For victims and their families, this is an unimaginable crime. Medical serial killers are trained healthcare professionals who have taken it upon themselves to kill their patients. Cases of doctors, nurses, and healthcare assistants have been documented throughout history highlighting how trusted positions and access to vulnerable patients can be abused in the worst way possible.
The medical professionals we all rely on in our most helpless and unguarded moments train for many years in order to treat and support patients within their care. They have a level of responsibility to their patients and a level of trust which is seen in few other relationships between individuals. In the early years, such cases were often referred to as ‘angel of mercy’ killings. This comes from the notion that some of those responsible carry out their crimes to, in their eyes, relieve the patient of their suffering.
However, not all cases fit this mold and it is not uncommon for what may have started as an act of perceived mercy, to turn into something else over time, where a perpetrator begins to expand their victim pool out with this criterion of the suffering patient.
Nurses Who Kill
There have been numerous cases of Medical or Healthcare Serial Killers (HSKs), as they are preferably known, around the world. Charles Cullen in New Jersey may have killed over 400 patients across 16 years as a nurse in nine hospitals. Kimberly Saenz also in America murdered five patients in Texas by injecting them with bleach.
Italian nurse Daniela Poggiali murdered 38 patients using potassium chloride and took pictures of herself next to the deceased bodies and shared them on social media. Then there is Genene Jones, a pediatric nurse in San Antonio, Texas known to have killed four children by injecting them with drugs.
Most nurses who kill work alone, however a case in Austria saw four nurses in Vienna who worked together between 1983 and 1991. Led by nurses aide Waltraud Wagner at Lainz General Hospital, they killed patients using morphine and later by drowning, holding the patient down, pinching their nose, and pouring water down their throat, a truly horrific and terrifying way to die.
Maria Gruber, Irene Leidolf, Stephanija Mayer, and Waltraud Wagner, collectively known as the ‘Lainz Angels of Death‘, have admitted killing 49 patients but as with many medical serial killers, it is feared the true number of patients murdered may be as high as 200. They were caught when a doctor overheard them laughing about their latest victim, starting an investigation that resulted in their arrest in 1989.
The UK has, in these last few months, witnessed its own healthcare serial killer whose actions were truly unthinkable. After a 10 month long trial and 22 days of jury deliberations, Lucy Letby, a 33 year old neonatal nurse at the Countess of Chester Hospital in England, was convicted of 7 murders of tiny vulnerable babies and the attempted murder of 6 others.
On August 21, 2023, she was formally sentenced by Mr. Justice Goss but she refused to come into the courtroom and sit in the dock to hear her fate. Her refusal also meant she did not hear the brave and heartbreaking victim impact statements from the parents of the children she brutally murdered or attempted to murder. Those babies who survived her horrific actions have been left with life-changing health conditions with some requiring around-the-clock care.
Letby’s defiance has caused significant and understandable anger that she is able to simply refuse to attend court and has the right legally to do so under current laws. The calls for laws to be changed to force convicted criminals to attend their sentencing hearings are getting increasingly louder.
In her absence she was sentenced to life in prison, the automatic sentence applied to murder in the UK. The judge listened to the request of the prosecution team and agreed whole-heartedly that Lucy Letby more than met the requirements to be given a whole life term. This means Letby will never be released from prison. She will die behind bars.
“This was a cruel, calculated and cynical campaign of child murder involving the smallest and most vulnerable of children, knowing that your actions were causing significant physical suffering and would cause untold mental suffering. There was a deep malevolence bordering on sadism in your actions. During the course of this trial you have coldly denied any responsibility for your wrongdoing and sought to attribute some fault to others. You have shown no remorse. There are no mitigating factors. In their totality, the offences of murder and attempted murder were of exceptionally high seriousness and just punishment, according to law, requires a whole life order.” – The Hon. Mr Justice Goss, Judge in Lucy Letby trial
The depravity of her crimes is truly shocking. When alone with the most vulnerable babies in the ward where she worked she would inject them with insulin, overfeed them, or pump air into their stomachs or straight into their bloodstreams.
The results were catastrophic and sudden collapse leading to death for seven of these babies and lifelong damage to those who the medics who ran to help were able to save. Lucy Letby had a quiet demeanor. She was friendly and polite with the parents and generally thought of as a professional and competent nurse. All factors which she used to get away with murdering children for 13 months in 2015 and 2016.
Concerns and direct accusations from senior doctors working on that ward were ignored and brushed aside by hospital bosses who refused to even consider Lucy Letby could be harming the babies in her care. After information and claims during the trial these bosses, some who are now in new and different roles, are being investigated.
The British Government has announced an official inquiry will now take place into what happened in this case and how Lucy Letby was not stopped sooner. While an inquiry has been welcomed many want to see the level upgraded to a statutory inquiry which means a judge presides over the full investigation and witnesses can be forced to testify.
Lucy Letby was not arrested until July 2018 after police were finally called in by hospital bosses to investigate the spike in mortality rates on the neonatal unit that were completely outwith usual rates and were deaths and collapses that could not be explained. After it was determined these babies were deliberately harmed, it became apparent the only staff member who could have harmed all of these children was Letby. When she was finally moved away from the ward and into an administrative role after 13 months, all instances of sudden collapse and unexpected deaths stopped.
It took a further two years for police investigators to gather enough evidence to charge Letby with 21 counts of murder and attempted murder. She was charged in November 2020 and the case was tried at Manchester Crown Court from October 2022 through to August 2023.
Sadly, Lucy Letby is not the first healthcare serial killer the UK has seen. In early 1991 in Lincolnshire, England a nurse called Beverley Allitt murdered four children and attempted to murder three more while working in the children’s ward at Grantham and Kesteven Hospital.
The methods of Lucy Letby are a chilling echo of how Allitt carried out her crimes, the use of insulin, and the introduction of air bubbles into the children’s systems. After her convictions, Beverley Allitt was sentenced to thirteen life sentences in May 1993. She is now 54 years old and currently still behind bars at Rampton Secure Hospital in Nottinghamshire.
In the UK, the case of Dr. Harold Shipman is one that caused shock across the country. A friendly local GP who had been murdering his elderly patients by injecting them with diamorphine and falsifying their medical notes. His choice of patients, their ailing health, and his cool and reassuring manner with family members ensured the deaths were attributed to poor health.
When he was finally caught after family members raised concerns and a discovery of false medical records was made, it was believed this doctor murdered up to 250 of his patients between 1975 and 1988. Convicted of murder for 15 of his patients, Dr. Harold Shipman was sentenced to life in prison and was recommended never to be released. He hung himself in his prison cell in 2004.
Research on Medical Serial Killers
Dr. Eindra Khin Khin, Assistant Professor of Psychiatry and Behavioural Sciences at the University of Virginia has highlighted cases of healthcare serial killings have increased since the 1970s. Ten cases were recorded within that decade, by 2001 to 2006 this number had risen to forty cases.
In a presentation at the annual meeting of the American Academy of Psychiatry and the Law, Dr. Khin Khin showed the majority of cases took place within a hospital setting (72%), with 20% of cases happening in nursing homes and 6% within the patients’ homes. Over half of all cases were carried out using a lethal injection.
Often victims are elderly or very sick and their deaths can be put down to natural causes rather than suspicions being raised. In most cases a cluster of deaths raises questions and the most common form of killing is through the use of an injectable substance only detectable through toxicology. In many cases, the age and health conditions of patients mean such tests are not carried out and the crime remains undetected.
Are There Common Traits In Healthcare Serial Killers?
Criminologists have begun to examine cases in order to try and identify common traits among such healthcare professionals, predominantly nurses, who turn on their patients. Using the term ‘healthcare serial killers’ or HSKs rather than ‘angel of death nurses’, criminologists have found some interesting results through their research.
Published in the Journal of Investigative Psychology and Offender Profiling, the research carried out by Dr. Elizabeth Yardly and Dr. David Wilson, both prominent criminologists, has been influential in the understanding of such crimes. Attention seeking, strange behavior when a patient dies, frequent changes in hospital working locations, and a disciplinary record have all been flagged as common factors seen in healthcare serial killers.
This research examined 16 nurses, both male and female who have been convicted of murdering patients within a hospital setting including the case of Beverley Allitt. Further case studies included Victorino Chua convicted of two murders and 19 poisonings at Stepping Hill Hospital in Stockport, England in 2015. Colin Norris who was convicted in 2008 of four murders carried out in 2002 in Leeds, England, and American Charles Cullen who confessed to killing 40 patients over a 16-year period in New Jersey and Pennsylvania in America.
In many cases of murder within healthcare settings, the perpetrator has carried out multiple killings before they are caught. This repetitive cycle suggests a pleasure is received from the acts leading some to believe there may be an addictive element to their murderous behavior.
The Vulnerable Patient: Access and Opportunity
Access to drugs appears to be the enabler for these crimes with the most common method of killing being poisoning with the majority of cases included in this study involving insulin. Beverley Allitt was the only case in the study that used two methods of killing, poisoning, and suffocation. Of the 16 offenders studied, over 50% had a history of mental health issues of some kind and signs of a personality disorder.
Charles Cullen is believed to have been murdering his patients for 16 years across nine different hospitals between 1987 and 2003 before he was caught. Some estimates on the actual number of patients who died at his hands are in the hundreds, as many as 400 patients.
The case of Charles Cullen is a complicated one with a personal history marked with suicide attempts, police investigations, and stays in psychiatric wards, however, no one raised the alarm when his working practices were dangerous and not up to standard. A nurse who was reportedly fired five times from nursing roles was still able to practice as a nurse at different hospitals and continue gaining access to patients.
A 2006 study examining 90 cases of healthcare serial killers from twenty different countries between 1970 and 2006, found that 86% of those who became serial killers within healthcare were nurses, both male and female.
Further research has categorized healthcare serial killers in accordance with their motives. These categories show the range of motivations and psychological rewards achieved by those in the medical profession who kill their patients. According to Dr. Khin Khin, they can often be categorized into the following groups:
- Thrill Seekers – these are individuals who achieve a thrill from the act of killing, a thrill that they want to repeat over and over again.
- Power Oriented – in this group, they kill to achieve a feeling of power and control. Dr. Harold Shipman is an example of a medical serial killer who falls within this category.
- Gain Motivated – these individuals receive something from the act of killing, this may be relieving a burden by removing the patient from their care or they may be able to steal money or belongings from the patient.
- Missionary Killers – less common, these are serial killers within healthcare who believe they are doing a good deed by getting rid of people who are “immoral or unworthy” in some way.
Further to categorization by motives, studies have identified a number of character traits and behaviors which may when combined, be a warning sign for a potential medical serial killer;
- History of mental instability
- Preference for night shifts, or shifts with fewer staff and supervisors on duty
- History of difficult personal relationships
- A tendency to ‘predict’ when a patient will die
- Felt patients were a burden to them and an annoyance
- Had a problem with substance misuse
- Often moved from hospital to hospital
An important area highlighted by research was that in many cases the fact that the nurse was on shift during all of the killings has often been cited as the main piece of evidence of their guilt. However, this should not be the case and their presence in the hospital at the time of the deaths is not enough alone to point to their guilt.
A recent case in the United Kingdom saw 48-year-old nurse Victorino Chua sentenced to a minimum of 35 years for two murders and 19 poisonings at Stepping Hill Hospital in Stockport. Convicted in May 2015, Chua maintains his innocence, claiming he is not responsible for these crimes and is going to prison as an innocent man. A further 10 deaths at the hospital across the time-span Victorino Chua was working are now currently under investigation with concerns that these too may have been the result of foul play.
Although in 94% of the 16 serial killer nurse cases studied by Dr. Yardley and Dr. Wilson, the death rate when those nurses were on shift was higher than average, the researchers highlight the importance of looking at the data as a whole and not using one such trait or characteristic on its own to implicate one individual.
“We hope that this research might help hospital administrators to think more critically when they notice a spike in deaths on a particular ward, rather than relying on crude statistical analyses related to particular nurses and their shift patterns. Inevitably, that method will lead to miscarriages of justice.” – Professor David Wilson, Leading Criminologist
Convicted Nurse Colin Norris: Guilty or Innocent?
Healthcare nurse Colin Norris was jailed for life in 2008 in Leeds, England, for the murder of four of his patients, Ethal Hall, 86, Doris Ludlan, 80, Bridget Bourke, 88, and Irene Crookes, 79, and the attempted murder of Vera Wilby, 90, over a 6 month period in 2002.
An eagle-eyed doctor became suspicious of the death of one elderly patient who was suffering from very low glucose levels. They ordered blood tests that showed lethal doses of insulin in her system. For a patient having no medical condition requiring insulin, this led them to believe she was most likely injected with the drug as a deliberate act of harm. A police inquiry was launched. 72 patient deaths were investigated, 18 were flagged as suspicious with at least 8 who had died during a working shift of Colin Norris.
As the investigation moved forward it was believed very early on that Norris injected very high doses of insulin into frail elderly victims causing their deaths. He was compared to Dr. Harold Shipman at the time of his court case with police feeling Norris would have gone on to kill many more victims had he not been caught.
Police claimed in the case of Colin Norris, his killing was not acts of mercy but due to a dislike of many of the duties he had in caring for his elderly female patient’s needs. Police have had to make assumptions about his motives as Norris has never spoken of the reasons behind his crimes and has been described as cold and showing no remorse throughout his police interviews and trial.
“Here, we have a killer caught at the very beginning of his career. I am convinced that Colin Norris would have gone on to kill considerably more people if he was not stopped in his tracks.” – Detective Chief Superintendent Chris Gregg
There is, however, mounting doubt about his conviction and his guilt. In December 2014 a BBC Panorama television program aired that investigated the deaths and claimed it is possible the victims of Colin Norris may have died from natural causes. This, if correct, would mean Norris is not guilty and he is in prison, labeled as a healthcare serial killer, for murders he did not commit.
“For anybody to commit the crimes he is convicted of they would have to have a severe personality disorder. In other words, they would have to be a psychopath. Colin is nothing of the kind.” said Justice campaigner Paul May in 2016.
Experts featured on the program claimed the abnormal levels of insulin found in the victim’s blood could have been due to a rare condition called insulin autoimmune syndrome (IAS).
This was apparently raised at the original trial of Colin Norris but the prosecution claimed it was too rare to be possible in this case and to account for all the murders, which they felt were a cluster of unexplained deaths. However, since 2008 more cases of IAS have emerged and experts are beginning to believe this is not as rare as it was first thought.
After multiple submissions of fresh evidence and new research findings were submitted to the Criminal Cases Review Commission, in February 2021 they referred all five of Colin Norris’ convictions to the Court of Appeal. The fresh evidence includes new expert evidence advising the high levels of insulin found in four of the patients could be due to pre-existing illnesses. Therefore, their deaths could in fact have been by natural causes.
More recent research on hypoglycemia, when glucose levels in the blood are too low, is also now available compared to in 2007 when Norris was tried. This has also provided new evidence which may mean his convictions based on these patients are unsafe. However, this does not apply to the case of Ethel Hall whose case would need to be reviewed in light of the others if their status were to change.
It is vital we investigate any possible miscarriage of justice not only for the person wrongly convicted but also for the families of the persons they were convicted of killing. If loved ones have been unlawfully killed, making sure the person responsible is held accountable needs to happen for justice to have been done. Currently, we do not know if there has been a miscarriage of justice in the case of Colin Norris. That will be for the Court of Appeal to decide, but this is a case that highlights the complexity of medical serial killer cases and the risks of implicating an innocent nurse.
Thoughts also must be for the families of the five elderly patients involved. They have endured a horrifying ordeal losing their loved ones and understanding their deaths were at the hands of the nurse who was supposed to be caring for them. This case being referred to the Court of Appeal is a decision that will have signifcant impacts on them. Families who have already been through so much.
A stay in hospital is a difficult time for anybody and is a time when we are at our most vulnerable regardless of our age. Nobody should have to fear for their safety and quality of care while in hospital and cases such as these put fear into each and every one of us.
A medical serial killer has the opportunity and the resources available to enable them to carry out their crimes. Often hiding in plain sight under the guise of being a doting and conscientious medical professional. Our minds struggle to grasp the notion that an individual could be inflicting fatal harm. The stark truth, though rare, is that such instances do occur, defying our comprehension.
With greater insight and by studying past incidents, we can fortify our defenses to try and prevent such crimes from occurring in the future. Unfortunately, there will always be people in this world with sinister intentions; the ongoing challenge persists in detecting them before they unleash irreplicable harm.
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Cite This Article
Guy, F. (2018, Jun 28) Medical Serial Killers: The So-Called Angels of Mercy. Crime Traveller. Retrieved from https://www.crimetraveller.org/2018/06/healthcare-medical-serial-killers
- Inside the Minds of Healthcare Serial Killers – Using numerous real-life cases in every chapter, Dr Katherine Ramsland provides a fuller picture of this most deadly type of serial killer and helps readers understand how they work, and how they can be stopped.
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