Blind eye: how the medical establishment let a doctor get away with murder

I wonder how many of us even know of Michael Swango, MD. Or, for that matter, have we heard of Dr Harold Shipman or of Gerald Barnbaum? Even though this is not a new book, I suggest it makes for great reading, both as a thriller based on a true story and even moreso as a scathing indictment of medicine and the processes we are all involved in. The mishaps, reluctance to tell on a colleague, the ignoring of suspicious behavior, all tell a humbling, suspenseful, but not altogether rare story of how a serial murderer who also happens to be a doctor can get away, literally, with murder. In his book, Stewart does a masterful job of detailing the life of Swango from his days as an eccentric medical student at the Southern Illinois University School of Medicine in the early ‘80s, where he is alleged to have earned the nickname of “Double-O Swango (Licensed to Kill)” after he happened to be conveniently close to several elderly patients who mysteriously succumbed despite being on the road to recovery. Although rumors flew, nothing more was done. This then led to stints as a resident in multiple specialties in Ohio, New York, and South Dakota with unusual deaths among his patients. It is significant that despite clear suspicions, investigations went nowhere because it was considered inconceivable that a physician could deliberately kill. In particular, suspicions raised by nonphysician personnel such as a student nurse received superficial review because, I suspect in part, it came from a nonphysician. His habit of moving around in different specialties always followed by stories of premature deaths raised no suspicions among those who hired him in subsequent residencies, a searing indictment of the credentialling system in many of our prestigious hospitals. When Swango deemed it appropriate to leave the United States because of increasing questions, he settled in Zimbabwe and continued his swath of death, culminating in an allegation of close to 40 murders in almost 20 years. What went wrong? To start with, Swango had charisma and charm and was able to smoothly talk his way out of situations. His case is a particularly egregious example of what happens when we ignore suspicious behavior. The medical administrators who hired or investigated him displayed incredible naivete, were quick to close ranks and jump to conclusions exonerating Swango, performed incredibly superficial investigations, and in general came very close to obstruction of justice in the Ohio University case, where Swango was quickly cleared and passed on to other institutions. It is of interest that many of those involved remain at the pinnacle of American medicine. This lack of a systematic process to investigate and an unseemly haste to direct him elsewhere does not enhance the reputation of medicine. One does need to be fully aware of the potential for abuse, particularly if accusations are inaccurate, but the lack of a suitable system to check Swango’s continued ability to practice is what draws attention to us from legislatures nationwide. Swango was imprisoned for an earlier attempt to poison fellow paramedics and was subsequently, after his return to the US, sentenced to prison for fraud—gaining admission to a residency under false pretenses—and upon release in July 2000 pleaded guilty to murder and is currently safely in federal prison. One needs to read this fascinating book to discover all the multiple clues strewn throughout his life. One episode in particular stands out: Upon seeing a TV story of a security guard killing 21 people in a 334 p. New York, Simon and Schuster, 1999 ISBN: 0-6848-5484-8