Blind Eye: How the Medical Establishment Let a Doctor Get Away with Murder

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With features on "20/20" on August 18 and "Good Morning America," on August 19, the buzz is building for this terrifying true tale. The bestselling author of Den of Thieves and Blood Sport returns with another revealing, shocking, era-defining story of deception and misdeeds. This time around, Pulitzer Prize-winner James B. Stewart follows the path of one Michael Swango, a serial killer in a doctor's coat. Stewart slips inside America's cloistered medical establishment to find out how a convicted criminal could ...
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NY 1999 Hardcover New 0684854848. 334 pages; Clean and clear, tight and bright copy. --BOOK REVIEW: Matthew J Ruane. The Air Force Law Review. Maxwell AFB: 2002. Vol. 53; p. ... 231--"In a harrowing and exhaustively researched account of neglect by the medical profession, a Pulitzer Prize-winning editor and author (Den of Thieves) presents convincing evidence that alleged serial killer Michael Swango injected a minimum of 35 patients with various toxic substances during the 15 years he was a medical student at Southern Illinois University, an intern at Ohio State University Medical Center and a physician at various hospitals in the U. S. And in Africa. In addition, the author makes a strong case that Swango, who has been described by many as charismatic, was responsible for the severe digestive upsets that plagued his colleagues and friends due to poisoned food and drink. Since Swango has never been evaluated by a psychologist, Stewart relies on the work of medical researchers who view serial killers as psycho Read more Show Less

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Overview

With features on "20/20" on August 18 and "Good Morning America," on August 19, the buzz is building for this terrifying true tale. The bestselling author of Den of Thieves and Blood Sport returns with another revealing, shocking, era-defining story of deception and misdeeds. This time around, Pulitzer Prize-winner James B. Stewart follows the path of one Michael Swango, a serial killer in a doctor's coat. Stewart slips inside America's cloistered medical establishment to find out how a convicted criminal could keep finding employment with prestigious hospitals and medical schools across the country.

Winner of the 2000 Edgar Allen Poe Award for Best Fact Crime.

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Editorial Reviews

Bill Vourvoulias

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 July 2000. 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.
Salon

Lance Morrow
...chillingly thorough and superbly matter-of-fact...wonderfully done...An elaborate journalistic reconstruction that has the fascination of an acutely observed and troubling novel...
New York Times
Michael Kenney
When Michael Swango arrived for his morning shift with the Adams County, Ill., Ambulance Corps in September 1984, the other paramedics thought he must be feeling particularly generous. He had a box of Honey Maid doughnuts for the crew. As they ate, however, Swango's colleagues became violently ill and rushed from the room. ''What did you do, Mike, poison us?'' one joked later. Swango looked incredulous and issued a vehement denial.

But, as James B. Stewart documents in ''Blind Eye: How the Medical Establishment Let a Doctor Get Away With Murder,'' that was the moment when Swango's double life began to unravel. In a meticulously researched book, Stewart makes the case that Swango was a serial killer in a white coat - a doctor who does plenty of harm.

A former editor of The Wall Street Journal, Stewart won the Pulitzer Prize in 1988 for his reporting on the stock market crash and insider trading. In ''Blind Eye,'' he follows Swango's progress through medical school at Southern Illinois University, to a residency at Ohio State University, to a job as a missionary doctor in Zimbabwe. Through interviews with doctors, patients, relatives of victims, and nurses, Stewart penetrates the hermetically sealed world of medicine. In the process, he exposes the arrogance and the fraudulent professional courtesies that allowed Swango to move ahead unchallenged. In other words, Stewart does the work that hospital administrators and supervising physicians in Ohio, South Dakota, and New York should have done.

The tally is grim. Stewart writes: ''My own investigation has found circumstantial evidence that links him to the deaths of five patients at SIU, five at Ohio State, and five at the VA hospital in Northport, Long Island, for a total of 15 in the United States. In Africa, he became either more prolific or more reckless or both.'' By some law enforcement accounts, Swango may have dispatched as many as 60 patients.

It's hard to pinpoint the making of a monster in Swango's small-town Midwestern upbringing, but Stewart amasses telling evidence. His father was a Vietnam veteran who was rarely home and who apparently passed on a fascination with violent death to his son. (Both kept clippings about car accidents.) Swango's mother was a rigid woman who did her best to keep a family of four boys together. Her special focus on Michael, Stewart suggests, might have contributed to his narcissism. This kind of diagnosis at a distance is always risky, however, and Stewart would have done well to avoid it.

At SIU, Swango's medical career got off to a rocky start. He flunked his OB/GYN rotation in medical school and couldn't graduate with his class. In fact, serious concerns were raised about his fitness to practice. Fearing a lawsuit, the school pulled its punches in its written evaluation, and Swango snagged a prestigious residency in neurosurgery at Ohio State University in Columbus.

Trouble seemed to follow the blond, clean-cut resident, and nurses began to take notice. Patients died suddenly after his visits, and one woman was mysteriously paralyzed. Academic politics trumped sound medical practice, however, and OSU made only a cursory investigation. Despite suspicions, Swango was licensed as a physician in Ohio.

Stewart finds dangerous gaps in the use of the National Practitioner Data Bank, a monitoring system that took effect in 1990: Swango was accepted as a doctor in Sioux Falls, S.D., and at the State University of New York-Stony Brook because officials never checked his history. According to a federal report obtained by Stewart, about 75 percent of all hospitals in the United States never reported adverse actions to the data bank. ''In other words,'' Stewart writes, ''three-quarters of the nation's hospitals over a three-year period either took no disciplinary action against any physician - something that strains credulity - or failed to report to the data bank when they did, as required by law.'' When Stewart called the data bank to ask about Swango, he was told indignantly that such information was confidential.

Given the rise in serial killings generally, and in hospitals specifically, it seems inevitable that more Swangos will surface,'' Stewart writes, &#34and it thus seems all the more critical that criminal physicians be monitored and prevented from having access to patients."

When the law finally caught up with Swango, it barely nicked him. In 1994, federal authorities issued a warrant for his arrest on charges that he gained admission to the Stony Brook residency program by making false statements. The assistant US attorney amended the indictment to include distribution of controlled substances; conviction carried a maximum prison term of three years. Swango was arrested when he returned to the States from Africa, on his way to yet another hospital, in Saudi Arabia. Rather than face a trial, he agreed last year to plead guilty.

In 1998, he was sentenced to 42 months. But unless authorities build a murder case, Stewart's story may have a chilling coda: Swango will be eligible to move to a halfway house by next January.
Boston Globe

Scott Tobias

From 1984 to '97, Dr. Michael Swango was responsible for the fatal poisoning of roughly 60 patients, placing him among the most prolific serial killers in American history, but his crimes are not the most unsettling aspect of James B. Stewart's riveting Blind Eye. Using Swango as a grisly case study for a larger and more common problem, Stewart reveals just how easily dangerous or grossly incompetent physicians can slip through the system and continue to practice medicine. Only part of the Quincy, Illinois, native's elusiveness can be attributed to his brilliance in covering up past transgressions --including a felony conviction for lacing his colleagues' food and drink with arsenic--or the simple fact that death, no matter how sudden and inexplicable, is a regular occurrence at hospitals. With resounding clarity and force, Stewart levels equal blame on a medical establishment that cares more about financial liability than patient welfare, lacks an effective national system for red-flagging poor physicians, and supports the arrogant fraternity of hospital doctors and administrators. There's no more potent example of this than an incident at Ohio State in which three people--elderly patients Rena Cooper and Iwonia Utz and student nurse Karolyn Beery--witnessed Swango injecting a foreign substance into Cooper's IV line, causing a near-instant seizure and resulting in paralysis. A half-hearted internal investigation followed, but as more reports of suspicious deaths surfaced, administrators, fearing liability, chose to disbelieve the witnesses, shut out campus-police inquiries, and quietly relieve the doctor of his duties. As he follows Swango's zigzagging path through various hospitals in America, ending in a remote community facility in Zimbabwe, Stewart observes with astonishment and indignation as the cover-up at Ohio State repeats itself again and again. At their worst, true-crime books revel in grotesque pathology. But while Swango has plenty to offer in that regard--the perverse enjoyment he got from informing family members of the newly deceased, his obsessive clippings of articles on violent deaths--Stewart understands that he's an anomaly and insists on putting his horrible actions in context. An urgent, scrupulously researched piece of reportage, Blind Eye is a wake-up call to both the medical community and the vulnerable public-at-large.
&#151: Onion.com

Publishers Weekly - Publisher's Weekly
In a harrowing and exhaustively researched account of neglect by the medical profession, a Pulitzer Prize-winning editor and author (Den of Thieves) presents convincing evidence that alleged serial killer Michael Swango injected a minimum of 35 patients with various toxic substances during the 15 years he was a medical student at Southern Illinois University, an intern at Ohio State University Medical Center and a physician at various hospitals in the U.S. and in Africa. In addition, the author makes a strong case that Swango, who has been described by many as charismatic, was responsible for the severe digestive upsets that plagued his colleagues and friends due to poisoned food and drink. Since Swango has never been evaluated by a psychologist, Stewart relies on the work of medical researchers who view serial killers as psychopathic narcissists. The major strength of Stewart's study, however, rests on his expos of poor medical monitoring practices. For example, when female nursing personnel linked mysterious patient deaths to Swango's injections, male physicians dismissed their suspicions. Swango was finally sent to prison in 1985 after being convicted of poisoning his co-workers while he was employed as a paramedic. After his release, he found work at other teaching hospitals because they were not required to check with the national practitioners' data bank, a self-monitoring mechanism endorsed by the AMA that Stewart considers inadequate. Currently serving time in prison on fraud charges, Swango faces an FBI investigation for murder. Agent, Amanda Urban; 9-city author tour; TV satellite tour. (Sept.) Copyright 1999 Cahners Business Information.
Library Journal
Pulitzer Prize-winning journalist Stewart, noted for Den of Thieves, elevates the story of a peripatetic doctor who leaves behind a trail of dead patients beyond the true-crime genre. This compelling look at one bad seed becomes an indictment of an industry that ignores and even covers up the errors of its own. (LJ 9/15/99) Copyright 2000 Cahners Business Information.
Talk Magazine
Blind Eye follows the professional and criminal career of Michael Swango, a physician who poisoned dozens of people. It's a true crime book, a very good and important one.

Talk Magazine's 10 Best Books of November

Kirkus Reviews
The shocking story of Dr. Michael Swango, who, despite being a convicted felon suspected of murdering dozens of his patients, was allowed to practice medicine. Best-selling author Stewart (Den of Thieves, 1991, etc.) brings us inside the life of a killer who thrived in a medical establishment where doctors typically cover up for other doctors, where hospital administrators live in constant fear of litigation, and where regulatory agencies don't share crucial information. At Southern Illinois University's medical school, Swango kept to himself, but classmates noticed that patients who came into contact with him tended to die. After graduating, Swango got a prestigious medical internship at Ohio State University. In February 1984 at Ohio State, patient Ruth Barrick died immediately after Swango treated her. Later a nurse saw Swango injecting a patient with a syringe; the patient almost died. The nurse who accused Swango was ignored and, in a pattern that would repeatedly benefit Swango, other doctors circled the wagons to defend their colleague. As more patients died, Ohio State initiated an in-house investigation, led by a fellow doctor, that fully exonerated Swango. Hospital administrators refused to even reprimand him, because they "didn't want to be sued by Swango as a result of unfounded charges and nurses' gossip." When his internship was up, Swango worked as a paramedic in his hometown of Quincy, Ill. He related fantasies to his co-workers about killing people. When Swango brought in donuts, his co-workers got sick. After a few more poisonings, Swango was arrested and convicted. A felon, he nonetheless went on to practice medicine in South Dakota, New York, and Africa. In eachplace, patients died mysteriously under Swango's care. Finally, upon his return from Africa, the FBI arrested the young doctor for falsifying medical records. He's currently in prison, but could be released within three years. Although Stewart writes skillfully about the medical establishment's unforgivable "code of silence," he never quite succeeds in taking us very far into Swango's warped mind. Thus, we're left to guess about his psychotic motives and thought processes.
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Product Details

  • ISBN-13: 9780684854847
  • Publisher: Simon & Schuster
  • Publication date: 8/17/1999
  • Pages: 334
  • Product dimensions: 6.43 (w) x 9.57 (h) x 1.13 (d)

Read an Excerpt

Prologue

Keneas Mzezewa had dozed off for a nap that May afternoon, but was awakened at about two p.m. when he felt someone removing his loose-fitting pajama trousers. He lifted his head, still a bit groggy from sleep, and saw that it was Dr. Mike. The handsome American doctor had a syringe in his hand, and seemed about to give him an injection, so Mzezewa, eager to help, pulled down his trousers and turned on his side. Then the doctor plunged the unusually large needle into his right buttock. Mzezewa saw that after he finished the injection, the doctor concealed the used syringe in the pocket of his white medical coat.

"Good-bye," Dr. Mike said softly, pausing briefly to look back at Mzezewa.

Then he left the hospital ward.


Howard Mpofu, the director of hospitals for the Evangelical Lutheran Church in Zimbabwe, liked the new doctor the minute he met him, in November 1994, when he picked him up at the Bulawayo city airport. Michael Swango looked like the American athletes Mpofu had seen on television. He was blond and blue-eyed, taller than Mpofu, with a ready smile. According to the résumé the church had received, he was forty years old, but he looked younger. Mpofu tried to help Swango with his duffel bags, but the doctor wouldn't hear of it. He quickly hoisted the heavy bags and insisted on carrying them to the car himself.

On the ride into the city, Swango was garrulous, flushed with excitement at his new assignment. Mpofu asked why Swango had wanted to come to Zimbabwe to take up a post that would pay him a small fraction of what he could earn in the United States. After all, Swango was an honor student; he'd graduated from an American medical school and had completed an internship at the prestigious Ohio State University Hospitals, which meant he could go anywhere. "All my life," Swango told him, "I have dreamed of helping the poor and the disadvantaged." He said America had plenty of doctors, but in Africa, he would be truly needed. Mpofu couldn't argue with that.

When they reached the Lutheran church headquarters in central Bulawayo, they walked up one flight of stairs to the church offices, and Mpofu introduced Swango to the Lutheran bishop of Zimbabwe. To the amazement of the church officials, Swango knelt before the bishop and kissed the floor. He said he was so grateful to have been hired and to be in Zimbabwe at last.

The bishop seemed equally delighted. Indeed, he and Mpofu were overjoyed simply to have succeeded in recruiting an American doctor for one of their mission hospitals, let alone one willing to kiss the ground at their feet. Before Swango, the only European or American doctors the church had succeeded in bringing to Zimbabwe were Evangelical Lutherans from church headquarters in Sweden, and none of them stayed more than a few years.

Not many foreign doctors -- even from places like Eastern Europe and Asia -- wanted to come to Zimbabwe, the former British colony of Rhodesia, which lies between Mozambique and Botswana, just north of South Africa. Before the end of the white supremacist regime of Ian Smith and the holding of supervised elections in 1980, the country had endured a prolonged civil war. And after independence came the consolidation of dictatorial power by the mercurial Robert Mugabe, who, among other controversial pronouncements, has denounced homosexuals as "perverts" who are "worse than dogs and pigs." Since independence, the country has experienced the suppression of human rights, the collapse of its currency, a steep decline in the standard of living, and the emigration of much of its white population. Fully 25 percent of the adult population of Zimbabwe is estimated to be infected with HIV, the highest infection rate in the world. At times the country's hospital system has been plunged into turmoil, and there is a critical shortage of doctors.

With a population of about 650,000, Bulawayo is Zimbabwe's second-largest city, the capital of the province of Matabeleland, once a powerful African nation in its own right. For the most part, the local population speaks Ndebele, a linguistic cousin of Zulu, whereas the Zimbabwean majority speaks Shona. A debilitating civil war between the two ethnic groups broke out almost immediately after Zimbabwe gained independence, and though a truce was reached, simmering tensions persist.

Bulawayo residents complain that the city has been neglected by the national government because of continuing ethnic discrimination against the Ndebele. But a result of that neglect has been that the colonial-era architecture and city plan have been largely unmarred by the building boom that has swept Harare, the nation's capital. Even the cars generally date from the fifties and sixties, owing to years of international economic embargo during white-supremacist rule and the collapse of the Zimbabwean dollar following independence. Many people in Bulawayo seem to prefer the atmosphere of faded gentility, especially the fifty thousand or so remaining whites, most of British descent. These days few live lavishly; there is little conspicuous wealth. But they praise the city's unhurried pace (nearly all businesses seem to close by three p.m.); the nearly ideal climate of the high African veldt, in which even summer temperatures almost never reach ninety degrees; the gracious residential neighborhoods of walled villas and jacaranda-lined streets. Most white people still return home for a lunch prepared by black servants. They congregate at the Bulawayo Golf Club, the oldest club in Zimbabwe, with manicured fairways and a swimming pool, and the Bulawayo Club, an imposing beaux-arts mansion downtown.

By contrast, the orderly grid of colonial Bulawayo is surrounded by scores of "settlements," in which thousands of black people live crowded into small houses and shanties along dirt roads that seem to have been laid down at random. Many commute into the city on aging, diesel-fume-spewing buses, and the central bus terminal is a colorful and chaotic mass of shouting passengers, piles of goods and luggage, buses, taxis, bicycles, and handcarts. There is an almost eerie sense of a time warp in Bulawayo. In the award-winning 1988 film A World Apart, it stood in for 1960s Johannesburg.

Swango spent his first night in Zimbabwe at the Selborne, a colonial-era hotel whose wide verandah overlooks the city's bustling central square. The next morning, Mpofu picked him up for the drive to the church's mission hospital at Mnene. Mpofu had made the six-hour drive many times, and he was accustomed to the dismay of first-time visitors as the pavement gave way to a dirt road so rough that a four-wheel-drive vehicle or truck is required. Yet Swango voiced no complaints as they ventured ever farther from what most Americans would consider civilization.

Mnene -- a cluster of buildings -- can't be found on many maps. It lies in the region of Mberengwa in south-central Zimbabwe, in what in colonial times were known as the tribal lands of Belingwe, in the heart of the bush. Inhabitants identify themselves by the name of their tribal chief; the land is still owned communally, and the local people's life of subsistence farming has changed little for generations. There are no towns to speak of, scant electricity, almost no telephones. Most people live in extended family units in clusters of mud-walled buildings with thatched roofs. The landscape is often stunningly beautiful: verdant valleys give way to distant panoramas of mountain ranges. Drought and malaria are constant threats, in part because the lower elevation makes the climate more tropical than it is on the high plateau where most of the white population lives.

The region is served by three hospitals, one of them also called Mnene, all founded in the early part of the century by Evangelical Lutheran missionaries. Mnene Mission hospital, a cluster of one-story whitewashed buildings with corrugated metal roofs and wide verandahs, is set atop a hill with distant views and refreshing breezes. The buildings look much the same as they do in a photograph taken in 1927, when the hospital was built.

When Mpofu and Swango finally arrived, Dr. Christopher Zshiri, the hospital director, hurried out to greet them. He introduced Swango to Dr. Jan Larsson, a Swedish missionary doctor who was the other member of Mnene's medical staff, and showed Swango to his quarters, a spacious bungalow with a verandah, adjacent to the hospital. Zshiri is a native Zimbabwean. Under the country's system of socialized health care, he reported to the provincial medical administrator in Gweru and was paid by the government, even though nominally he worked for the Lutheran church. Even more than the others, Zshiri thought it was almost too good to be true that they had managed to recruit an American doctor to a place like Mnene.

Zshiri and Swango soon became friends. Zshiri couldn't get over how talkative Swango was, always eager for conversation and filled with curiosity. After his arrival, Swango had garnered glowing reports from patients and staff members. He was soon known to everyone as "Dr. Mike." It was true that he lacked experience in general surgery and obstetrics, two areas most in demand at Mnene. After a month at Mnene, Zshiri sent him to Mpilo Hospital in Bulawayo, where Swango spent the next five months gaining additional clinical experience. The doctors at Mpilo wrote glowing recommendations, and Swango was far more confident and proficient when he returned to Mnene in late May. He was seen as a nearly tireless worker, able to complete forty-eight-hour stints without sleep. He even worked extra shifts, giving up his free time. Of course, at Mnene, there was little else to do. Even the indefatigably cheerful Swango finally complained about the isolation, asking Zshiri if the church could possibly provide him with use of a car, since he couldn't afford one. Fearful that Swango might decide to leave, Zshiri wrote church officials a letter asking whether there wasn't some way they could accommodate him.

Swango often made extra rounds to check on his patients, sometimes at night or during afternoons when he was otherwise off-duty. So when Dr. Swango arrived in the surgery recovery room one May afternoon in 1995 to check on Keneas Mzezewa, the only patient there, no one thought it unusual, even though Swango had already completed his rounds that morning, and technically Mzezewa wasn't his patient.

Mzezewa had recently had his foot amputated by Dr. Larsson. A farmer in the Mberengwa area who was also a part-time laborer at the nearby Sandawana emerald mine, Mzezewa had come to the hospital the previous week complaining about severe pains in his leg. A tall, slender man with a wide smile, Mzezewa had reacted calmly to the news that his infected foot would be amputated. The doctor reassured him that he would be fitted with a prosthesis and should be able to lead a normal life once he returned to his farmstead. The operation had been uneventful, but Mzezewa had been kept in the recovery ward for close monitoring, which was routine in amputation cases. Dr. Larsson had been pleased with his progress, and mentioned to Zshiri how well Mzezewa was doing.

That afternoon Mzezewa was awakened from his nap by the new doctor, Dr. Mike. Before the doctor gave him the injection, Mzezewa noticed, he neglected to swab the skin with disinfectant. Mzezewa also noticed that when Dr. Mike put the used syringe in his jacket pocket, the needle's cover fell to the floor near his bed.

Still, it seemed a routine visit. Despite the large size of the needle, Mzezewa didn't mind the pain. He relaxed and lay back on his bed, prepared to resume his nap. But as the drug given him by the doctor spread through his body, he began to feel a strange loss of sensation in all his muscles. With mounting alarm, he realized that he couldn't turn over and couldn't move his arms or legs. He wanted to speak or cry out, but his jaws, tongue, and throat wouldn't respond. Then the room, brightly lit by the afternoon sun, grew dim. Soon all was darkness.

Mzezewa didn't know how much time passed while he lay there, alive and conscious but paralyzed and terrified. But then the darkness began to lift; he could see, though he still couldn't move his head. A nurse's aide entered the recovery ward and came over to his bedside. She held a thermometer and told him it was time to take his temperature. Mzezewa's mind was racing. His heart beat furiously. He wanted to cry out, but he couldn't make a sound. He could hear the aide, but he couldn't move; his muscles wouldn't respond. She asked him to move his arm so she could put the thermometer in his armpit. He lay motionless. She asked him again. Suddenly the aide looked alarmed, and ran from the ward.

Moments later, Mzezewa regained his voice. He screamed and began shouting to attract attention, though he still could not produce recognizable words. A nurse came rushing into the ward, followed by the aide. She came and stroked his hand, trying to calm him, asking him what had happened. But he was still unable to speak. Two more nurses arrived.

Slowly Mzezewa regained his voice. "Dr. Mike gave me an injection," he finally gasped. The nurses were puzzled, for while Mzezewa was taking oral painkilling medication, he was not scheduled for any injections. In any event, injections were administered by the nursing staff, not by the doctors.

Then Swango himself came into the ward, coolly appraising the commotion. Mzezewa looked terrified. The nurses fell silent.

"Did you give him an injection?" a nurse finally asked. "What was it?"

Swango seemed mystified. "He must be delirious," he said. "I didn't give him any injection."

Copyright c 1999 by James B. Stewart

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First Chapter

Chapter Three After his brush with expulsion, Swango was a model medical student. He dutifully repeated the OB/GYN rotation, attending all the required surgeries and oral examinations, and he acquitted himself satisfactorily in his other supervised assignments.

Dean Richard Moy had taken an additional step that he believed might put others on notice that SIU had experienced problems with Swango's performance. Every graduating medical student receives a "dean's letter," which reviews his or her strengths and weaknesses and is used in applications for internships, residencies, and other employment. Though another administrator usually drafted such letters, Dean Moy took a personal interest in Swango's. It was carefully written to call attention to the fact that he had not graduated with his class, that he had failed a rotation and been required to repeat it, and that there had been concern about his professional behavior. Given the school's anxiety about possible legal liability, this was as far as Moy felt the letter could go. He was confident that, at the least, it would cause a teaching hospital to call SIU for more explanation before admitting Swango for further training.

Yet on Match Day, March 16, 1983, Dr. William Hunt, director of the department of neurosurgery at Ohio State University in Columbus, offered Swango a residency in neurosurgery after the successful completion of a year's internship in general surgery to begin on July 1. That year, Ohio State, one of the most prestigious residency programs in the country, had received about sixty applicants for its neurosurgery residence program and had invited twelve for personal interviews, Swango among them. He was the only student finally offered a position. Swango's success seemed even more astounding than his offer from the University of Iowa had been the year before.

Michael Swango was graduated from SIU on April 12, 1983. Though there was no ceremony, he received his diploma in the mail, and Muriel spread the good news of his graduation and acceptance at Ohio State to family members. These developments lent credence to Michael's explanation that a computer glitch had postponed his graduation. No one questioned why it would have taken nearly a year to correct such an error. Nor did Michael mention to anyone in Quincy, let alone at Ohio State, that shortly after his graduation from SIU he was fired by America Ambulance.

Already on probation there because of his violent outbursts, Swango had responded to an emergency call in Rochester, Illinois, a small town close to Springfield. The patient, gasping for air and in acute pain, was suffering a heart attack. Swango's instructions were to administer any emergency treatment called for and then transport him in the ambulance to the nearest hospital. Instead, he made the patient walk to his own car and told the family to drive him to the hospital themselves. The patient survived, but the family called America Ambulance to complain about Swango. No one could explain his cavalier behavior. It was both medically unsound and a clear violation of the ambulance corps' rules. Swango offered no adequate explanation and was fired.

But Michael was no doubt indifferent to his dismissal now that he had graduated from SIU. He returned to Quincy and was promptly hired as a paramedic by the Adams County Ambulance Corps. He worked there for just three months, since he had to be in Columbus, Ohio, by July 1 to begin his internship.


Anne Ritchie first met the new blond intern on the ninth floor of Rhodes Hall, one of the largest buildings in the Ohio State medical complex. She did a double-take. She thought he was handsome, with an athletic build and angular face, a very all-American look. But what struck her most was that he looked remarkably like her cousin's husband in Minnesota. The similarity was so pronounced that she checked the I.D. tag on his surgical jacket to see if there might be some family relation. That was why she remembered his name: Michael Swango.

Attractive, popular, and vivacious, Ritchie was the daughter of a physician, and had always wanted a career in health care. She loved working in the Ohio State Hospitals, even though as a "casual" or supplemental nurse, working two to four shifts a week whenever she was needed, she ranked fairly low. Swango didn't seem the least bit interested in his resemblance to her cousin, but Ritchie was accustomed to indifference on the part of doctors. At the Ohio State Hospitals, which maintained a rigid hierarchy among doctors, nurses, and other staff, nurses didn't speak to attending physicians unless specifically questioned by them. The physicians gave their instructions to residents and interns, who in turn passed them on to the nursing staff. Any questions or statements by the nurses were supposed to be directed either to the interns and residents for transmittal to attending physicians, or to their nurse supervisors.

With over 50,000 students at the time Swango arrived, Ohio State is virtually a city unto itself; it even has its own police force and governance. The Ohio State University Medical Center is located just a few blocks from "the oval," the grassy center of the sprawling campus. After the Ohio State Buckeye football team, the medical center is the crown jewel of the giant state university. It has 1,123 beds and 4,278 employees, and university officials describe it as the second-largest teaching hospital program in the country (after the University of Iowa's). The hospitals sometimes vie for supremacy in Ohio with the prestigious Cleveland Clinic, the highly regarded Case Western Reserve University, also in Cleveland, and the University of Cincinnati. But its size and political clout -- the university trustees are appointed by the governor, and the hospitals' board is a Who's Who of prominent Ohio business and civic leaders -- usually ensure Ohio State's preeminence. Graduates of the medical school dominate Ohio's medical establishment and institutions.

So Swango joined an elite group of medical school graduates for his first assignment as a surgical intern, which was in the emergency room. Given such competition, it didn't take long for some of his shortcomings to surface. Each doctor in charge of a surgical rotation evaluates the interns at the conclusion of the rotation, and Dr. Ronald Ferguson, the doctor in charge of transplant surgery, who oversaw Swango's work from mid-October until mid-November, told Dr. Hunt that he was going to fail Swango, and that he didn't believe he was competent to practice medicine.

While the details of Swango's performance have been shrouded in secrecy by Ohio State (the school has said only that nothing of a criminal nature was contained in Swango's evaluations), Ferguson complained specifically about Swango's brusque and indifferent manner with patients, his cursory H & P's -- charges that echo the criticisms of his performance at SIU -- and a general sense that Swango lacked the temperament and dedication necessary to be a doctor. Swango also alarmed at least one other of his supervising physicians with remarks suggesting a fascination with the Nazis and the Holocaust. (This fascination was noted in his student record.)

Some of the residents, who spent more time with Swango than the attending physicians did, also complained to doctors on the faculty that Swango was "weird." While making rounds, residents often give interns tasks and then critique their performance. Whenever they criticized Swango -- as they often did, because of his incompetence -- Swango would immediately drop to the floor and begin a strenuous set of push-ups. He could do hundreds of them. It was almost as if he were still in the Marines, and this was his self-imposed punishment. Of course, the residents thought his reaction not only peculiar but highly inappropriate for a doctor making rounds. Despite their admonitions, he persisted.

At the time Swango was hired, no one from Ohio State called anyone at SIU. Indeed, no one appears even to have noticed that he should have graduated from SIU a year earlier than he did. But now, troubled by the negative report from Ferguson and other comments about Swango's odd behavior, Dr. Hunt got on the phone to SIU's Howard Barrows, the associate dean for medical education. Barrows was in charge of student recommendations, including the dean's letters signed by Moy, and had helped draft Swango's. With an edge of annoyance, Hunt asked about Swango. "What kind of guy did you send us?"

Barrows said that Hunt should have seen plenty of warning flags in Swango's dean's letter. "Well," Hunt retorted, "I don't read dean's letters."

Barrows asked him if he'd kept the dean's letter in Swango's file, and Hunt said he'd check. Soon after, Hunt called back: he'd found the letter.

"Oh, my God," Hunt said. "You're right. You did tell me."

Still, no consideration seems to have been given to terminating Swango's internship. On January 14, 1984, Hunt met with Swango and warned him that he had received a failing evaluation from Dr. Ferguson that might threaten his residency. He reminded Swango that the offer of a residency in neurosurgery was contingent on successful completion of the one-year internship. Swango took the news calmly; he seemed suitably concerned and sincere in his desire to improve. He was sufficiently charming and contrite that Hunt helped him plot strategies for overcoming the negative review and continuing with his residency. Hunt recommended that Swango appeal Ferguson's evaluation to the Residency Review Committee, made up of doctors from the surgery department. Swango took him up on the suggestion, and the committee met later that month to reevaluate him.


Ritchie and Swango didn't have much contact after their initial meeting, when she had examined his name tag, though she did talk fairly often to his new girlfriend: a fellow nurse named Rita Dumas, who also often worked in Rhodes Hall. The relationship surprised many on the nursing staff, because Dumas hardly seemed a catch for a promising and handsome young intern. She was reasonably attractive, but her personality had caused some of the other nurses to keep their distance. Divorced a few years before, with three young children, she was always complaining about something. She worked the night shift, returning home at seven in the morning, just as the children were awakening. She said she was never able to get enough sleep, which might have accounted for her often surly mood.

But she seemed transformed by the romance with Swango. Though she still kept mostly to herself, she acquired a new glow of confidence, and her attitude toward life seemed to improve. A few of the other nurses noted the changes with a touch of envy. Dumas had been going through a difficult period. Swango had been tender and supportive. He was wonderful with her children, and they loved it when he performed feats of juggling for them. She later said, "I do not think that I would have survived had Swango not been there for me."

On February 6, Anne Ritchie reported to Rhodes Hall for the morning shift, and was assigned to a neurosurgery patient in Room 968, named Ruth Barrick. Barrick was a pleasant, elderly woman who had been admitted to the hospital on January 17. She had fallen and hit her head at home ten days earlier and suffered a cerebral hematoma. Though her condition was serious, it had never been considered life-threatening until she suffered respiratory arrest and nearly died on January 31 -- just after Swango's appeal of his negative evaluation was rejected.

No one told Ritchie what had happened. But on January 31, another nurse, Deborah Kennedy, had given Barrick her breakfast and assessed her condition. The patient seemed to be doing well. She was sitting up in bed, talking, and responding to directions. At about 9:45 a.m., Dr. Swango had come into Barrick's room and told Kennedy, "I'm going to check on her." Kennedy thought this was peculiar, since doctors rounded at 6:30 a.m. and rarely returned unless there was a specific problem. In such cases, it was the attending physician, not an intern by himself, who would call on the patient. But Kennedy gave the matter little thought. She left Swango alone in the room with Barrick.

About twenty minutes later, Kennedy returned to check on Barrick. Swango was gone. Barrick was now reclining and seemed to be asleep, but when she drew close to the bedside, Kennedy was alarmed. Barrick was barely breathing. Her skin was taking on a bluish cast, a sign of imminent death from respiratory failure. Kennedy immediately called a code over the intercom, and doctors came rushing to the room. Swango was the first to respond, but others too began working to resuscitate her. After forty-five minutes Barrick's vital signs seemed to stabilize and she was transferred to intensive care. There she recovered without any evident lingering effects, and returned to her room.

At about eight a.m. on February 6, Ritchie gave Barrick a bath. The patient was alert, talking, cheerful, and seemed to be recovering. But Ritchie noticed that the central venous pressure (CVP) was low in the central line, an intravenous tube supplying medication to the major blood vessels. She called to ask that a doctor check the line, and then left the room to check other patients. A few minutes later, she saw Swango enter Barrick's room, remembered him as the new doctor who looked like her cousin, and felt relieved that an M.D. had responded to her call. Ritchie might have given the matter no further thought, but some time passed and she didn't see Swango emerge, which made her think that there might be a problem with the central line. This wasn't unusual, because the central line, connected as it is to the major blood vessels, often requires some delicate work if a blockage occurs, and there is a particular risk of air getting into the tube, which can be fatal. So Ritchie went back into Barrick's room to see if Swango needed help.

Swango had drawn the curtains entirely around Barrick's bed, which meant that neither Barrick's roommate nor anyone passing the room's open door could see what was happening. Ritchie found this odd. She stuck her head through the curtains. Swango was hovering over Barrick's chest area and seemed startled. "Do you need any help?" she asked cheerfully. "No," Swango replied. Ritchie left.

Ten minutes later, concerned that Swango still hadn't finished, Ritchie entered the room, saw the closed curtains, and again asked if Swango needed any help. He said he didn't. Three minutes later, Ritchie returned, opened the curtain, and looked in. This time she saw that Swango was using two or three syringes. One was stuck directly into the central line. Another was resting on Swango's shoulder, as if he was waiting to insert it whenever the other syringe had emptied. Had Swango simply been using the syringes to clear the line, there should have been blood in them. But there was no blood. Swango again said he needed no assistance and Ritchie left the room.

Just a few minutes later, Ritchie saw Swango finally leave. "Good," she thought to herself. "That's finally over." Whatever was wrong with Barrick's line had evidently been corrected. Almost immediately -- no more than ten seconds had elapsed -- she went back into the room to check Barrick's dressing where the central line entered the body.

Ritchie was stunned. Barrick had turned blue. She gave one terrifying shudder and gasp, then stopped breathing. Ritchie screamed "Code Blue! Code Blue!" then began mouth-to-mouth resuscitation, desperately trying to get breath into Barrick's lungs. She looked up and saw Dr. Swango coolly watching her from the back of the room, doing nothing to assist her or the patient. "That is so disgusting," Swango said of her efforts at mouth-to-mouth resuscitation, his voice tinged with contempt.

Still in shock, Ritchie stared at him in disbelief. "You jerk!" she shouted, before returning frantically to the patient. Other nurses and doctors rushed in and began chest compression, to no avail.

Ruth Barrick was dead.

The last entry in Barrick's "physician progress notes" was made by Swango and dated February 6 at eleven a.m.:

PT [patient] suffered apparent respiratory arrest witnessed by R.N. No pulse present, Code Blue called at 10:25 hrs. PT did not respond to resuscitative measures...pronounced dead at 10:49. Dr. Joseph Goodman and family notified per Dr. Arlo Brakel.
Swango.

The death certificate cited the cause of death as "a. Cardiopulmonary arrest, due to, b. Cerebrovascular accident," a stroke in lay terms.

Ritchie was astounded and appalled when Swango insisted he wanted personally to convey the news of Barrick's death to her family members. (She later saw him leading relatives into a private room.) And she could hardly believe what she had witnessed. She was almost certain that something Swango had done had killed Barrick. Still, it never crossed her mind that he might have killed her deliberately. She assumed that he had accidentally allowed an air pocket to enter the central line, causing a fatal embolism in the bloodstream. Such accidents did sometimes happen, which was one of the reasons only doctors were allowed to adjust central lines. But why hadn't Swango acknowledged the error? Why had he acted as he did? And what was he doing with those syringes?

These troubling questions were still swirling in Ritchie's mind that afternoon when she responded to an urgent call in another room. The head nurse, Amy Moore, was with a patient who was having serious trouble breathing. Ritchie was alarmed to see that Swango was also in the room. With the patient gasping for breath, he ordered Ritchie to fetch a heart monitor.

Moore seemed incredulous: Using a heart monitor would take valuable time. "We don't need a heart monitor to check her lungs!" she exclaimed. It was rare for a nurse to defy a doctor, but the patient's condition plainly suggested blood clots in the lungs. She needed to be rushed to another floor for testing.

Swango was insistent. "She has to have a heart monitor."

"No she doesn't!" Ritchie interjected, fearing that the patient would die while they delayed dealing with an obvious condition.

But Swango was adamant. Moore said she could handle the situation, and told the visibly upset Ritchie she could leave. Moore got the patient to the other floor in time to save her life.

After her shift ended that day, Ritchie was driving home on Route 315 to the northwest suburbs where she lived. She couldn't get the day's disturbing events out of her mind. Barrick's death, Swango's unfeeling reaction to it, and his jeopardizing another patient made her consider the possibility that his actions had been deliberate. Her heart started racing; her head felt light; and she feared she would faint. She pulled over to the side of the busy highway to collect herself, but she still felt waves of anxiety. As soon as she could, she got off the highway and drove to her sister's house, where she broke down in tears. She told her sister about Ruth Barrick, and then about the other patient. Her sister called their father, the doctor, who said he'd check on Anne as soon as he could. Meanwhile, she did deep breathing exercises in an effort to stem the anxiety and calm herself. Surely she was wrong about Swango; Barrick's death was an accident. Eventually her pulse returned to normal, she regained her strength, and she was able to drive home.

The next day, in line with the hospital protocol that any irregular incidents should be reported to one's immediate superior, Ritchie told Amy Moore her suspicions that Swango had caused Barrick's death. She also talked with several other nurses about what had happened. Given hospital practice, she didn't dare say anything to any doctors. And in any event, she was afraid to mention the real cause of her anxiety attack: her suspicion that Swango's actions had been premeditated and deliberate.


That same evening, February 7, Swango and several other doctors made their evening rounds, stopping to see Rena Cooper, a sixty-nine-year-old widow who had had an operation that morning for a lower back problem, and Iwonia Utz, age fifty-nine, who was scheduled for, but had not yet received, treatment for a brain tumor. For twelve days the two had shared Room 900 in Rhodes Hall; over that time, they had become friendly. Cooper, a former seamstress and, for nineteen years, a practical nurse, and Utz, also a widow, and the mother of nine children, had discovered that they shared a strong Christian faith. (Cooper described herself as "born again.") On the evening of February 7, they had dinner, watched some television, and were avidly discussing the Bible when the doctors arrived. The doctors noted nothing unusual and continued their rounds. When they left, Cooper was lying comfortably on her side, with an intravenous tube for antibiotics connected to her left arm.

About an hour later, between nine and 9:15 P.M., an Ohio State nursing student, Karolyn Tyrrell Beery, came in to Room 900 for a routine hourly check and was surprised to see Swango there. Cooper had requested more pain medication, asking Utz to hold the call button down for her because she couldn't reach it, and Swango had apparently responded to the call. He was standing at Cooper's bedside, only about three feet from Beery, and the student noticed that he was adding something to Cooper's intravenous tube by inserting a syringe. "Her line must have clotted off" was her only thought; she assumed Swango was clearing a blockage. Beery stepped outside to enter data on Utz's chart. She was running late, and ready to move on to her next patient when, no more than two minutes later, she heard Utz call out, "Are you all right, Mrs. Cooper?" Then Beery heard a violent rattling of bed rails, followed by Utz's screams.

She rushed into the room. Utz cried out, "There's something wrong!" Cooper was turning blue and had stopped breathing.

Panicked, Beery rushed to the nurses' station for help, and returned to the room with a regular nurse, John Sigg. Sigg took one look at Cooper, then called a code. Two doctors, Rees Freeman, the chief resident in neurosurgery, and Arlo Brakel, another resident, were among the first to arrive, along with several nurses.

The genial, easygoing Freeman was referred to by nurses as "California Boy," since he'd grown up there. He was also a vitamin and mineral enthusiast, frequently handing out zinc tablets to patients, which the nurses also thought was a very West Coast habit. Brakel was often disheveled and tardy; as a joke, the nurses gave him an alarm clock with two large bells on top.

Swango, though he had just been in the room, didn't immediately respond to the code. As the senior resident, Freeman took charge of the emergency. He asked Beery what had happened. "Doctor," she said, "you know, Dr. Swango was in here and he left."

"Dr. Swango was in here?" Freeman asked, somewhat incredulous, since the doctors' rounds had been concluded some time earlier and Cooper wasn't scheduled for any follow-up visits. "What was he doing here?"

"I don't know," Beery said, adding: "This doctor's a real jerk."

Freeman asked what medication Cooper had taken, and another nurse said it was only codeine, a mild pain remedy. Beery then remarked that she had seen Swango giving Cooper something through the intravenous tube, but the doctors seemed skeptical, and she was convinced that neither of them believed her, probably because she was just a student nurse. Their skepticism may also have been rooted in the hospital custom that nurses, not doctors, adjust IV tubes (as opposed to the more complicated central lines). While doctors may inject drugs directly into IV lines, Cooper hadn't been scheduled for any such medication.

With the code and all the commotion in her room, Utz had become hysterical -- by her own account, she was "screaming like mad" -- and Freeman ordered her removed. As nurses converged on Utz, she called out that "a doctor with blond hair did something to Mrs. Cooper." Between sobs, she elaborated to the nurses: the "blond-haired doctor" had come into the room with a syringe and "something yellow that you wrap on your arm when you draw blood." She had heard him tell Cooper that "he was going to give her something to make her feel better." Utz said she had watched as the doctor wrapped the yellow tube around Cooper's arm, injected her with the syringe, and then "ran" from the room. Then Cooper's bed rails began to shake. Utz tried to press her emergency call button, but couldn't reach it, so she began screaming for attention. By the time Utz had finished her story, she had been moved to a private room down the hall, so only nurses heard the full account.

In any event, the doctors at this point were more concerned about saving Cooper than they were about determining the cause of her mysterious paralysis. Brakel later noted that Cooper "was not breathing. She was unconscious. She had no movements to any stimulus, even deep pain." But she wasn't dead -- she had a good pulse and heartbeat. The doctors checked her pupils and noticed that there was faint, sluggish reaction to stimuli. But the doctors were surprised by what they called her "total flaccidity" -- "she didn't even have any reflexes," as Brakel put it. The doctors inserted a tube down her throat to facilitate breathing. This is normally a painful procedure, but Cooper showed no reaction, and the doctors concluded she was essentially paralyzed.

Joe Risley, a nurse's aide, had responded to the code, and was standing outside Cooper's room when he heard Beery, who was a friend of his, tell Freeman that Swango had injected something into Cooper's IV. He moved west down the corridor and rounded a corner, checking to make sure there were no other patient emergencies while the medical staff was preoccupied with Cooper. As he neared Room 966, Risley saw Swango, wearing his white medical coat, come out the door. Risley knew Swango had just been in Cooper's room, and knew of no reason he would be in 966. But what really struck him was a peculiar look of satisfaction on Swango's face when he looked Risley directly in the eye. As Risley later put it, "He had a goofy look on his face....It's an old cliché, like a kid with his fingers in the cookie jar. I mean, it was basically just a shit-eating grin."

The two said nothing to each other as they passed, but Risley, his suspicions aroused, immediately went into the room. On the bathroom sink, located just inside the door, were an 18-gauge needle and a 10cc syringe with the plunger depressed. An 18-gauge needle is large, used on patients only in unusual circumstances when a large dosage needs to be injected at high speed. Lily Jordan, the charge nurse, who supervised other nurses on the floor, was walking by, and Risley asked her if anyone had been assigned to give an injection in Room 966. No, she replied, not that she knew of. Risley asked her to look in the bathroom, and pointed out the huge needle and syringe. "Did you leave that there?"

"No," she said emphatically.

"I just found it," Risley said.

The two thought the location of the abandoned syringe was peculiar, since a sharps container -- a box for disposing of used needles and syringes -- was located just behind the sink.

Risley told Jordan that he'd just seen Swango coming out of the room with a strange look on his face, and the significance of their discovery immediately sank in. Jordan took a paper towel, wrapped it around the syringe and needle, and carefully placed them in a cabinet under the sink.

"You are my witness," she told Risley, who nodded gravely.


Back in Room 900, Cooper was responding to resuscitation efforts. Within fifteen minutes she was breathing on her own, and the paralysis throughout the rest of her body quickly eased. Though the tube down her throat prevented her from speaking, she indicated with gestures that she wanted to write a note. The supervising nurse on the floor that evening, Sharon Black, fetched a notebook and pencil and handed them to her. Cooper scrawled, "He put something in my IV." Black took the note, dated it "February 7, 1984," and wrote Cooper's name and patient number on it. Cooper was immediately removed to the intensive care unit, where she again asked for pencil and paper. This time she wrote, "Someone gave me some med in my IV and paralyzed all of me, lungs, heart, speech" and "someone gave me an injection in my IV and it paralyzed my lungs and heart."

As soon as the tube was removed and Cooper could speak, Dr. Freeman asked her what had happened. She reiterated that a blond-haired person had injected something into her IV; she had seen a syringe in the person's hand. She had never gotten a clear look at this person's face. As soon as he gave her the injection, she felt a "blackness" spread through her body, beginning in the left arm attached to the IV, then spreading from the left to the right side of her body. She became frightened when she tried to speak and couldn't, and with her dwindling strength began shaking the bed rails to attract attention. Then, she said, she saw a "white angel of death" at her bedside and stopped breathing.

Though Beery had the impression that none of the doctors believed her, Dr. Freeman pursued her declaration that Swango had been in the room. He described Swango to Cooper as a "tall, blond doctor" and asked if he might have been the person Cooper saw inject something in her IV. Cooper replied, "Yes, it was that person." Freeman ordered a blood test on Cooper to see if the cause of the paralysis could be determined.

Freeman returned to the ninth floor, where Swango was still on duty, and confronted him with the allegation that he had given Cooper an injection. Swango denied that he had even been in Cooper's room after the doctors finished their rounds. Later, after hearing more reports from nurses, Freeman again asked Swango if he was sure he had never been in the room. Swango repeated that he had had no contact with Cooper. As Freeman later put it, "I confronted him and did question him and he said he was not in the room. Nor did he see her just previous to the incident."


With Cooper seemingly safe in intensive care and the immediate crisis over, a sense of shock descended on the nurses. Though none of them had ever confronted anything like this in their careers, they felt that something had to be done. Black, the supervising nurse, told Nurses Beery and Jordan to write down everything they could remember, and she did the same. Beery wrote that Swango was in the room and "it appeared" that he injected something into Cooper's IV tube. Black collected their statements and placed them in a sealed envelope, which she left for the director of surgical nursing, who would be in the next day. Just after eleven P.M., Black also took the unusual step of calling Amy Moore, the head nurse, at home, and told her what had happened. Then Jordan, too, called Moore to tell her about the syringe Risley had found in Room 966. Moore was alarmed, especially since she had heard about Swango that same day from Ritchie, who had told her about his involvement in Barrick's death. She told Jordan to retrieve the syringe and place it in her, Moore's, briefcase, which was in her office.

Moore was already concerned about the startling increase in the number of codes and deaths on the ninth floor of Rhodes Hall in the prior few weeks, though only now did she begin to link them specifically with Swango. On January 14 -- just after Swango's meeting with Dr. Hunt -- Cynthia Ann McGee, an attractive young gymnast from the University of Illinois, had been found dead in Room 901. Six days later, twenty-one-year-old Richard DeLong was found dead in Room 964. A nurse had said Dr. Freeman, who responded to a code on DeLong, "was definitely stunned" by the sudden and mysterious death. Another patient on the ninth floor, forty-three-year-old Rein Walter, died unexpectedly on January 24 after a nurse found him gasping for air and turning blue. Swango had been working on the floor at the time of all of these deaths, and the coincidence was hard to miss. As one nurse, Lynnette Brinkman, had put it, there had been more codes on the ninth floor since Swango began his neurosurgery rotation than there had been in the entire prior year.

The next morning, Moore went to Jan Dickson, the associate executive director for nursing, the highest-ranking nurse at Ohio State. Dickson had earned high praise for restoring morale and building up the staff after a bitter and debilitating nurses' strike that had preceded her arrival. She loved working at large teaching hospitals, and had been in charge of nursing at the University of Kentucky before moving to Columbus. Dickson, forty-two, had grown up on a farm in northeast Missouri, not far from Swango's hometown of Quincy, where she had relatives. An attractive blonde, she had a warm, down-to-earth manner and the ability to bridge the often large gulf between nurses, doctors, and hospital administrators. She was dating Donald Boyanowski, an associate executive director of the hospital, so she also had unusual access to the hospital's inner workings and politics.

Dickson had never encountered a head nurse so shaken and upset. Moore related the previous night's incidents, told how she'd been called at home by both Black and Jordan, and mentioned her fears about the sudden increase in mysterious deaths on the floor where Swango was working. The story was so incredible that had Dickson not known Moore so well and trusted her judgment and maturity, she wouldn't have believed it. It was obvious to Dickson that something was terribly wrong in Rhodes Hall -- so wrong, in fact, that she thought the police would have to be notified.

That, however, was not a decision she could make alone. Dickson dispatched Moore to talk to Dr. Joseph Goodman, a professor of neurosurgery and the attending physician who had operated on Cooper's spine. Dickson also called to arrange a meeting with Donald Cramp, the hospital's executive director and top administrator. Cramp was alarmed and upset, and readily agreed with Dickson that there was an emergency. He immediately called Dr. Manuel Tzagournis, the university vice president for health services and dean of the College of Medicine, who scheduled a meeting for six that evening.

In Columbus, few figures are viewed with more reverence than Tzagournis, the quintessential Ohio boy made good. Though he reported directly to Ohio State's president, Edward H. Jennings, Tzagournis was close to members of the hospital's powerful board, some of whom were also university trustees. The board included such local luminaries as Charles Lazarus, chairman of the department store chain; John Wolfe, owner and chairman of The Columbus Dispatch; and Dean Jeffers, chairman of Nationwide Insurance. Tzagournis, a native of Youngstown, earned both his bachelor's and medical degrees from Ohio State and was a specialist in endocrinology, the study of the glands and hormones. He had cemented his ties to the hospital board by treating some of its members, not to mention prominent state legislators. Tzagournis's cousin, Harry Meshel, was the Ohio state Senate minority leader, and Vernal G. Riffe, Jr., the speaker of the Ohio House of Representatives, was one of Tzagournis's patients. (Ohio State received $229.4 million in state aid in fiscal 1984.) Tzagournis had become dean in 1981, transforming the office into a highly visible fund-raising position. Charming, sociable, and urbane, Tzagournis cultivated not only state legislators, but the local business and professional elite.

At the time, Tzagournis had been overseeing what was arguably the hospital's most important campaign -- the Arthur G. James Cancer Hospital, named after an oncologist at Ohio State and initially financed with $40 million from the state government. Ground was about to be broken on the new hospital when the Swango matter surfaced. The new hospital's prestige, success, and future operations depended on Ohio State's ability to attract additional donations, major research grants, and $12 million in additional funding from the state. This potential scandal could not have come at a worse time.

Before the scheduled meeting, Dickson summoned Beery and Jordan and asked them to read and sign typed versions of their handwritten statements from the previous night. Jordan took the opportunity to tell Dickson in greater detail about the McGee, DeLong, and Walter deaths and the nursing staff's suspicions of Swango -- a topic that was dominating conversation among the nurses that day. Like Moore, Jordan was extremely upset, and Dickson grew even more alarmed.

But the nurses were receiving a very different reaction from Dr. Goodman. Though relatively young, Goodman was perceived by some nurses as the epitome of the cold, detached, aloof, even arrogant surgeon. He was especially disdainful of questions from patients. Some complained they couldn't get answers from him, and nurses assigned to work with Goodman were warned that, as one put it, "he doesn't have much of a bedside manner."

Though nurses tended to be especially circumspect in Goodman's presence, Moore related the story she'd told Dickson. She told him about Risley's discovery of the syringe, and said she had the syringe in her briefcase. And she mentioned the other mysterious deaths, and the fact that Swango had been present for all of them. Goodman thanked her, then dismissed her without asking any questions or offering further instructions. He said nothing about what to do with the syringe.

Goodman's major concern was that the nurses' "grapevine," as he later put it, was overreacting and recklessly spreading virulent and unfounded gossip about a fellow doctor. He was annoyed that Swango was being arbitrarily linked to every death or unusual event in the hospital for the past year, and felt the situation was getting "out of hand." He didn't find anything unusual or suspicious about finding a used syringe on a hospital sink.

After conferring with Dr. Larry Carey, the chief of surgery, who had been notified by Cramp, Goodman asked Swango to come to his office. He told Swango that questions had been raised about his treatment of Rena Cooper, and said he thought he should take some time off from the hospital until the matter was cleared up. Goodman later observed that Swango appeared calm, even placid. He seemed entirely unaware that there had been any problem the previous night, and didn't show any undue concern or anxiety, a reaction that only reinforced Goodman's suspicion that nurses' gossip was the root of the problem. Goodman didn't ask Swango for any explanation or account of his activities.

Dr. Carey, too, spoke to Swango, mentioning that there had been an "incident report" concerning him that would need to be investigated. Unlike Goodman, Carey did ask Swango specifically whether he had "done anything" to Cooper or "injected anything in her IV." Swango said no, but then volunteered a detailed account that differed sharply from his answers to Dr. Freeman the night before. He said that he had gone into Cooper's room because either Cooper or Utz -- Carey couldn't remember which -- had told him her feet were cold, and asked him to fetch her slippers. He did so and left immediately, without doing anything to an IV line.

Carey told Swango that a committee would be meeting that evening to consider his status, and suggested he wait outside for the results.

Dr. Carey also spoke to Dr. Hunt, the head of neurosurgery, who had admitted Swango to the residency program. Goodman was widely viewed as Hunt's protégé, though Hunt was more personable and outgoing. Hunt, too, was a graduate of Ohio State's medical school, and was a Columbus native. Hunt had been married for years to Charlotte Curtis, long the highest-ranking woman at The New York Times, a member of the paper's editorial board. After her death he married Carole Miller, a former resident of his who had joined the neurosurgery staff at Ohio State. Hunt had long taken a professional interest in the residents' program; as a member of the American Board of Neurological Surgery, he was in charge of graduate medical education. Hunt was urbane and nationally known, spending time in New York and at his summer home on the coast of Maine.

Both Hunt and Carey were aware of some cases at other hospitals in which residents sued after being fired and the hospitals were ordered to reinstate them. They didn't want to be sued by Swango as a result of unfounded charges and nurses' gossip, and then be ordered to reinstate him.

Hunt immediately called Cramp, the hospital's executive director, and said a lawyer should attend that evening's meeting. Hunt thus appears to have been the first person involved in the matter who recognized that the situation might threaten Ohio State with possible legal liability. Besides fears of a lawsuit by Swango, there were also possible suits by patients to consider.

The questions about Swango coincided with what is generally referred to as the second malpractice insurance "crisis." The first of these occurred in the mid-1970s, when doctors' insurance premiums shot up, on average, 500 percent. During the second "crisis," in the mid-1980s, the U.S. General Accounting Office reported that malpractice insurance costs for physicians nearly doubled between 1983 and 1985, rising from $2.5 billion to $4.7 billion. The St. Paul Fire and Marine Insurance Company, the largest underwriter of medical malpractice insurance, reported a 55 percent increase in claims from 1980 to 1984. And the GAO reported that damage awards increased over 100 percent in some states in the same period. This "crisis" received enormous publicity, especially in the medical press, and fueled intense concern and resentment on the part of many doctors.

The issue of potential legal liability was especially sensitive at Ohio State, because, as a large state-financed and taxpayer-supported institution, the university was largely self-insured. Though individual doctors carried malpractice insurance and were subject to the explosion in premium costs, judgments against the hospitals, the medical school, or the university itself were paid by the university, which meant the money ultimately came out of taxpayers' pockets. Because of Ohio State's unusual status, the office of the Ohio attorney general, an elected official, served as the university's lawyer. One assistant attorney general, Robert Holder, maintained an office on the Ohio State campus and worked full-time on university matters, including issues at the medical college. Indeed, Holder and Tzagournis had worked closely together and had become friends. Cramp called Holder, who was out that day. He then called Richard Jackson, vice president of the university for business and finance. Jackson in turn asked Alphonse Cincione, a probate lawyer with a downtown Columbus law firm, to represent the university at the meeting.

The group convened at 6:30 that evening in a large conference room at the university hospital. Tzagournis did not attend, nor did Michael Whitcomb, the hospital's medical director, whom no one had been able to reach. Dickson was there as head of nursing, as were hospital administrators Cramp and Boyanowski. Cincione functioned as legal counsel. The only doctors present were Goodman, Carey, and Hunt. Goodman and Hunt had already expressed their skepticism of the nurses' claims.

Just a few years earlier, Carey had hired and brought to Ohio State a surgeon with a criminal record. The surgeon, an old friend of Carey's, had been fined and sentenced to six months' hard labor after pleading guilty to eleven counts of attempted sodomy, indecent assault, committing lewd and indecent acts, and using his position to solicit sexual favors from women subordinates while he was chief of surgery at a Philadelphia hospital. Though the prosecutor had characterized the offenses as "crimes of violence, crimes that shock the conscience," in 1982 Carey recommended to the Ohio Medical Board that the doctor be licensed to practice medicine, saying that the sex crimes were "misbehavior at worst. From my point of view, they are not the kind of charges that ought to permanently damage a man's career." Tzagournis had approved hiring the surgeon even after Carey informed him of the doctor's criminal record.

Knowing this history, Dickson considered the possibility that the doctors' first instinct might be to rally around Swango, a fellow doctor. She had seen how protective of one another doctors were, both at Ohio State and in other hospitals where she had worked. Yet these circumstances were extraordinary, with the lives of patients possibly at stake. She took the lead, presenting the evidence she had been able to collect during the course of the day. She reviewed the Cooper incident, described Utz's observations, mentioned the syringe found by Risley, and briefly reviewed the McGee, DeLong, Walter, and Barrick cases. Then she listened with mounting dismay as the doctors undercut the gravity of her disclosures. She thought the doctors seemed more concerned about Swango's rights than they did the patients' lives.

Hunt immediately cast doubt on anything Utz might have said, noting that she was awaiting treatment for a brain tumor. The group discussed what might have caused Cooper's respiratory arrest, and while conceding that a toxic drug might be one explanation, the doctors noted that there might also be many others.

Dickson and Boyanowski thought the evidence was sufficiently serious and compelling that the police should be notified. Cincione, the lawyer, disagreed and said there was no evidence any crime had been committed, nor was there enough evidence to know how to proceed. Cincione recommended that the hospital's medical staff -- the doctors -- conduct a discreet internal investigation.

Dickson, Boyanowski, and Cramp all thought it was a mistake for the hospital to try to investigate itself, but they deferred to Cincione's legal judgment. Dickson was expressly ordered not to question any nurses further -- this because of the fear, first expressed by Dr. Goodman, that to do so would only fuel the nurses' "tensions and concerns," which might in turn alarm patients. Instead, Goodman himself, who from the outset had been highly skeptical of the nurses' claims, took charge of the investigation. He agreed to report his findings to the group at a meeting the following Saturday morning.

The meeting ended at about eight P.M. Swango had been sitting on a bench in the lobby. Dr. Carey suggested he "go home for a few days" because of the incident report. Swango took the news calmly.

Dickson was upset by the meeting, but felt if she could only get her message across to Tzagournis, whom she knew and respected, he would surely recognize how serious the situation was. She couldn't reach the dean, so she called Holder, the assistant attorney general, who had been briefed on the meeting by Cincione, to try the same tack. She asked him to meet with her in her office, which he did the next day. Holder insisted on deferring to Cincione's judgment that there wasn't any credible evidence of a crime and they should await the results of Goodman's investigation, but he did agree to pass on Dickson's request to meet with Tzagournis. The next day, Dickson narrated the alarming events to the dean; she thought he at least listened carefully. Tzagournis seemed to recognize the gravity of the matter, and though he made no commitments, she felt she was making headway.

On February 9, the day after the meeting, Goodman began what would prove to be a pivotal investigation of Swango's activities. His investigation had three components. At 3:30 P.M., he interviewed Cooper; next, he reviewed the files of seven patients who had died since Swango began his neurosurgery rotation; last, he considered the results of a blood test on Cooper. He did not interview either of the residents, Freeman and Brakel, who responded to the code on Cooper. Had he interviewed Brakel, he would have learned more about Swango's involvement in Ruth Barrick's death the same day, since Brakel had responded to Barrick's code as well.

Nor did Goodman interview any of the nurses who witnessed the events, or the orderly who discovered the syringe, or Utz, Cooper's roommate. He did not ask to see the syringe, still in Nurse Moore's custody. He didn't speak to any witnesses to any of the patient deaths, such as Nurse Ritchie. No autopsies or physical tests were ordered for any of the possible victims, nor were any experts in toxicology or anesthesia consulted for possible explanations of the deaths and of Cooper's apparent paralysis. While Goodman did not purport to be a trained investigator, the extremely limited scope of his inquiry is hard to comprehend unless he had already largely concluded that Swango was innocent and that the nurses' "grapevine," as he had put it, was largely to blame for the rumors sweeping the hospital. These were sentiments he had expressed from the outset.

The following statements appear in a memorandum Goodman wrote the next day, summarizing the interview with Cooper: "Someone was standing by the bed and injected something into the I.V."; "Blonde, short, unable to see face"; "Yellow pharmacy jacket."

Goodman's principal reaction to the interview seems to have been distress that Cooper was spreading stories that were agitating other patients. He called Cramp, the hospital chief, at 4:30 P.M. to complain that rumors about Swango were "rampant" on the floor and to say he was moving Cooper to a private room to stop them. Although Cramp objected, Goodman did so. He also ordered that only Amy Moore, the head nurse, would be allowed contact with Cooper; this move, too, was intended to contain her inflammatory allegations.

That Saturday morning, the initial group involved in the matter met to hear Goodman's report and conclusions. Three important people joined this meeting: Holder, Tzagournis, and Michael Whitcomb, the hospital medical director, a close friend and protégé of Tzagournis. Although Dickson and others had urged that the university president, Edward Jennings, and Richard Jackson, the vice president, attend, Tzagournis had decided that there was no need.

To Dickson's amazement, Goodman was even more dismissive of the allegations against Swango than he had been at the first meeting. His interview with Cooper, he assured the group, had gone a long way toward eliminating the possibility that Swango had been involved in foul play of any kind. Goodman reported that Cooper had identified the alleged assailant as a "female" and "neither a nurse nor physician on the hospital staff." Since his notes also indicated the person was wearing a "yellow pharmacy jacket," he concluded the suspect was probably a woman pharmacy technician, and he had already determined that there was no one who fit that description.

Virtually everything about Goodman's conclusions and interview with Cooper is puzzling. Cooper insisted she never described her assailant as a "female." Indeed, in her numerous other accounts of the incident, Cooper said consistently that she couldn't see the person's face, and whenever she identified her attacker's sex she said he was male. In her first handwritten note she referred to the assailant as "he." Nor, she maintained, did she ever mention anything about a yellow pharmacy jacket; her roommate did refer to a yellow tourniquet. Goodman said that Nurse Moore was a witness to the interview and, by implication, would support his account. However, Cooper herself said she remembered that only Goodman was present. In any event, at the time participants in the meeting had only Goodman's version.

Goodman also reported on his review of the files of patients who died. While he conceded that seven deaths in a little more than two weeks was abnormally high (he said the norm was two or three), he said that all the patients had been "extremely ill" and that the deaths were "clearly explainable medically." As another doctor put it, sometimes the "grim reaper of death" just sweeps through a hospital. While Goodman also conceded that Swango had been present when at least half the patients died, this was only to be expected given that he was an intern assigned to the floor, working long hours. The only death that caused Goodman any concern at all, he said, was that of Cynthia Ann McGee, the young gymnast. Goodman noted that she had been improving and that the sudden death had come as a surprise. But an autopsy had been performed, and Goodman said he'd been told the cause of death was a pulmonary embolism. Such embolisms aren't uncommon in cases where patients have been transported, as McGee had been from Illinois, he explained. Goodman's colleague and mentor Dr. Hunt said he, too, had reviewed the patient files and seconded Goodman's conclusions.

McGee's autopsy results in fact cite "cardiopulmonary arrest due to incipient pneumonia" as the cause of death. There is no mention of a pulmonary embolism.

Finally, the group discussed the results of the blood test on Cooper. But no such blood test results were ever found in Cooper's medical file. It is at least possible that the blood test ordered by Freeman was never administered, or that the results were lost. The notes of the meeting don't make clear whether Goodman reviewed the results himself, or relied on a hearsay report that they were normal. In either case, the results may have come from a blood test given Cooper when she entered the hospital; they were in her file and, not surprisingly, showed nothing suspicious.

That was the end of the investigation as far as Goodman was concerned.

The group did consider some troublesome evidence that seemed to call Goodman's conclusions into question. Dickson, for example, circulated the written eyewitness accounts of the Cooper incident she'd collected from the nurses, including Karolyn Beery, who had been only several feet from Swango when she saw him inject something into Cooper's IV line. She also showed the meeting participants Cooper's handwritten notes. Dr. Carey reported on his conversation with Swango, in which he denied injecting anything into Cooper's IV, a statement also in conflict with Beery's observations. But the doctors, especially Goodman and Whitcomb, dismissed their significance, noting disdainfully that Beery was a student nurse. "What does a student nurse know?" one of the doctors asked, to knowing snickers around the table. The comment left Dickson quietly seething.

Swango's file was reviewed, and the group discussed the evidence suggesting that he had "attitudinal problems." Carey mentioned the residents' reports that Swango had "weird ideas about death," that he was fascinated by the Nazis, and that his work was "sub-standard." But Cincione's sketchy notes of the meeting conclude only that "this discussion shed no light on the situation at hand." Nor could any support for the proposition that a pharmaceutical technician was the culprit be produced. Boyanowski, the administrator, had investigated that possibility, and there were no "blonde, female" technicians. Cooper hadn't been scheduled to receive any medication during the relevant time period.

The group also discussed at some length what might have caused Cooper's respiratory failure, a fact which could hardly be ascribed to nurses' paranoia. Potassium was mentioned as a chemical that, when injected, can easily cause cardiac arrest, but the doctors pointed out that Cooper didn't suffer a heart attack; she experienced a respiratory failure. Her IV line had been discarded, so no tests on it were possible. Curiously, the mention of possible tests on the IV line triggered no mention of the syringe by Goodman, although he had been told of its existence by Nurse Moore. The group concluded that the cause of Cooper's seizure was probably unknowable.

Then the lawyers weighed in. Without knowing the cause of Cooper's code, Cincione told the group, they had no legal basis for accusing Swango of a criminal act or, for that matter, even removing him from the intern program. But while the lawyers seemed to have been focusing on Swango's rights and the potential liability of Ohio State, they seem to have given no consideration to an Ohio statute that requires any "physician" to report "any serious physical harm to persons that he knows or has reasonable cause to believe resulted from an offense of violence." In any event, these requirements were never mentioned at any of the group's meetings, despite the presence of two lawyers, Holder and Cincione.

The meeting lasted about three hours. At its conclusion, Tzagournis ordered that Swango be returned to the hospital, but watched closely. He asked Dr. Whitcomb to conduct a "quiet inquiry" into the matter, and report his findings at another meeting in three days. At least some participants understood that the report was to be in writing. Both Dickson and Boyanowski objected, again arguing that the hospital couldn't effectively investigate itself, and that there was enough evidence to justify notification of the campus police. But Tzagournis disagreed, no doubt in part because he was steeped in the medical profession's tradition of "peer review," in which only other doctors are deemed competent to evaluate a fellow physician. Dickson, increasingly troubled by the direction of the inquiry, asked if she could assist Whitcomb by at least being present at interviews with the nurses. Tzagournis said no.

As Ohio State's medical director, Whitcomb held the number two medical position in the hospital, just under Tzagournis. Like his boss, Whitcomb was an Ohio native and graduate of Ohio State, though he attended medical school at the University of Cincinnati. He worked at Walter Reed Army Hospital before returning to Ohio State in 1974. He was largely given responsibility for the investigation by virtue of his position as medical director, and because he was a pulmonologist, or lung specialist, it made some sense to assign him to investigate what appeared to be a respiratory failure.

But Whitcomb looked terrible, as if he hadn't had much sleep. It hadn't surprised anyone that he couldn't be located in time for the first meeting. It was much discussed in the hospital that he had been having an affair with his secretary, and was involved in a messy divorce. At the meeting Whitcomb's hands were visibly trembling, so much so that Dickson later asked if he was suffering from some neurological condition. (He later publicly acknowledged a drinking problem.)

Some who felt Swango should be vigorously investigated were dismayed that Whitcomb was put in charge, and their concerns were soon borne out, for Whitcomb's investigation was even more cursory than Goodman's. He spoke to Goodman and reviewed his notes; interviewed Beery, the student nurse; and, significantly, interviewed Swango. He did little else. Incredibly, he may not even have interviewed Rena Cooper, relying instead on Goodman's notes. (Cooper later insisted that Whitcomb never interviewed her.) Whitcomb kept no notes of his investigation and prepared no written conclusions. He delivered his report orally on February 14, 1984, to the same audience, which included Tzagournis and Holder.

Whitcomb concluded that no one in the hospital fit the description of a blond female wearing a yellow pharmacy jacket. For all practical purposes, that description ruled out Swango as a suspect. In any event, Cooper's observations weren't reliable. She was no doubt "confused," he said, which wasn't surprising since she had been given an anesthetic for her surgery earlier that day. Utz, the roommate, was also unreliable, as Hunt had earlier noted, because she had a brain tumor. Whitcomb hadn't interviewed her, either, but he did go over her patient file.

During Whitcomb's interview, Beery, the student nurse, had softened her earlier account. Under what must have felt like cross-examination by Whitcomb, Beery acknowledged that she was "not certain" she actually saw a syringe in Swango's hand. This, Whitcomb maintained, was inconsistent with her earlier statement that it "appeared" that Swango had injected something into Cooper's IV. Because of this, Whitcomb told the group that Beery's "identification testimony" was "shaky," noting that she had been in the room only a short time. As he had suspected, she was an unreliable witness and her statement should be discounted accordingly. Thus, Beery's statement in every interview that she had seen Swango in Cooper's room and had been only a few feet away was also discarded as unreliable.

In diagnosing the cause of Cooper's respiratory arrest, Whitcomb identified the fact that she shook the bed rails as all but incontrovertible evidence of a seizure followed by paralysis. (The possibility that Cooper could have rattled the rails before a paralyzing drug took full effect does not appear to have been considered.) Whitcomb had spoken briefly to Dr. George Paulson, a neurologist at Ohio State, who said that it was "possible" for a seizure to be followed by paralysis. By contrast, drugs such as muscle relaxants might cause paralysis, but not a seizure. On that basis, and without speaking to any other specialists, such as anesthesiologists, Whitcomb diagnosed Cooper's problem as "grand mal," a severe form of epilepsy characterized by seizures and loss of consciousness -- but not paralysis.

Whitcomb told the group he'd interviewed Swango, and that Swango had given him a version of the "slippers" story, in which Cooper had complained that her feet were cold. However, Whitcomb later told police an entirely different story: that Swango told him he was in the room to draw blood.

Nonetheless, Swango's account appears to have been accepted as credible, even as Beery's and Cooper's versions were dismissed as unreliable and confused.

That was the end of Whitcomb's report. As Hunt later summed up the evidence, "All we have is a crazy patient who had an unusual episode and a nurse who saw something. Is that enough to prove anything?" Tzagournis ordered that Swango, who had already returned to his work in the hospital, should resume h is internship. The residents who worked with him in Rhodes Hall should be told that there wasn't any evidence against him, but that he should nonetheless be "closely observed."

The nurses, on the other hand, should be told only that Swango had been exonerated. And other doctors, including those on Swango's future rotations, would be told nothing. On Tzagournis's orders, there would be no further inquiry or investigation into the matter, and the police would be told nothing of the incident or the sudden increase in deaths.

Dickson had by now fallen into stunned silence. Swango's accusers were all female nurses; his defenders, male doctors. She was convinced that the entire point of the so-called investigation had been to exonerate Swango and thereby avoid any liability or embarrassment to the university. She had tried to see the patient files herself; she was denied access. She felt it would now be impossible to observe Swango closely in the hospital. There was too much to do, and too few doctors who had been alerted to Swango's suspicious activities, to keep him under close surveillance, especially if the nurses and most of the doctors were kept in the dark. Still, she felt she had done what she could, at considerable personal risk. Now that Swango was back at work, and she had emerged as the strongest advocate for his dismissal, she thought it likely that someone on the medical staff would tell Swango. She was afraid to walk her dog at night alone, even in the safe neighborhood where she lived. She was afraid Swango would kill her.

Karolyn Beery, the discredited student nurse, was also frightened, and tried to avoid Swango. She and other nurses usually brought bag lunches to work, which they labeled with their names and kept in a refrigerator. "Who's been messing with my lunch?" Beery asked a group of nurses one day, explaining that for several days, it had been obvious that her food had been rearranged in the bag. Then she started to feel nauseated, and developed headaches. She thought she might be pregnant, but three separate pregnancy tests were negative. After several weeks, when Swango left the neurosurgery rotation, her symptoms eased. She wondered if she was just being paranoid.

Dr. Carey met with all the residents on the rotations remaining on Swango's schedule. He told them he was "worried" about Swango, that he wanted them to watch him closely and "report to me any untoward events, any patients that had complications or difficulties that weren't expected." As he later put it, "Our intent was to do everything possible to protect people from harm and get him out the door at the end of the year without risk that a court would order us to reappoint him."


On the same day as the meeting in which Swango was exonerated, Charlotte Warner, a seventy-two-year-old leukemia patient, had a routine splenectomy performed by Dr. Marc Cooperman. The operation went well and she recovered sufficiently to be transferred out of intensive care to Room 968 in Doan Hall.

Swango began working in Doan Hall on February 18 as part of his general surgery rotation. The next day, Cooperman met with Warner, found his patient to be doing very well, and talked with her about when she wished to be released from the hospital. That night, a nurse found her slumped on the floor by her bed. She was dead. An autopsy concluded she had suffered massive and unexplained blood clots all over her body, including the liver, lungs, kidneys, and left coronary artery.

Dr. Cooperman was mystified and upset. As he later put it, "Basically what happened is she had developed clots in the arteries in her heart, in the vessels to the intestine, in the vessels to her kidneys, to her liver, and to her lungs. And I could never understand why this thing would have happened to somebody who had undergone a straightforward surgical procedure five days earlier and was walking around having no problems."

That same month while Swango was in general surgery, he examined another surgical patient, Evelyn Pereny, with her attending physician, Dr. Carey. Later, the chief surgical resident, Gary Birken, was urgently summoned to Pereny's bedside. She was bleeding all over her body -- even from her eyes. As Dr. Birken noted, her coagulation was "off the wall," as if she had been bitten by a poisonous snake, such as a "cobra."

On the afternoon of February 20, Mary Popko came to visit her twenty-two-year-old daughter, Anna Mae, who had undergone intestinal surgery for a deformed bowel. She was sitting with her daughter when Swango asked her to leave the room so he could give Anna Mae an injection to raise her blood pressure. Popko asked to remain so she could hold her daughter's hand. Swango refused, and she reluctantly left the room. Later that afternoon, Swango summoned Popko to a small conference room. He leaned back and put his feet on the table. "She's dead now," Swango said of Popko's daughter. "You can go look at her."

Popko later complained about what she considered Swango's inappropriate comments and demeanor. "It seemed like it lifted his ego or something," she said of her daughter's death. "He just seemed so happy."

Despite Dr. Carey's warning, none of the residents who had been alerted about Swango reported anything unusual.


Swango completed his general surgery rotation and in April moved to Children's Hospital for his pediatrics rotation. Swango had often mentioned to his fellow interns and residents how much he loved fried chicken, and one night he offered to get Kentucky Fried Chicken for the residents on duty with him. Thomas Vara, the senior resident, said that would be fine, but suggested, "Instead of getting separate boxes, why don't you get a big bucket for all of us to eat?"

"No, no," Swango said. "Let's keep it separate." He insisted on taking everyone's chicken and drink order. He returned with the orders about five P.M.

"It's extra spicy chicken," Swango told Ed Hashimoto, one of the residents, as he gave him his food. That was news to Hashimoto. He knew that Kentucky Fried offered "extra crispy" chicken, but he'd never heard of "extra spicy."

Vara, Hashimoto, and a third resident, Douglas Hess, ate the chicken. About three hours later, all three fell violently ill, with fever, nausea, and vomiting that lasted over a week.

As Vara later described it, "It's as sick as I've ever been. We were sick there at the hospital. The other guys were, Jesus...like in the operating room vomiting in their masks and stuff. That's how bad it was."

When the doctors later discussed the episode, they thought maybe they'd suffered a violent reaction to something in the chicken. But then they tended to discount their own theory. After all, Swango, too, had eaten Kentucky Fried Chicken. He hadn't been sick at all.


Cooper, the elderly born-again Christian whose brush with death had triggered the investigation of Swango, recovered from her back surgery and mysterious respiratory arrest without further incident. Before she was released, the hospital prepared a written "discharge summary," which became a part of her permanent hospital record, something that would be produced in the event of any lawsuit. The summary contains a description of the Swango incident:

Post operatively during the evening of surgery, the patient had a witnessed pulmonary arrest. She was noted to have seizure-like activity just prior to this arrest...when the patient received adequate oxygenation via endotracheal intubation. She was awakened and was intact neurologically. However, her sensorium was noted to be unusual in that she had apparent paranoid ideation as to the cause of her respiratory arrest. The patient gave indication that she entertained some paranoid ideation regarding the cause of her respiratory arrest and felt that it may be due to unnamed person or persons. The patient was carefully observed for further psychologic parameters of this nature....

In other words, in the official opinion of the hospital that had treated her, and where she nearly died, Cooper was mentally unstable -- "paranoid."

Copyright © 1999 by James B. Stewart

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Introduction

Prologue Keneas Mzezewa had dozed off for a nap that May afternoon, but was awakened at about two p.m. when he felt someone removing his loose-fitting pajama trousers. He lifted his head, still a bit groggy from sleep, and saw that it was Dr. Mike. The handsome American doctor had a syringe in his hand, and seemed about to give him an injection, so Mzezewa, eager to help, pulled down his trousers and turned on his side. Then the doctor plunged the unusually large needle into his right buttock. Mzezewa saw that after he finished the injection, the doctor concealed the used syringe in the pocket of his white medical coat.

"Good-bye," Dr. Mike said softly, pausing briefly to look back at Mzezewa.

Then he left the hospital ward.


Howard Mpofu, the director of hospitals for the Evangelical Lutheran Church in Zimbabwe, liked the new doctor the minute he met him, in November 1994, when he picked him up at the Bulawayo city airport. Michael Swango looked like the American athletes Mpofu had seen on television. He was blond and blue-eyed, taller than Mpofu, with a ready smile. According to the résumé the church had received, he was forty years old, but he looked younger. Mpofu tried to help Swango with his duffel bags, but the doctor wouldn't hear of it. He quickly hoisted the heavy bags and insisted on carrying them to the car himself.

On the ride into the city, Swango was garrulous, flushed with excitement at his new assignment. Mpofu asked why Swango had wanted to come to Zimbabwe to take up a post that would pay him a small fraction of what he could earn in the United States. After all, Swango was an honor student; he'd graduated from an American medical school and had completed an internship at the prestigious Ohio State University Hospitals, which meant he could go anywhere. "All my life," Swango told him, "I have dreamed of helping the poor and the disadvantaged." He said America had plenty of doctors, but in Africa, he would be truly needed. Mpofu couldn't argue with that.

When they reached the Lutheran church headquarters in central Bulawayo, they walked up one flight of stairs to the church offices, and Mpofu introduced Swango to the Lutheran bishop of Zimbabwe. To the amazement of the church officials, Swango knelt before the bishop and kissed the floor. He said he was so grateful to have been hired and to be in Zimbabwe at last.

The bishop seemed equally delighted. Indeed, he and Mpofu were overjoyed simply to have succeeded in recruiting an American doctor for one of their mission hospitals, let alone one willing to kiss the ground at their feet. Before Swango, the only European or American doctors the church had succeeded in bringing to Zimbabwe were Evangelical Lutherans from church headquarters in Sweden, and none of them stayed more than a few years.

Not many foreign doctors -- even from places like Eastern Europe and Asia -- wanted to come to Zimbabwe, the former British colony of Rhodesia, which lies between Mozambique and Botswana, just north of South Africa. Before the end of the white supremacist regime of Ian Smith and the holding of supervised elections in 1980, the country had endured a prolonged civil war. And after independence came the consolidation of dictatorial power by the mercurial Robert Mugabe, who, among other controversial pronouncements, has denounced homosexuals as "perverts" who are "worse than dogs and pigs." Since independence, the country has experienced the suppression of human rights, the collapse of its currency, a steep decline in the standard of living, and the emigration of much of its white population. Fully 25 percent of the adult population of Zimbabwe is estimated to be infected with HIV, the highest infection rate in the world. At times the country's hospital system has been plunged into turmoil, and there is a critical shortage of doctors.

With a population of about 650,000, Bulawayo is Zimbabwe's second-largest city, the capital of the province of Matabeleland, once a powerful African nation in its own right. For the most part, the local population speaks Ndebele, a linguistic cousin of Zulu, whereas the Zimbabwean majority speaks Shona. A debilitating civil war between the two ethnic groups broke out almost immediately after Zimbabwe gained independence, and though a truce was reached, simmering tensions persist.

Bulawayo residents complain that the city has been neglected by the national government because of continuing ethnic discrimination against the Ndebele. But a result of that neglect has been that the colonial-era architecture and city plan have been largely unmarred by the building boom that has swept Harare, the nation's capital. Even the cars generally date from the fifties and sixties, owing to years of international economic embargo during white-supremacist rule and the collapse of the Zimbabwean dollar following independence. Many people in Bulawayo seem to prefer the atmosphere of faded gentility, especially the fifty thousand or so remaining whites, most of British descent. These days few live lavishly; there is little conspicuous wealth. But they praise the city's unhurried pace (nearly all businesses seem to close by three p.m.); the nearly ideal climate of the high African veldt, in which even summer temperatures almost never reach ninety degrees; the gracious residential neighborhoods of walled villas and jacaranda-lined streets. Most white people still return home for a lunch prepared by black servants. They congregate at the Bulawayo Golf Club, the oldest club in Zimbabwe, with manicured fairways and a swimming pool, and the Bulawayo Club, an imposing beaux-arts mansion downtown.

By contrast, the orderly grid of colonial Bulawayo is surrounded by scores of "settlements," in which thousands of black people live crowded into small houses and shanties along dirt roads that seem to have been laid down at random. Many commute into the city on aging, diesel-fume-spewing buses, and the central bus terminal is a colorful and chaotic mass of shouting passengers, piles of goods and luggage, buses, taxis, bicycles, and handcarts. There is an almost eerie sense of a time warp in Bulawayo. In the award-winning 1988 film A World Apart, it stood in for 1960s Johannesburg.

Swango spent his first night in Zimbabwe at the Selborne, a colonial-era hotel whose wide verandah overlooks the city's bustling central square. The next morning, Mpofu picked him up for the drive to the church's mission hospital at Mnene. Mpofu had made the six-hour drive many times, and he was accustomed to the dismay of first-time visitors as the pavement gave way to a dirt road so rough that a four-wheel-drive vehicle or truck is required. Yet Swango voiced no complaints as they ventured ever farther from what most Americans would consider civilization.

Mnene -- a cluster of buildings -- can't be found on many maps. It lies in the region of Mberengwa in south-central Zimbabwe, in what in colonial times were known as the tribal lands of Belingwe, in the heart of the bush. Inhabitants identify themselves by the name of their tribal chief; the land is still owned communally, and the local people's life of subsistence farming has changed little for generations. There are no towns to speak of, scant electricity, almost no telephones. Most people live in extended family units in clusters of mud-walled buildings with thatched roofs. The landscape is often stunningly beautiful: verdant valleys give way to distant panoramas of mountain ranges. Drought and malaria are constant threats, in part because the lower elevation makes the climate more tropical than it is on the high plateau where most of the white population lives.

The region is served by three hospitals, one of them also called Mnene, all founded in the early part of the century by Evangelical Lutheran missionaries. Mnene Mission hospital, a cluster of one-story whitewashed buildings with corrugated metal roofs and wide verandahs, is set atop a hill with distant views and refreshing breezes. The buildings look much the same as they do in a photograph taken in 1927, when the hospital was built.

When Mpofu and Swango finally arrived, Dr. Christopher Zshiri, the hospital director, hurried out to greet them. He introduced Swango to Dr. Jan Larsson, a Swedish missionary doctor who was the other member of Mnene's medical staff, and showed Swango to his quarters, a spacious bungalow with a verandah, adjacent to the hospital. Zshiri is a native Zimbabwean. Under the country's system of socialized health care, he reported to the provincial medical administrator in Gweru and was paid by the government, even though nominally he worked for the Lutheran church. Even more than the others, Zshiri thought it was almost too good to be true that they had managed to recruit an American doctor to a place like Mnene.

Zshiri and Swango soon became friends. Zshiri couldn't get over how talkative Swango was, always eager for conversation and filled with curiosity. After his arrival, Swango had garnered glowing reports from patients and staff members. He was soon known to everyone as "Dr. Mike." It was true that he lacked experience in general surgery and obstetrics, two areas most in demand at Mnene. After a month at Mnene, Zshiri sent him to Mpilo Hospital in Bulawayo, where Swango spent the next five months gaining additional clinical experience. The doctors at Mpilo wrote glowing recommendations, and Swango was far more confident and proficient when he returned to Mnene in late May. He was seen as a nearly tireless worker, able to complete forty-eight-hour stints without sleep. He even worked extra shifts, giving up his free time. Of course, at Mnene, there was little else to do. Even the indefatigably cheerful Swango finally complained about the isolation, asking Zshiri if the church could possibly provide him with use of a car, since he couldn't afford one. Fearful that Swango might decide to leave, Zshiri wrote church officials a letter asking whether there wasn't some way they could accommodate him.

Swango often made extra rounds to check on his patients, sometimes at night or during afternoons when he was otherwise off-duty. So when Dr. Swango arrived in the surgery recovery room one May afternoon in 1995 to check on Keneas Mzezewa, the only patient there, no one thought it unusual, even though Swango had already completed his rounds that morning, and technically Mzezewa wasn't his patient.

Mzezewa had recently had his foot amputated by Dr. Larsson. A farmer in the Mberengwa area who was also a part-time laborer at the nearby Sandawana emerald mine, Mzezewa had come to the hospital the previous week complaining about severe pains in his leg. A tall, slender man with a wide smile, Mzezewa had reacted calmly to the news that his infected foot would be amputated. The doctor reassured him that he would be fitted with a prosthesis and should be able to lead a normal life once he returned to his farmstead. The operation had been uneventful, but Mzezewa had been kept in the recovery ward for close monitoring, which was routine in amputation cases. Dr. Larsson had been pleased with his progress, and mentioned to Zshiri how well Mzezewa was doing.

That afternoon Mzezewa was awakened from his nap by the new doctor, Dr. Mike. Before the doctor gave him the injection, Mzezewa noticed, he neglected to swab the skin with disinfectant. Mzezewa also noticed that when Dr. Mike put the used syringe in his jacket pocket, the needle's cover fell to the floor near his bed.

Still, it seemed a routine visit. Despite the large size of the needle, Mzezewa didn't mind the pain. He relaxed and lay back on his bed, prepared to resume his nap. But as the drug given him by the doctor spread through his body, he began to feel a strange loss of sensation in all his muscles. With mounting alarm, he realized that he couldn't turn over and couldn't move his arms or legs. He wanted to speak or cry out, but his jaws, tongue, and throat wouldn't respond. Then the room, brightly lit by the afternoon sun, grew dim. Soon all was darkness.

Mzezewa didn't know how much time passed while he lay there, alive and conscious but paralyzed and terrified. But then the darkness began to lift; he could see, though he still couldn't move his head. A nurse's aide entered the recovery ward and came over to his bedside. She held a thermometer and told him it was time to take his temperature. Mzezewa's mind was racing. His heart beat furiously. He wanted to cry out, but he couldn't make a sound. He could hear the aide, but he couldn't move; his muscles wouldn't respond. She asked him to move his arm so she could put the thermometer in his armpit. He lay motionless. She asked him again. Suddenly the aide looked alarmed, and ran from the ward.

Moments later, Mzezewa regained his voice. He screamed and began shouting to attract attention, though he still could not produce recognizable words. A nurse came rushing into the ward, followed by the aide. She came and stroked his hand, trying to calm him, asking him what had happened. But he was still unable to speak. Two more nurses arrived.

Slowly Mzezewa regained his voice. "Dr. Mike gave me an injection," he finally gasped. The nurses were puzzled, for while Mzezewa was taking oral painkilling medication, he was not scheduled for any injections. In any event, injections were administered by the nursing staff, not by the doctors.

Then Swango himself came into the ward, coolly appraising the commotion. Mzezewa looked terrified. The nurses fell silent.

"Did you give him an injection?" a nurse finally asked. "What was it?"

Swango seemed mystified. "He must be delirious," he said. "I didn't give him any injection."

Copyright © 1999 by James B. Stewart

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Interviews & Essays

On Monday, August 23rd, bn.com welcomed James Stewart to discuss BLIND EYE.

Moderator: Welcome, James Stewart! Thanks for joining us this evening to discuss your latest true crime book, BLIND EYE. How are you this evening?

James B. Stewart: Fine, thank you.


Marcus from California: How did you become interested in the Swango case, and when did you decide it would be the topic of your next book?

James B. Stewart: I first became interested when the judge in Illinois who had convicted Swango of poisoning his coworkers in 1985 called me to say that he had just heard that Swango had been arrested at Chicago's O'Hare airport, and he knew that Swango kept getting new jobs at hospitals. He was very upset about this. He said that by writing about this it would bring him to national attention and stop him from getting new jobs. The truth about Swango turned out to be far worse than the judge suspected. As to when I decided to write a book about this, I originally wrote about Swango in The New Yorker. My editor at Simon and Schuster has long had a rule of thumb that is very wise, and that is if you write a magazine article you probably don't need to write a book. But this is the rare case where there were so many unanswered questions in the case, my curiosity almost compelled me to keep working on the story, and I quickly realized that both in the seriousness of the topic and the drama of the story, it should be a book. In terms of time, the judge called me in September of 1997 and by November/December I was determined to write a book about it.


Katie Harrell from Alexandria, VA: "Innocent until proven guilty," but Swango was proven guilty early in his medical career. Wouldn't this charge be at the top of his record and prevent or delay future hirings? How, after being convicted of poisoning, could Swango continue to be hired at major hospitals? Do you think this mistake resulted from Swango's own sheer cunningness or from failures in the medical profession?

James B. Stewart: His ability to get new medical jobs is at least as shocking as the fact that he poisoned people, and evidence suggests that he is a serial killer. It is a combination of Swango's cunning and charm, the arrogance of the medical profession and its willingness to trust a doctor over anyone else, and the failure of federal legislation that was intended to protect the public from incompetent or criminal doctors. I think that the book makes clear that there is an urgent need for legislative reform to prevent this from happening again.


Dale from Wooster, OH: I hope that your book sparks some discussion among the medical professionals and law enforcement. What major concerns of the medical profession does your book and the Swango case expose?

James B. Stewart: One thing that became very clear to me in working on this story is how much of a gulf there is between law enforcement and the medical profession. Doctors involved in this story were in some cases very hostile toward police and prosecutors. And law enforcement people were very suspicious of doctors. I think the reasons for this are complex, but they include a concern among doctors that law enforcement was insensitive to the rights of patients and that, more importantly, doctors have become very fearful of lawsuits and suspicious of anyone connected to a judicial system that they feel has saddled them with a crisis in malpractice, litigation, and judgments. Law enforcement people found the doctors uncooperative, evasive, and, in a few instances, even accused them of obstructing justice. Something needs to be done to ease these tensions, and it probably has to start on the community level.


Lacy97@aol.com from Chicago: Did you interview Swango personally for this book? What were some of the most challenging interviews you conducted?

James B. Stewart: I tried repeatedly to interview Swango, who rejected all my requests. The prison official who spoke to him on my behalf told me that I wouldn't want to know what Swango said about me. Many of these interviews were quite challenging because victims and relatives of victims were still devastated emotionally. Some of the most difficult reporting I have ever done was in remote locations in Africa, where sources were very difficult to reach and didn't speak English, but I spent about three weeks in Zimbabwe, where some of the most horrifying details emerged. As an aside, driving a four- wheel-drive vehicle in a country using the English system (where you drive on the left), I was constantly trying to shift and drive over unpaved roads, and there were many times I was afraid I would never make it back.


Heather R. from Michigan: How many newspapers do you read each day and which ones?

James B. Stewart: I read a lot more when I was the page-one editor at the Wall Street Journal, and as stimulating as that was, I don't think anyone knew more current events than I did. It is somewhat of a relief that I don't need to read everything. But basically I read the Wall Street Journal and New York Times every day and often glance at the Washington Post and LA Times and the other daily New York papers, the Post and Newsday. When I am in the Midwest, where my parents live, I read the Chicago Tribune.


M. Connelly from San Fran: What profile would a forensic psychologist give Swango? How would you describe him?

James B. Stewart: Swango has never allowed himself to be examined by a psychiatrist, but I gave all the materials I collected about him, especially focusing on his family background and childhood, to a clinical psychologist who is an expert on serial killers, named Jeffrey Smalldon. While he couldn't diagnose someone he hadn't interviewed, he thought Swango was a fairly common example of a psychopathic personality and categorized him as an extreme narcissist. To put that in simpler terms, he shows no empathy for victims whatsoever, yet he probably derives an intense thrill from controlling life and death and, even more importantly, eluding capture. A confessed serial killer named Donald Harvey who confessed to killing 52 people while serving as a nursing aide at an Ohio hospital addressed similar themes in describing his motives. He talked about the almost "godlike" quality of exercising life and death over another human being and being able to fool intelligent people like doctors. According to the experts I interviewed, this type of serial killer is motivated by the thrill of killing and the ego enhancement, rather than some serial killers who are primarily sexual psychopaths. The causes of this mental disorder are not well understood. Some psychologists believe there is a genetic predisposition, but these people tend to be highly intelligent. They often come from families with distant fathers and doting mothers, and they have an unrealistic and exalted sense of their own abilities. Swango does fit that profile.


Seth from Dallas, TX: Have you thought of turning your book into a documentary? I think it would make a chilling piece and be a great educational tool.

James B. Stewart: Well, that is a good idea, but I am not a filmmaker myself. I would be happy to work with someone who wanted to do something on this.


Bruce Stewart from Williamsburg: I understand Swango is currently serving jail time but is eligible for parole in 2000. Why did he get such a light sentence? What can be done to keep him incarcerated? Do you think your book will help?

James B. Stewart: Swango is serving a three-and-a-half-year prison term for fraud based on false statements he made to be hired at the veterans' hospital on Long Island. He is eligible for a halfway house in January, and his term ends in July 2000. The only way to keep him incarcerated, which is where I believe he belongs, would be to file additional charges. Another possibility would be to extradite him to Zimbabwe, which has issued an arrest warrant for him. In the U.S., the FBI has been actively investigating what they are treating as a major murder case. I think it is likely -- and I certainly hope -- that the investigation will be concluded before Swango is released. I certainly hope my book will focus public attention on this case and will encourage the FBI to devote whatever resources are needed to prove their case and keep Swango in jail. Many people I interviewed told me that they personally fear retaliation by Swango, and the only way to protect them and every other unsuspecting member of the public is to keep him in jail.


Zoe from Williamsburg: What an important revelation you have made! Have you had repercussions from the medical profession because of your book?

James B. Stewart: No, I haven't. I am hoping that the medical profession, seeing the gravity of the situation, will support the reforms I am calling for. Several doctors I interviewed were very encouraging about the book. It was primarily at Ohio State where I ran into strong resistance and where I understand people who helped me with the book feared retaliation from medical and hospital authorities. But even Ohio State admitted on the "20/20" program...about the book that they should have called in the police. While I am hoping for a change in attitude I am not so naive as to assume it will happen. The AMA in particular has fiercely opposed any efforts by nondoctors to regulate the right of doctors to practice.


Nancy from Miami: Has anyone accepted any blame for Swango's ability to slip through the cracks so many times? Have any hospitals been sued by the families of Swango's victims?

James B. Stewart: Several of the hospitals were sued, but one of the very disturbing aspects of this story is the rush of the hospitals where Swango worked to assure everyone that no patient was harmed by him even before they knew the facts. This was an obvious attempt to limit any potential liability and unwittingly played into Swango's hands by hampering any later police investigation. No victim has recovered any significant amount of money from a hospital. Several of the cases were thrown out of court. One patient, Rena Cooper, who was paralyzed after Swango injected her, was paid only $8,500, and much of that went to her lawyer. I understand that since my book has come out, several families have hired lawyers and are considering whether to bring suits.


Hank Wells from Charlottesville, VA: What are the latest developments with this case? When will this case be resolved?

James B. Stewart: The latest developments that are in my book are that the FBI has exhumed bodies on Long Island of people who died while in Swango's care, as well as bodies of patients in Zimbabwe, and has used very sophisticated testing to examine the remains for poison and has obtained positive results for poison in several of those cases. This is the first time that law enforcement authorities have been able to establish physical evidence of poison even though they had eyewitnesses in the past who said they saw Swango inject a patient. Physical evidence has been the missing link in the past, and this means the FBI will in all likelihood pursue charges. I assume -- though I have no way of knowing -- that the investigation will be wrapped up before Swango is released from prison, for obvious reasons.


Moderator: Could you recommend three books that you have read recently and enjoyed?

James B. Stewart: I read recently and reviewed AN AFFAIR OF STATE by Richard Posner about the Clinton impeachment trial (not yet in bookstores). I read ANOTHER LIFE by Michael Korda and learned more about the publishing industry than I ever knew as an author. I also read A MAN IN FULL by Tom Wolfe .


Sam from NYC: You mentioned that some of the people you interviewed were afraid of Swango. Were you ever afraid?

James B. Stewart: No, not really, although some of my family and close friends have been afraid on my behalf. It has crossed my mind that I am in some jeopardy, but it has never been his M.O. to kill for any rational reason such as revenge. There is some evidence that he poisoned people out of spite, but the murders seemed to be random, so however dangerous he may be I didn't think he'd come after me. I would add that the best protection for everyone, including myself, is to keep him in jail.


Moderator: What was the worst job you ever had to endure before achieving your success as a writer?

James B. Stewart: I mowed lawns -- that goes way back! I grew up in Quincy, Illinois, and could stand at one intersection and in any direction, I mowed the grass. In terms of jobs as an adult, I wrote headlines for the Ann Landers column at the Quincy Herald-Whig. While one or two Ann Landers columns can be interesting, anything more is like being force-fed buttered popcorn or cotton candy. It was so hard to find things provocative and witty at number 30. I have actually been quite lucky. A former boss of mine, Norman Pearlstein, once told me, "Never take a job you don't like thinking it will lead to something better," and so I have really enjoyed every job I have had in journalism, even when it was writing very short, unbylined pieces.


Moderator: Thank you so much for your time. It's been a great pleasure to have you chat with us. Before we go, do you have any closing comments for your fans?

James B. Stewart: Let me just say that I hope that if people are as shocked by this story as I was and agree that something needs to be done, they should write their congressman or senator. Thank you.


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Sort by: Showing all of 2 Customer Reviews
  • Posted August 19, 2011

    more from this reviewer

    Dr Wacko

    This is a story about a physician who actually got away with murder. He worked in several hospitals in the United States and in Africa. Each establishment found his work inferior and there were unexplained deaths when he was around. Each hospital instead of doing the right thing they covered it up to avoid law suits. Due to the cover ups, Swango kept getting jobs at other hospitals. By the time it was evident that Swango was killing people there was a lack of physical evidence and was unable to be tried for murder. This is based on a true story and is much scarier than any work of fiction that I have read. Doctors are suppose to help those in need and they are suppose to advise patients and families about the best course of action to take in medical decisions. Amazingly, all the high level medical officials who covered up these deaths all are still in the medical profession. A

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  • Anonymous

    Posted February 21, 2000

    Facts More Chilling Than Fiction

    True, Ted Bundy murdered sorority women at Florida State in Tallahasee, not U. of Florida in Gainesvile. But the horror of this story is amazing. Even more horrifying is that the laws, medical ethics, etc. haven't changed. This could be going on somewhere (or several places)right now-- just change the names and other details.

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