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:

1. Lucia de Berk
   1. 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.
   2. 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.
   3. Direct Evidence: No direct evidence was found of Lucia de Berk administering lethal substances or physically harming patients.
   4. 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.
   5. 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.
   6. The statistical analysis used to implicate de Berk was later heavily criticized for methodological flaws.

2. Susan Nelles

   1. 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.
   2. 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.
   3. Direct Evidence: No direct evidence was found of Nelles administering lethal substances or physically harming infants.
   4. 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.
   5. 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.
   6. Charges were ultimately dropped due to lack of evidence.

3. Daniela Poggiali:

   1. 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.
   2. Suspicion: Daniela Poggiali was present during a disproportionate number of patient deaths.
   3. Direct Evidence: No direct evidence was found of Poggiali administering lethal substances or physically harming patients.
   4. Evidence Implicating Suspect: Surveillance footage showed Poggiali acting suspiciously around patients, including injecting them with unknown substances.
   5. Evidence of Foul Play: Post-mortem examinations revealed evidence of lethal doses of potassium chloride in some patients.

4. Jane Bolding:

   1. Situation: An unusually high number of patient deaths occurred in Prince George’s Medical Center in Maryland. ​
   2. Suspicion: Jane Bolding was accused of serial murder by allegedly administering lethal doses of potassium chloride to patients. ​
   3. Direct evidence: An alleged confession obtained through coercive methods, was later retracted, and excluded from the trial. ​
   4. 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.
   5. 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:

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.