Professional Courtesy (an excerpt from The New Yorker, November 24, 1997)

Edward Morgan, in the course of his investigation..., learned that during the week after Mrs. Cooper's mysterious respiratory arrest the Ohio State University hospitals held three meetings to review Dr. Swango's performance and the Cooper case. The ad-hoc inquiry group included several administrators and doctors, the hospital's lawyer, and an assistant Ohio attorney general assigned to the university, but only one nurse — Jan Dickson, a supervisory nurse, who had demanded the review. One of the physicians, Michael Whitcomb, the hospital's medical director, was assigned the task of reviewing the information, and told the group that he believed that Mrs. Cooper, far from being injected with an anesthetic or poison, had suffered a grand-mal seizure and had been paralyzed immediately afterward. However, a later internal report by the hospital revealed that had the group spoken with a trained anesthesiologist or toxicologist its members would have learned that Mrs. Cooper's symptoms were consistent with the injection of either curare or anectine into her I.V.

Swango was asked by three doctors if he had injected anything into Mrs. Cooper's I.V. He said no, but offered a different explanation to each of them. To one he said that he was never in Mrs. Cooper's room; to another he said that he entered her room at either her or her roommate's request to retrieve some slippers; and to the third he said that he had entered the room to draw blood. He was never asked about these inconsistencies. Nor did anyone ask about the empty syringe that the nurses had preserved after Mrs. Cooper's respiratory failure. About six months later, the head nurse threw the syringe away. "No one ever collected it from me," she later told university-police investigators, "and I asked somebody, 'Do you think it's O.K.?' They said, 'Well, sure, it's gone now. It's over with.' So I threw it away."

Morgan was nearly beside himself on learning about the loss of such crucial physical evidence. "It was incredibly frustrating," he told me recently. "If we had been contacted at the time, there was a lot of evidence that would have been available. Instead, the evidence had disappeared." He was astounded, he later noted in his report, that the members of the hospital group investigating Swango "failed to call the actual witnesses before them for statements," and "did not interview any of the nurses, [Mrs. Cooper], her roommate, or Dr. Swango." Morgan recently told me, "I can only arrive at one conclusion —they didn't want to know. They just wanted him out of the hospital."

Legal issues appear to have figured prominently in the group's discussions. Dr. Whitcomb later said, "...we presented the information we had to the lawyer who was providing us advice. Based on the information that was available, it was his opinion that there were no grounds for us to take any action against Dr. Swango and that there was no other investigation that needed to be carried forward." But when the lawyer was asked by Morgan about that advice, he insisted that it was the doctors who, after hearing the report by Dr. Whitcomb, "indicated there would be no further in-house investigation or further inquiry." In any event, on February 14th, the ad-hoc inquiry group concluded that Dr. Swango should be permitted to return to patient care immediately, but with greater supervision.

When Mrs. Cooper was released from the hospital, the discharge summary on her chart contained a suggestion that her suspicions about someone's tampering with her I.V. was a paranoid delusion.

Ohio State did not renew Swango's appointment for the following year, notifying him of the fact in a letter that gave no reason for the decision, but Dr. Jerry Carey, the chairman of the department of surgery, recommended that Swango be licensed to practice medicine in the state of Ohio that March, albeit with "reservations." When the State Medical Board asked for details, Dr. Carey focused on Swango's general performance as an intern. He mentioned the investigation but said that Swango had been "exonerated." Ohio state doctors subsequently recommended that he be licensed to practice medicine in Illinois. When Dr. Carey was later questioned at the behest of Quincy authorities about Dr. Swango's background, he again said only that Swango had been accused of tampering with a patient's I.V. but had been completely cleared of any wrongdoing. Morgan and the police officials spent ...months investigating Swango. "We were in over our heads," Morgan told me. "Your usual prosecutor is comparable with weapons, guns, beatings. But when it comes to poison we needed professional help...." The professional help that Morgan said he needed was not forthcoming from the university hospitals. Morgan said that from a law-enforcement perspective the hospitals' internal investigation was shockingly inadequate, and stated in his report that doctors, administrators, and lawyers appeared to coordinate their responses to his investigation, closely monitoring its progress. Morgan's boss, the Franklin County Prosecutor, requested that he submit a statement of his report to the president of Ohio State University and afterward asked him to delete the names of the patients and the doctors and hospital officials involved. The doctors and administrators of the university hospitals "greatly resent the intrusion of law enforcement in their affairs," Morgan told me. "From Day One, they resented us. They never truly cooperated, or it was grudging cooperation, it was on the surface. ...It's all done under the rubric of patient care. They said, 'We can't have police running around the hospital. It would upset the patients.' ...They were petrified of lawsuits." Morgan reluctantly concluded that he could not prosecute Dr. Swango without at least some corroborating physical evidence, such as syringes, blood tests, or hair samples, but none of these had been retained by the hospitals. "The circumstantial evidence was not enough," Morgan said. His anger at the Ohio State doctors and administrators still audible in his voice, he told me, "They covered it up, that's what it was."

Robert Holder, a lawyer for Ohio State who participated in the Swango inquiry at the time, strongly denies that. "Naturally, our review was criticized by others after the fact," he said. But "you don't come to a meeting thinking someone is a complicated psychopathic killer." Emphasizing that no one knew then of any blemish on Swango's character, he said, "This complaint was taken very seriously and was considered by a distinguished group" that "did a more extensive review than my subsequent experiences tells me that a lot of places would do." He added that "the concern of the group at the time was to be even-handed," and denied that potential liability was a factor. Still, he acknowledged that "we could have done better — there's no doubt about that. If we had some of the evidence that was later produced, this would have been an easy decision." He said that the university has since taken steps to improve relations between the police and the hospitals.

...[In the fall of 1991], Dr. Anthony Salem, the head of the residents' program at the University of South Dakota, in Sioux Falls, had received a letter from an applicant living in Virginia. The applicant seemed to have a solid academic record: he'd completed a distinguished internship at Ohio State, and he'd devoted himself to emergency medicine as a paramedic. But he had not practiced as a doctor for some time, and there was a gap in his resume; he indicated that he'd been convicted of battery after an incident "unrelated to medicine."

...A series of letters ensued. Dr. Salem sent Swango an application and, mystified by the ...unexplained legal trouble, subsequently invited him for a personal interview. Like so many people who have met Swango, Dr. Salem was immediately taken with the earnest young man. Swango was also remarkably forthcoming about his past legal trouble, telling Dr. Salem that he had been charged with and convicted of poisoning his fellow-paramedics in Quincy. He even disclosed that in the past he had lied about his conviction, describing it as arising out of a barroom brawl, but had now concluded that it was better to be honest about it. He maintained that he was innocent of the charges, that he had been convicted on the basis of flawed evidence from a discredited crime lab, and that he had expected to be exonerated on appeal but the appeals court had looked only at procedural issues, and that the whole thing had been a gross miscarriage of justice. "He was very convincing," Dr. Salem said. "I wasn't experienced in dealing with people with this sort of record. I didn't even think about calling the prosecuting attorney, or the parole officer, or getting the records. I thought he had got a bad deal."

Still, Salem would not admit medical students who couldn't be qualified to practice in the state, and he assumed that a felony conviction was such a disqualification. But Swango explained that South Dakota was one of a "handful" of states in which, if a doctor showed that he'd "turned his life around," he could be licensed to practice medicine.

Dr. Salem, who is also in charge of accrediting physicians hired at the local veterans' hospital for the university, told me that Swango was subjected to a lengthy hiring process. He was interviewed by other doctors in the internal-medicine department, and they found him acceptable. Salem obtained Swango's medical-school records, and they proved to be positive except for the problem with the OB/GYN course. He then called the State Medical Board of Ohio, and it reported that Swango's license had been suspended. Salem was not surprised, since Swango had already told him that his licenses had been suspended in Ohio and Illinois as a result of his conviction. The Federation of State Medical Boards told Dr. Salem that Dr. Swango had experienced "problems." Dr. Salem assumed that that, too, referred to the conviction.

Dr. Salem had his secretary write to Ohio State University to request verification of Swango's records, and in reply he received a letter saying that both Swango and the University of South Dakota would first have to sign a number of legal waivers. "I thought this was strange," Dr. Salem recalled. "But I didn't even know who our lawyers were. I didn't know whom to contact. We've never had to deal with lawyers." In any event, he thought he knew what Ohio State was talking about — the same "problems" that the medical boards had mentioned, which he'd already learned of from Swango himself. So Dr. Salem put the letter in Swango's file and forgot about it. Anyway, Michael Swango had begun his residency a few weeks earlier. "He did fine," Dr. Salem recalled. "He was very popular with the staff. He worked hard. He was ingratiating, nice, intelligent."

...[Last] September, Swango was arraigned in federal district court on Long Island. He pleaded not guilty, and he remains in custody at the Metropolitan Detention Center. He has refused my requests for an interview. Meanwhile, the F.B.I. and the United States Attorney's office continue to search for evidence to elevate the current charges against him. (In particular, they are hoping that he kept a journal.) To the single charge of misrepresentation, they recently added five counts of gaining possession of controlled substances — hospital medications — by means of deception. Swango's trial is scheduled to begin on January 5th. The V.A. hospital on Long Island has reopened its investigation. Despite the earlier finding that no patient had been harmed by Swango, an investigator there now says, "We just don't know. Clearly, he was doing his thing."