Healthcare Serial Killings

As seen in this longer article by Joyce Frieden, News Editor, MedPage Today

Healthcare Serial Killings

The number of serial killings committed by healthcare providers has leveled off in the U.S. in recent decades, although it is rising internationally, Eindra Khin Khin, MD, said in Chicago at the annual meeting of the American Academy of Psychiatry and the Law.

According to the literature, the number of cases of healthcare serial killings overall rose from 10 in the 1970s to 21 in the 1980s, 23 in the 1990s, and then to 40 in the years 2000 to 2006, said Khin Khin, who along with her colleagues presented a poster on the topic.

One reason the rates of healthcare serial murders are rising internationally, but not in the U.S., is electronic medical records (EMR), Khin Khin, of George Washington University in Washington, told MedPage Today in a phone interview. She noted that several serial killers, including physician Michael Swango, first got into trouble in the U.S. and then went overseas.

"We know that in America, with the implementation of the EMR system, that really decreases the potential for these incidents," she said. "You can't just take out medications and start injecting someone; everyone's accountable because of EMR. But in most parts of world, they don't even have EMR."

"At least in the [United] States, because of incidents in 1990s and 2000s, we've really beefed up on the credentialing system, and institutions have started to communicate with each other better," she continued. "People are not shedding enough light on the international phenomenon, and the global community has a little bit to catch up on in implementing guidelines and regulatory measures."

In terms of the site, the vast majority of killings (72%) occurred in a hospital, with the remainder occurring in nursing homes (20%), patients' homes (6%) and outpatient settings (2%).

Among the killings occurring in hospitals, the biggest percentage (38%) were committed on medical/surgical units, followed by the intensive care and critical care units (18%); the rest were spread among other wards including geriatrics, pediatrics, psychiatry, neurology, and the emergency department.

As to the method used, the majority of killings -- 52% -- were done via lethal injection, followed by unknown methods (25%), suffocation (11%), and water in the lungs (4%). Air embolus and oral medications were each used in another 3%, while equipment tampering and poisoning accounted for 1% each.

Among the drugs used were opiates and opioids (23%), potassium chloride (17%), insulin (13%), and other neuromuscular-blocking drugs (9%). More than half of killers (60%) were RNs, followed by aides (18%), physicians (12%), and non-RNs (8%).

Healthcare serial killers have a variety of motivations, according to Khin Khin, including:

• "Visionary": This rare type of serial killer is psychotic and kills in response to visions. For example, serial killer Herbert Mullin slaughtered 13 people because he thought he was preventing California from suffering an earthquake, she said.
• "Missionary": These killers are trying to rid the world of people they see as "immoral or unworthy," Khin Khin said. One example is Thomas Cream, a physician in late 1800s England who killed the prostitutes who came to him for abortions.
• "Thrill-Seeker": These people get a "high" from killing and are very sadistic.
• "Lust Killer": These killers -- Swango is a good example -- get sexual pleasure from murder.
• "Power/Control-Oriented Killer": These people kill to gain and exert power over their victims; they may have a sexual tone but they are not motivated by lust, said Khin Khin. Physician Harold Shipman is an example of this type of killer.
• "Gain-Motivated": This group kills for psychological or tangible gain, which may come in the form of relieving a burden or in monetary profit. This can also take the form of Munchausen by proxy, such as the case of Richard Angelo, a nurse who injected patients with medications to paralyze their respiratory muscle, causing the patients to code. "When the code happened, he'd perform very well and colleagues would praise him, and he really liked that so he kept on doing it," she said.

Healthcare professionals who are concerned about a co-worker who might be involved in such activity can watch for certain "red flags," according to Khin Khin, including:

• Unexpected deaths given patients' illnesses
• A higher death rate with the suspect on duty
• Multiple deaths in which the suspect is the last one seen with the victims
• A suspect who is overly interested in death and dying
• A suspect who is always available to "help"
• A suspect who frequently moves from one facility to another
• A suspect who has falsified information in the past

The researchers recommended several steps for preventing healthcare serial killings, such as educating staff members on the issue, designating a national or international regulation and monitoring body, routine institutional monitoring of high-alert medication use and monthly morality/cardiac arrest rates, and consensus guidelines for managing suspicious situations.

Unaddressed are the psychiatrists who do not kill, but instead who are content to cripple and crush the lives of their patients.