Healthcare serial murder

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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 as the healthcare serial murderer par excellence, but he wasn’t quite the classic case, as the majority of his 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 in the end) he had 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)	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)	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.