Book Review

Blind Eye: How the medical establishment let a doctor get away with murder

N Engl J Med 2000; 342:1057April 6, 2000

Article

Blind Eye: How the medical establishment let a doctor get away with murder
By James B. Stewart. 334 pp., illustrated. New York, Simon & Schuster, 1999. $25. ISBN: 0-684-85484-8

In Blind Eye, a book that lays the foundation for an indictment against medicine, James B. Stewart, the recipient of a 1988 Pulitzer prize for his reporting on the stock-market crash and insider trading, has assembled the known facts of Dr. Michael Swango's 14-year career (1983–1997) as a suspected medical serial killer. Swango is referred to as a suspected serial killer because he has never been convicted of murder and is currently in federal prison for committing fraud in his applications to work as a physician.

The facts are these: Swango came from an unloving home dominated by a tyrannical, cruel, and often absent father and a loving but inadequate and frustrated mother. He graduated as the valedictorian from his Catholic high school in Quincy, Illinois, in 1972, attended Millikin University for two years, enlisted in the Marines for two years, and then graduated summa cum laude from Quincy College, having already started on his road to fraud by falsifying his military record when applying to the college.

Enrolling at Southern Illinois University's medical school in 1979, Swango quickly stood out because of his odd, militaristic, and antisocial behavior. He failed to graduate with his class in 1982 because of what Stewart describes as startlingly apathetic and fraudulent activity on an obstetrics and gynecology rotation. By that time a macabre circumstantial association was already evident between his presence and patients' deaths. Although he came within one vote of expulsion, Swango graduated in April 1983, bound for a neurosurgery residency at Ohio State University (OSU). It is at this point that the conspiracy of silence begins.

The narrative is often chaotic and choppy, yet Stewart is adroit at detailing the institutional and individual naiveté, the incompetence, the old-boy mentality — in short, the tragicomedy of medical administrative errors — that, along with Swango's luck and charisma, combined for a 14-year career as a suspected medical serial killer. Beginning with the statement by the director of neurosurgery and head of graduate medical education at OSU that “I don't read dean's letters,” those in the medical profession, both here and abroad, do not fare well when examined as critical appraisers of their peers as guardians of the health of strangers.

Despite a between-the-lines letter of warning from Southern Illinois University, OSU hired Swango, who proceeded to hover, like some lethal Goya-esque spirit, over the unexplained deaths of five patients (by Stewart's count). After a mysterious death in February during Swango's surgical internship, the administration at OSU conducted what can only be called an incredibly inept and superficial investigation. This ineptitude, of course, was only compounded later in the form of what will strike the reader as a self-serving coverup that comes very close to becoming obstruction of justice when local and then more distant authorities turned to OSU, asking difficult questions about OSU's initial opportunity to catch Swango.

Swango too often found himself inexplicably near the beds of patients who died but had recently been very alive — in other hospitals around the country and, eventually, the world. Abetted by the proclivity of some members of the medical establishment to protect self and institution over others, including patients, Swango learned early to count on a sloppy and cavalier system of credentialing. As Stewart tells the story, the trail from Ohio led to equally gullible administrators and their sloppy checking of credentials in Virginia, North Dakota, New York, and then to Zimbabwe, where the innocence and susceptibility to what must be a certain amount of charm continued, both within and outside the medical communities into which Swango insinuated himself.

Although the author documents the credentialing mishaps in all the different venues in an apparently balanced way, his own curriculum vitae as journalist and commentator begins to unravel, unfortunately, when it counts the most. We first learn, for instance, that Stewart is from Quincy, Illinois, the same town as Swango, on page 287, the same page where he discloses that the judge he glorified 150 pages earlier is a long-standing family friend. His journalistic skills shine no better than his ability to handle conflict of interest. Swango's first lawyer goes unnamed. Stewart's reference to a primary work, David Abrahamsen's Confessions of Son of Sam (New York, Columbia University Press, 1985), is “as quoted in” another work, a sloppy technique not allowed in high school. And despite the author's explanation that he is preserving the confidentiality of sources who fear retaliation from Swango, the absence of documentation of sources, references, and citations is inexcusable. The author's worst sin, however, is his unsupported and unreferenced tirade against the entire medical establishment, which ranges from criticism of the National Practitioner Data Bank to his broadside against the “widespread failure of state medical boards to enforce statutory standards.”

Swango's release from prison is scheduled for July 15, 2000. The latest news about him comes from the Cleveland Plain Dealer. In articles published on January 11 and January 17 of this year, this newspaper, from a state highly sensitized to Swango's past, quoted an unnamed federal source as saying that Swango would be facing murder charges before his release. One can only hope that any appropriate murder charges will stick. This book is not as important for its story of a rogue killer as it is for its reminder that all of us fail dismally when it comes to minding the store. In my 13 years on Connecticut's medical examining board, I cannot think of one case brought to us by another physician. It should be the standard of practice to try to segregate any colleague who we think may be likely to hurt an unsuspecting but trusting person who comes to us sick and asking for help.

Richard M. Ratzan, M.D.
University of Connecticut Health Center, Farmington, CT 06030