A second year medical student at Boston University, Phillip Markoff, was charged with murdering a woman at a luxury Boston hotel. Allegedly, Markoff met the woman after answering her ad for “masseuse services” in Craigslist. When a physician (or student doctor) is charged with murder, the public is doubly shocked. The public empowers physicians to use lethal compounds and knives to “do good.” Physicians are also obligated to “Do no harm.” The public should be shocked when doctors abuse that trust.

But some doctors, like the rest of humanity, do kill.

Remember the explosive laden jeep that was driven into a Glasgow, Scotland airport in 2007. Bilal Abdulla, a British-Iraqi doctor was convicted of conspiracy to murder and conspiracy to cause explosions. His defense: he did not intend to kill. He only wanted to frighten people by setting off explosions. Dr. Abdulla was employed by the British National Health Service.

Probably the most bizarre story is the fifteen year saga of Michael Swango.

Between 1978 and 1983, Michael Swango, studied medicine at Southern Illinois University. His classmates nicknamed him “Double –O Swango- licensed to kill”. The reason: patients were more likely to die under his care.

Swango worked as a surgical intern at Ohio State University Medical School. There, in 1984, an elderly patient suffered a respiratory arrest, accusing Swango of injecting a compound into her IV line that paralyzed her. The patient’s roommate and a student nurse confirmed the story. A subsequent investigation exonerated Swango (dismissing the report of the patient as delusional and the student nurse as unreliable). The University decided not to accept Swango as a resident after his internship ended in June.

Swango then worked as a paramedic in Illinois. Several months later, after a series of suspicious incidents in which his fellow employees developed gastro-intestinal symptoms, Swango was arrested and charged with attempted poisoning (aggravated battery). Following his felony conviction, he was sentenced to five years in prison, of which he served two. Both the Ohio and Illinois Medical Boards suspended Swango’s medical licenses.

In 1992, Swango resurfaced in an Internal Medicine residency program at the University of South Dakota after his release from prison. He explained his felony conviction as false allegations made by jealous co-workers. More importantly, Ohio State refused to release any information about Swango unless both Swango and the University of South Dakota executed hold-harmless agreements in favor of Ohio State. The investigation was not pursued.

When University of South Dakota learned of Swango’s true history, he was dismissed from the residency program. Swango resurfaced in yet another residency program, Stony Brook in New York. When the issue of his conviction in Illinois arose, Swango “explained” that he was involved in a barroom brawl and “took the fall” for others. In addition, he produced a forged document showing he had been pardoned. As soon as his real past was discovered, he was fired, and Dr. Jordan Cohen, then dean of the medical school, sent a letter to every dean of every medical school in the country alerting them of Swango’s past. His goal was to prevent further potential harm. Swango was eventually charged with fraud. Ultimately, he was charged with murder of three patients at a VA Hospital in New York in 1993. He pled guilty and was sentenced to life imprisonment without parole. He then confessed to yet a fourth murder.

Interestingly, the trail of death might have ended years earlier had our legal system been a tad different. Ohio State did not want to fully disclose all details of Swango’s past unless an agreement was signed absolving Ohio State of potential liability for its candor. Dr. Jordan Cohen at Stoney Brook took a risk by notifying program directors across the country. Perhaps Dr. Cohen can rest comfortably given that Swango is in prison and is unlikely to claim that the disclosure harmed his career as a budding doctor.