Tomorrow, another chapter will begin in the long story of the former Ohio State medical intern now called “Doctor Death.” On that day, Michael Swango will appear in Franklin County Common Pleas Court to answer charges in the murder of Cynthia Ann McGee. He is expected to plead guilty to the 16-year-old homicide in return for a life sentence and no further charges being brought against him in Ohio.With his plea, Swango will admit that as a medical intern at the OSU Medical Center in 1984 he murdered McGee, one of the hospital’s patients. Many questions, however, still remain.The court hearing, for example, will not answer how he was able to murder McGee and without getting caught. Back in 1984, Swango poisoned another patient – Rena Cooper. She lived to tell about it, and yet the case was investigated by OSU Hospitals internally, not by University Police. No action was taken against Swango, except that his residency was later rescinded by the hospitals. Three of the doctors at the hospital even recommended that he be given a permanent medical license despite his loss of residency. Tomorrow’s guilty plea will bring the number of murders Swango has confessed to up to four, but possible victims could number in the dozens, perhaps more. In an interview, James Stewart, author of a major book on Swango, speculated that Swango may have killed at least 35 people, mostly in Zimbabwe, to as many as 60. Last month, Swango pleaded guilty to killing three patients in a New York veterans hospital. Edward Nitkewicz, attorney for the families of the New York victims, said his clients intend to sue OSU for negligence in its investigation of Swango. Hospital officials in New York would also be sued, he said.With no criminal investigation at OSU, Swango was able to go back to his hometown of Quincy, Ill. and non-fatally poison seven paramedics with whom he was working. A criminal investigation and trial yielded convictions on six charges of battery in 1985. During this investigation, then OSU police Chief Peter Herdt, the Quincy Police Department and the Adams County Coroner all accused OSU Hospitals of being non-cooperative. The Quincy police requested routine background information from OSU police on Swango`s time at OSU Hospitals. According to OSU officers who attempted to obtain Swango`s files, hospital officials stalled them. By the time the files and other information about the Cooper incident about were made available, Franklin County prosecutors were also involved. However, due to the length of time between the occurrences and the criminal investigation, prosecutors were unable to bring charges against Swango. Too much of the evidence had been disposed of or lost by those involved.Swango was convicted of the poisonings in Illinois and served time in prison, during which Illinois and Ohio rescinded his medical license. In 1993, he applied to a residency program at Stony Brook University Medical Center in Stony Brook, N.Y. The information he listed in his application was never checked properly, and he got the job. Swango has now admitted to murdering by poison three patients while working at the Veterans Hospital in Northport, N.Y. – a hospital associated with Stony Brook. After learning of his past, hospital officials discharged Swango in 1993, but he was still able to get hired by an overseas charity in 1995 to work at hospitals in Zimbabwe.While at Mnene Hospital, a small medical outpost in the Central African country, more suspicious deaths occurred. The hospital suspended Swango in July 1995 and alerted authorities. He then went to South Africa and eventually was hired in Saudi Arabia in 1997 by the Royal Hospital in Dharan, Saudi Arabia. To work there, Swango needed a visa issued in the United States. Swango was arrested in Chicago while transferring to a flight for Portland, Oreg. Federal officials charged him not with murder but with falsifying his federal medical record while working in New York. Swango was convicted in 1998 of this charge. The court sentenced him to 42 months in prison. It was while he was serving this sentence that he first confessed to the New York poisonings. When he confessed to these murders, he already had five warrants for his arrest for murder in Zimbabwe. With the signing of an extradition treaty between the United States and Zimbabwe earlier this year, lawyers have speculated that Swango is pleading guilty to the four hospital murders to avoid extradition. Zimbabwe has a death penalty that is much swifter in application than the United States. After he has pleaded guilty to the McGee murder, Swango will be serving four consecutive life sentences without parole as part of a plea bargain.Major interest in the Swango case resurfaced last year with the publication of Stewart`s “Blind Eye: How the Medical Establishment Let a Doctor Get Away with Murder.” Stewart used the book to trace the career of the man he calls “possibly the United States’ most prolific serial killer.” He also said it is frightening that serial killing has increased almost exponentially in America since the 1970s, with a large increase specifically in the field of health care. It is Stewart`s opinion that this particular increase could be curtailed if penalties for non-compliance with existing laws were stiffened. The medical profession has ignored its obligation to report dangerous doctors, Stewart said. Stewart maintains that OSU has engaged in a cover-up since the mid-1980s. In “Blind Eye”, Stewart details how OSU doctors Joseph Goodman and Michael Whitcomb apparently did not thoroughly pursue their investigations of Swango. Both came to the conclusion that there was no compelling reason to believe Swango was guilty of anything worthy of discharge or further investigation. They came to this conclusion despite two witnesses who saw Swango poisoning Cooper, as well as a great deal of circumstantial evidence linking Swango to other deaths and poisonings. Stewart also blames Dr. Manuel Tzagournis, then vice president for health services, for creating an atmosphere in the hospital that lead to the fear of lawsuits being more important than patient safety. Last year, OSU spokesman Lee Tashjian said there is no cover-up and that OSU Hospitals have improved their security. At the same time Tashjian also admitted that OSU “should have called in outside police authorities to investigate.” Tashjian claimed many recommendations made in a report by James Meeks, former dean of the OSU Law School, have been adopted by the university. The report said the possible actions by Swango were so much of an aberration that it was impossible to plan for, or prevent it from happening. Also, there was “open hostility” between the medical and police personnel on campus at the time because of an earlier undercover police investigation that had captured, with secret cameras, footage of doctors and nurses engaging in inappropriate behaviors such as drug switching and use, or being intoxicated on duty.This hostility was the reason the campus police were not contacted even after some staff expressed doubts about Swango, according to the report. The report also concluded the hospital investigators had been made aware of facts that should have been followed up by a more thorough inquiry. The testimony of the three witnesses to Cooper`s possible poisoning were dismissed despite the fact that all three had reported the same facts, which should have warranted further investigation. The most damning indictment against the investigation was the failure to test an unaccounted-for syringe found by a nurse`s aide after the Cooper occurrence. According to the report, Goodman was the only member of the investigative group who knew of the syringe and apparently never told anyone else. He was under the impression that the syringe had been left in the area the next day and was unrelated to the incident.Meeks used his most blunt language when he wrote:”We (the investigators) still find it astounding that no permanent record was kept detailing the occurrence and what was done about it. We understand the reluctance of those in the health care profe
ssion to put anything in writing because it could be used in a subsequent civil liability litigation context. Nevertheless, we believe a full formal report of this incident should have been prepared by someone and kept in the hospital records.”The question of whether Swango could have been stopped earlier still looms large for OSU. Instead of going to court in Columbus in 1984, Swango appears in court tomorrow – 16 years and many deaths later. OSU Hospitals held onto records back then to prevent a lawsuit, but such actions may lead to lawsuits today.Medical records are by their very nature private and confidential, and doctors are required to keep this confidence. Stewart writes that this seems to lead to a culture of closed ranks and non-cooperation with non-medical personnel. This leads to a question of confidence that is hard to settle for OSU Hospitals; it may very well be settled in court some years from now.