudi Arabia in June 1997, he was finally arrested, not for murder but for fraud. He was sentenced to 42 months in prison and could be freed as soon as next July. His story still has, as Hugh Downs put it in a 1986 "20/20" segment, "an ending that leaves room for a sequel."
It's a credit to the grace and authority of Stewart's writing that despite Swango's never having been convicted of murder, the reader does not question his capacity to kill. Stewart lays the blame for Swango's success at getting job after job on the medical peer-review process, which accepts only the judgment of experts -- i.e., other doctors -- as to whether a practitioner is guilty of malpractice or, in this case, malevolence. The notion is fatally undermined, he argues, by the siege mentality that rising numbers of malpractice suits have brought on: "The loyalty among physicians makes police officers' famous 'blue wall of silence' seem porous by comparison." He also excoriates the American Medical Association for opposing the National Practitioner Data Bank, a federal clearinghouse for information on disciplinary actions against doctors.
But he doesn't go far enough in condemning the medical fraternity. The fact that this clubbiness begins in medical schools deserves more than the passing mention it gets. And while Stewart notes that most of the hospitals where Swango worked were not legally obligated either to check with the Data Bank or to report him (because of his status as an intern), he says nothing about the dubious wisdom of letting doctors whose training wheels have yet to come off act as primary caregivers to large numbers of patients.
His examination of Swango's psyche is meticulous and convincing. But when it comes to creating a more general picture of serial killers, he's stymied, relying on Freudian psychopathology theories that, as he admits, haven't proved useful in treatment. Though he mentions that fully half of this country's serial and mass killings have occurred since 1970, the possibilities that the rise of popular culture or newer psychological theories might help explain the psychopathic mind never appear in the book. Which is a shame, really, since "Blind Eye" might have been more than a simple -- if artfully executed -- true-crime story with voyeuristic thrills and easy outrage. It was a timely opportunity to understand a horrifying and increasingly large part of our shared experience.