Michael J. Swango MD (AP)

Michael Swango was an intern at Ohio State University Medical Center when a patient named Ruth Barrick came in with a head injury.  She'd nearly died but then recovered. Swango told a nurse that he was going to check on her, and when the nurse went in later, she found Barrick barely breathing. Calling a code, she and the medical team managed to stabilize her vital signs and she recovered.

Then Swango went back into Barrick's room. After nearly half an hour with the patient, he left, and a nurse found Barrick once again in a very bad state. The woman soon died and the nurse suspected that Swango had done something. Yet getting anyone in the administration to pay attention proved difficult.

In fact, before Swango left the Center, five patients died and several grew terribly ill. He'd also given a "spicy" chicken dinner to several coworkers, all of whom had become ill afterward.  People suspected him, but hoped he'd just go away.

Throughout his medical career, administrators had covered for Swango, and the same thing would happen again and again, allowing him to get away with murder.  His fellow students, aware that he was unfit for practicing medicine, nicknamed him "Double-O Swango," and it seemed he'd actually entered the profession to cover his murderous intent. This athletic, blue-eyed blonde always managed to charm others and pass through the system.

In retrospect, it's difficult to understand how he even became a doctor, let alone practiced for almost two decades.  In 1983, Swango graduated from Southern Illinois School of Medicine in Springfield, Illinois.  He served his internship at Ohio State University, but when his post was finished, it was not extended---partly because of suspicions that no one wanted to voice. After he left, the authorities investigated him for murder, but found insufficient evidence to charge him with anything.

Swango then started to work with a team of paramedics. Feeling comfortable, he told them his ultimate fantasy: "It's like this," he said. "Picture a school bus crammed with kids smashing head-on with a trailer truck loaded down with gasoline. We're summoned. We get there in a jiffy just as another gasoline truck rams the bus. Up in flames it goes! Kids are hurled through the air everywhere, on telephone poles, on the street, especially along an old barbed wire fence along the road. All burning."

The others were put off. This guy was sick. They kept their distance, although they eventually trapped him in an attempt to poison them.  There was sufficient evidence from the amount of poison found in his locker and home to convict him of six counts of aggravated battery.  Even so, he did less than three years in prison---and also resumed his medical career.

He was accepted into several more positions in Virginia, South Dakota, New York, and Zimbabwe. He lied, faked his credentials, adopted aliases, and misrepresented his employment history. No one checked, and wherever he went, colleagues became ill and patients died. Each time authorities closed in, he was gone.

When Swango was finally stopped by the FBI, he'd been on a roll for almost two decades in seven different hospitals. In many cases, someone had seen him with a syringe, and several patients who recovered indicated that it was the blond doctor who had injected them before they lost the ability to feel and move.

During the investigation, Dr. Baden came in to oversee the exhumations and perform autopsies on suspected victims.

"I was contacted from the Veteran's Administration Hospital in Suffolk County, New York, because Michael Swango had several possible deaths there.  I exhumed those bodies and then exhumed six more in Zimbabwe.  The important thing was the toxicology, so tissue samples were sent for testing.  I also interviewed a number of people where he'd worked and found out about patients who'd survived and told how he'd injected things into their IV that paralyzed them.  At first, no one had believed them.  Based on the autopsies, we made our reports and the toxicology findings indicated that the cause of death of the three in Suffolk County and five in Zimbabwe was poisoning.  Swango had been the only one with access to those patients at the time."

Baden and the investigation team also looked through cases in Illinois, Ohio and South Dakota, and one in particular stuck out.  Cynthia McGee, who'd been an Olympic-level gymnast, had been hit by a car.  Her family had transferred her to Ohio State University and she had ended up on Swango's ward.  This one should have been caught.  "According to her record," says Baden, "in the morning she had normal potassium levels, and then he went in and a code was called, and they did an electrolyte reading, and her potassium level was way up.  That was automatic evidence that she'd been poisoned with potassium.  You can't survive the level she had, but that reading was ignored."  At that point, Baden believes, Swango could have been stopped.  Yet he wasn't.

The grand jury indicted him for the three deaths in Suffolk County and for McGee's demise.  Yet the statute of limitations had run out for the Federal government to investigate, so it had to be done with the cooperation of the locals.  Surprisingly, they were resistant, which proved to be a stumbling block in the investigation.  However, such limitations were not true for Zimbabwe, where capital punishment is more easily delivered, so given the evidence against him and what he faced there if extradited, Swango decided in September, 2000 to plead guilty. In a deal, he was sentenced to life in prison without the possibility of parole.  Had he been legally connected to all of the suspicious deaths of patients under his care since 1983, the estimates range from 35 to 60.

Swango had admitted in his own diary how much he liked to kill.  He enjoyed "the sweet, husky, close smell of indoor homicide," and murdering patients made him feel "alive."  So how does a person like that pass so easily through the hospital system?

"We talk about the thin blue line in which police protect police," says Baden, "but with doctors and hospitals, there's a thick white line.  I've been involved with a number of cases of health professionals who kill people in hospitals, and it's amazing how often the risk managers in the hospital administration will try to avoid bad publicity.  They'll force these people to leave and even give them positive letters of recommendation, and that's an area that has to be corrected.  Unexpected multiple deaths in a hospital always warrant a meaningful investigation."