Healthcare serial murder

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We characterise “healthcare serial murder” cases as ones where:

1. Situation: An unusual increase in deaths or medical incidents at a controlled hospital or care facility exceeding statistical averages for that facility and for which there is no obvious “innocent” explanation.
2. Suspect: A given carer or medical professional was present for all the incidents.
3. No direct evidence: There is no reliable direct evidence of the identified carer actually harming any of the patients.
4. “Small arrows”: There are many pieces of weak circumstantial evidence pointing to (or at least consistent with) the carer’s involvement, but which, when taken individually, do not strongly implicate the carer.
5. No motive: The suspect has no apparent motive.
6. No criminal propensity: The suspect has no record of violence, antisocial behaviour or mental illness other than the alleged offending.

The case par excellence is Harold Shipman, a British doctor, who systematically murdered hundreds of elderly patients by administering lethal doses of medication, exploiting the trust placed in him as their healthcare provider. Other famous cases are a little less edifying for the legal profession:

• Lucia de Berk: A Dutch nurse wrongly convicted of multiple murders due to statistical errors and misinterpretation of medical evidence. Her conviction was later overturned.
• Susan Nelles: A Canadian nurse accused of murdering infants; charges were dropped due to lack of evidence.
• Colin Norris: A British nurse convicted of murdering patients by insulin injection; his conviction was later overturned due to flawed medical evidence.
• Daniela Poggiali: An Italian nurse accused of murdering patients in a hospital. She was initially convicted but later acquitted on appeal due to a lack of conclusive evidence.
• Jane Bolding: A British nurse accused of murdering patients in her care. She was acquitted after a retrial due to lack of evidence.

And then there are some other, um, interesting cases:

1. Ben Geen
   1. Situation: An unusually high number of patient deaths occurred on a ward at Horton General Hospital where Ben Geen was employed as a nurse. The circumstances of many of these deaths involved respiratory failure.
   2. Suspicion: The primary reason for suspecting Geen was the statistical anomaly of a disproportionate number of patient deaths and collapses occurring on his shifts compared to other nurses.
   3. Direct Evidence: There was no direct evidence, such as CCTV footage or eyewitness accounts, of Geen harming patients.
   4. Evidence Implicating Suspect: The main circumstantial evidence was the statistical correlation between Geen's shifts and the number of respiratory arrests. Additionally, traces of muscle relaxants were found in some patients, although this evidence was not conclusive.
   5. Evidence of Foul Play: While the pattern of deaths was unusual and suggestive of deliberate harm, the ultimate cause of death in many cases was determined to be natural causes. The presence of muscle relaxants in some patients raised suspicions of foul play but did not definitively prove it.

2. Colin Norris

   1. Situation: A cluster of unexplained deaths occurred on Ward 42 of the Leeds General Infirmary, where Colin Norris worked as a nurse. The victims were elderly female patients.
   2. Suspicion: Norris was present during a disproportionate number of patient deaths and collapses. There were concerns about his excessive overtime and his apparent enjoyment of the drama surrounding patient crises.
   3. Direct Evidence: No direct evidence of Norris administering lethal substances or physically harming patients was found.
   4. Evidence Implicating Suspect: A syringe containing insulin was found hidden in Norris's locker. Witnesses reported seeing Norris “acting suspiciously” around patients, including one instance where he was seen injecting a patient. Norris had conducted internet searches related to insulin poisoning and patient deaths.
   5. Evidence of Foul Play: Post-mortem examinations revealed abnormally high levels of insulin in the blood of some victims. Medical experts concluded that the insulin levels were inconsistent with accidental overdose or diabetic conditions. The pattern of deaths and the victims' profiles suggested a deliberate act of harm.