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

• Author: Ruane, Matthew J.

By dissecting dozens of failed investigations into the exploits of serial poison-killing physician Michael Swango, Pulitzer Prize-winning author James B. Stewart created a magnificent teaching tool for judge advocates and other lawyers, investigators, and health care professionals. The key lessons of Blind Eye are derived from Stewart's meticulous analyses of flawed investigations conducted by medical school faculty, (1) senior administrators, (2) experienced police, (3) seasoned district attorneys, (4) and even a law school dean, (5) throughout Swango's seventeen-year poisoning spree. Stewart exposes embarrassing and simple blunders in evidence gathering (6) and other investigative missteps that allowed Swango to kill approximately sixty patients while practicing medicine in four states and three African countries over almost two decades. Incredibly, despite repeated exposure of the facts by the national media, (7) it was only after publication of this book that a prosecutor finally managed to convict Swango of murder. (8)

Despite the valuable lessons Blind Eye offers, Stewart unfortunately overreaches in concluding that Swango owed his successful avoidance of the law for such a long period to the greed of the medical establishment. Indeed, in his effort to indict the medical community, Stewart often glosses over the key reason Swango eluded the law for so long: Swango was an extremely intelligent psychopath who took advantage of inefficient bureaucracies. Nevertheless, thanks to Stewart's exhaustive research and superb attention to detail in evaluating the investigations, Blind Eye presents a gold mine of lessons for professionals.

This review provides an overview of the blunders that enabled Swango to practice deadly medicine, as well as an analysis of two of the basic lessons presented: the importance of early legal involvement in adverse personnel actions and the danger of giving legal opinions without carefully examining all of the relevant evidence. This review suggests that Blind Eye would have been a better book had the author focused more intellectual energy on the lessons learned in pursuing Swango and less on his own elusive case against the medical establishment.

1. OVERVIEW

   In his childhood, Swango was above average socially and academically, despite a home life strained by his alcoholic father's frequent deployments to Vietnam and his mother's emotional distance. (9) In college, however, classmates noticed Swango's gradual social withdrawal, starting in his sophomore year. As Swango withdrew, he began exploring what was to become a lifelong past-time: avidly reading about cases involving violent and gruesome death. He also began talking about going to medical school. (10)

   At the end of his sophomore year, Swango withdrew from college and began a short and unremarkable two-year stint in the Marine Corps. Following discharge, he returned to college and pursued premedical courses exclusively. He wrote his senior chemistry thesis on the subject of ricin, a poison that kills without leaving any identifiable trace. (11)

   After obtaining his undergraduate degree in chemistry in 1979 from Quincy College in Quincy, Illinois, Swango began his murderous odyssey as a medical student at Southern Illinois University (SIU). From the beginning, his classmates found it odd that Swango never expressed any interest in patient well-being nor offered any particular reason why he wanted to become a doctor. In fact, the only element of the curriculum for which he showed any enthusiasm was toxicology, the study of poisons. (12) Additionally, many students noticed that an unusually large number of patients unexpectedly died in whatever ward Swango was assigned. This phenomenon was obvious enough to earn him the nickname "Double 0 Swango," meant to imply that, like the famed fictional James Bond, British Agent 007, Swango had a license to kill. (13)

   With his medical degree from SIU in hand, Swango pursued several short-lived internships at various hospitals throughout the country. Carelessness allowed the school that accepted him as an intern, Ohio State University, to overlook a warning letter from Swango's medical school cautioning the university's faculty that there had been concern about his professional behavior. (14) If only the letter in Swango's application file had been read, Swango would have likely been either denied employment in Ohio's internship program or watched closely enough to prevent the five poisoning deaths that occurred during his internship.

   Here, Stewart overreaches and attempts to construe this tragic but simple carelessness as evidence of some greedy conspiracy by the medical establishment. He weakly supports this thesis by discussing the American Medical Association's (AMA) political opposition to physician misconduct reporting laws. (15) However, this support is misplaced because there is no nexus between the AMA's political agenda and Ohio State's carelessness in overlooking the written warnings on Swango. Stewart's view on this point should not distract the reader from the real lesson, which is the critical importance of attention to detail in administrative matters.

   Despite a 1986 conviction and two-year prison term for nonfatal...