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{{a|crime|}}We characterise “healthcare serial murder” cases as ones where: {{healthcare serial murder capsule}}
{{a|crime|}}We characterise “healthcare serial murder” cases as follows: {{healthcare serial murder capsule}}
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:
====The classic case?====
{{L1}}'''Lucia de Berk'''
{{Drop|H|'''{{plainlink|https://en.wikipedia.org/wiki/Harold_Shipman|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 doctor is  often cited but it wasn’t ''quite'' the classic case, as the majority of Shipman’s murders took place ''away from'' a medical facility and in the patients’ homes, where there would be no witnesses, security devices or cameras that might record his action. The circumstantial evidence (when people knew to look for it) that implicated Shipman was both overwhelming and strong, and (at least at the end) there was a financial motive — though this might not have been present earlier.
{{L3}}'''Situation''': An unusually high number of patient deaths occurred on wards where de Berk worked at three different hospitals. These deaths involved patients of various ages, from infants to elderly. <li>
'''Suspicion''': Lucia de Berk was present during a disproportionately high number of patient deaths and collapses. There was a pattern of deterioration or death in patients shortly after she took over their care. <li>
'''Direct Evidence''': No direct evidence was found of Lucia de Berk administering lethal substances or physically harming patients. <li>
'''Evidence Implicating Suspect''': Statistical analysis suggested an improbable concentration of adverse patient incidents during de Berk’s shifts. Witnesses claimed to have seen de Berk “behaving suspiciously” around patients. <li>
''''''Evidence of Foul Play''': Some patients exhibited symptoms [[consistent with]] poisoning. In some cases, toxicology reports indicated the presence of drugs or substances that could have contributed to patient deaths. In many cases the cause of death remained undetermined or was attributed to natural causes. <li>
The statistical analysis used to implicate de Berk was later heavily criticized for methodological flaws. </ol><li>
'''Susan Nelles'''
{{L3}}'''Situation''': An unusually high number of infant deaths occurred on the Gledhow Wing of Southern General Hospital in Glasgow, Scotland, where Susan Nelles was a nurse. The deaths were initially attributed to natural causes, but the frequency raised concerns among medical staff. <li>
'''Suspicion''': Susan Nelles was present during a disproportionate number of infant deaths. Staff noticed a pattern of deterioration or death in infants shortly after Nelles took over their care. <li>
'''Direct Evidence''': No direct evidence was found of Nelles administering lethal substances or physically harming infants. <li>
'''Evidence Implicating Suspect''': Statistical analysis suggested an improbable concentration of infant deaths during Nelles' shifts. Witnesses claimed to have observed Nelles “behaving suspiciously” from Nelles, around patients. <li>
'''Evidence of Foul Play''': Post-mortem examinations revealed evidence of unusual substances, including opiates, in some infants. Medical experts concluded that the cause of death in some cases was not natural but due to external factors. The statistical analysis, while controversial, supported the hypothesis of foul play. <li>
Charges were ultimately dropped due to lack of evidence. </ol><li>


'''Daniela Poggiali''':
====Some examples of apparent healthcare serial murderers====
{{L3}}'''Situation''': An unusually high number of patient deaths occurred in the intensive care unit of the Umberto I Hospital in Italy, where Daniela Poggiali worked as a nurse. <li>
The other famous cases are a little less edifying for the legal profession:
 
{{divhelvetica|{{small|80}}{{healthcare serial murderers table}}</div>}}
'''Suspicion''': Daniela Poggiali was present during a disproportionate number of patient deaths. <li>
 
'''Direct Evidence''': No direct evidence was found of Poggiali administering lethal substances or physically harming patients. <li>
 
'''Evidence Implicating Suspect''': Surveillance footage showed Poggiali acting suspiciously around patients, including injecting them with unknown substances. <li>
 
'''Evidence of Foul Play''': Post-mortem examinations revealed evidence of lethal doses of potassium chloride in some patients. </ol><li>
'''Jane Bolding''':
{{L3}}'''Situation''': An unusually high number of patient deaths occurred in Prince George’s Medical Center in Maryland. ​<li>
'''Suspicion''': Jane Bolding was accused of serial murder by allegedly administering lethal doses of potassium chloride to patients. ​<li>
'''Direct evidence''': An alleged confession obtained through coercive methods, was later retracted, and excluded from the trial. ​<li>
'''Evidence Implicating Suspect''': Statistical evidence showed a high incidence of cardiac arrest during her duty periods, with her patients being 47.5 times more likely to experience cardiac arrest on her shifts compared to other nurses. <li>
'''Evidence of Foul Play''': Post-mortem examinations showed elevated potassium levels in patients, but it was inconclusive as a cause of death. ​
 
And then there are some other, um, interesting cases: {{L1}}
'''Ben Geen'''
{{L3}}'''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.<li>
'''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.<li>
'''Direct Evidence:''' There was no direct evidence, such as CCTV footage or eyewitness accounts, of Geen harming patients.<li>
'''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.<li>
'''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.</ol><li>
'''Colin Norris'''
{{l3}}'''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. <li>
'''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. <li>
'''Direct Evidence''': No direct evidence of Norris administering lethal substances or physically harming patients was found. <li>
'''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. <li>
'''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.

Revision as of 10:41, 27 August 2024

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We characterise “healthcare serial murder” cases as follows:

  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 classic case?

HHarold 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 doctor is often cited but it wasn’t quite the classic case, as the majority of Shipman’s murders took place away from a medical facility and in the patients’ homes, where there would be no witnesses, security devices or cameras that might record his action. The circumstantial evidence (when people knew to look for it) that implicated Shipman was both overwhelming and strong, and (at least at the end) there was a financial motive — though this might not have been present earlier.

Some examples of apparent healthcare serial murderers

The other famous cases are a little less edifying for the legal profession:

The “healthcare serial murder” cases
Name Date Sex Situation Reason for suspicion Direct evidence Key evidence Evidence of foul play Motive Tendency Outcome Appeal
Jessie McTavish (Scotland) 1974 F Victims found with inexplicable quantity of pethidine Defendant witnessed injecting patient with phenobarbitone Statements, apparent admission to police Blood tests, admission of injections. Awareness of insuline as an MO for murder. Post-mortem forensics consistent with poisoning. None. None. Convicted. Acquitted on a technicality.
Susan Nelles
(Canada)		 1981 F Unusually high number of infant deaths.
Initially attributed to natural causes		 Suspect was present during a disproportionate number of incidents.
A pattern of sudden deterioration when suspect took over their care.		 None. Shift pattern analysis.
Witnesses saw suspect “behaving suspiciously” around patients.		 Post-mortem forensics consistent with poisoning. Expert opinion that deaths were “not natural”. None. None. Charges dropped due to lack of evidence. N/A
Genene Jones (USA) 1982 F Unusually high number of infant deaths. Puncture marks in bottle of paralytic drug None Only suspect had access to the succinylcholine Puncture marks in bottle None. None. Convicted None.
Marianne Nölle (Germany) 1984 F Unusually high number of elderly deaths. Initially attributed to natural causes Suspect was present during a disproportionate number of incidents. A pattern of sudden deterioration when suspect took over their care. None Lethal dose found in patient’s system administered while suspect on duty. Reports from patients. None. None. None. Convicted None.
Beverley Allitt
(UK)		 1991 F Unusually high number of child deaths. Post-mortem forensics consistent with non-accidental poisoning. Suspect was present during a disproportionate number of incidents.
A pattern of sudden deterioration when suspect took over their care.		 None. Shift pattern analysis.
Suspect signed out medications that were found in lethal doses in the victims.		 Post-mortem forensics consistent with poisoning.
Witnesses saw suspect “behaving suspiciously” around patients.		 None. Some evidence of attention-seeking behaviour and prior mental illness. Convicted. None.
Kristen Gilbert (US) 1996 F Disproportionate number of deaths of low risk patients. Other nurses reported concerns about high levels of cardiac deaths. None. Motivation, access to epi­nephrine, the medical evidence of victim’s symptoms, peripheral behaviour. Post-mortem forensics consistent with poisoning. Reconciliation with/retaliation against ex-husband. History of psychiatric illness, violence, suicide attempts, behaviour on suspicion (called in a hoax bomb threat, left hospital). Convicted. None.
Jane Bolding
(USA)		 1998 F Unusually high number of adult deaths. Suspect was present during a disproportionate number of incidents. None. An alleged confession obtained through coercive methods, was later retracted, and excluded from the trial. Shift pattern analysis. Post-mortem forensics consistent with poisoning. None. None. Convicted. Acquitted on retrial due to lack of evidence.
Colin Norris
(UK)		 2002 M Unusually high number of adult deaths. Suspect was present during a disproportionate number of incidents. None. Shift pattern analysis.
Witnesses saw suspect “behaving suspiciously” around patients.		 Post-mortem forensics consistent with poisoning. Missing insulin from hospital fridge accessed by Norris immediately before death. Inspired by Jesse McTavish? Theft, behavioural problems. Convicted. Active campaign.
Ben Geen
(UK)		 2003 M Unusually high number of adult deaths. Suspect was present during a disproportionate number of incidents. None. Shift pattern analysis.
A syringe containing insulin was found hidden in suspect’s locker.		 Post-mortem forensics consistent with poisoning. None. None. Convicted. Active campaign.
Lucia de Berk
(Netherlands)		 2010 F Unusually high number of deaths (from infants to elderly). Suspect was present during a disproportionate number of incidents.
A pattern of sudden deterioration when suspect took over their care.		 None. Shift pattern analysis.
Witnesses saw suspect “behaving suspiciously” around patients.		 Post-mortem forensics consistent with poisoning. None. None. Convicted. Acquitted on retrial.
Use of statistics heavily criticised.
Victorino Chua (UK)[1] 2011 M Experienced nurse noticed a sudden and inexplicable drop in patients’ blood sugar levels. Saline bags clearly sabotaged. Patient dosages amended by Chua. Aggressive behaviour in one case. None. Shift pattern analysis. Saline bags clearly sabotaged. None. None. Convicted. None.
Rebecca Leighton (UK)[2] 2011 F Experienced nurse noticed a sudden and inexplicable drop in patients’ blood sugar levels. Tampering with saline solution. None. Leighton had access, was present at the scene and was found in possession of prescription drugs. Post-mortem forensics consistent with poisoning. None. Theft (of prescription drugs — for her own use!) Charges dropped due to insufficient evidence. N/A
Daniela Poggiali
(Italy)		 2014 F Unusually high number of adult deaths. Suspect was present during a disproportionate number of incidents. None. Shift pattern analysis.
Witnesses saw suspect “behaving suspiciously” around patients.		 Post-mortem forensics consistent with poisoning. None. None. Convicted. Acquitted on retrial.
Use of statistics heavily criticised.
Lucy Letby
(UK)		 2015-6 F Unusually high number of infant deaths.
Multiple apparent causes.
Initially attributed to natural causes		 Suspect was present during a disproportionate number of incidents.
A pattern of sudden deterioration when suspect took over their care.		 None.
Witnesses saw suspect “behaving suspiciously” around patients.		 Shift pattern analysis. Post-mortem forensics consistent with poisoning. Expert opinion that deaths were “not natural”. None. None. Convicted. Active campaign.
  1. ↑ See also Rebecca Leighton, charged for the same 2011 Stepping Hill Hospital poisoning incident.
  2. ↑ See also Victorinho Chua, charged and convicted for the same 2011 Stepping Hill Hospital poisoning incident.
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