‘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.he 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
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 who may have killed over 400 patients across 16 years as a nurse in nine hospitals. Kimberly Saenz also in America who murdered five patients in Texas by injecting them with bleach.
Italian nurse Daniela Poggiali who 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 in 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 which resulted in their arrest in 1989.
In the UK, the case of Dr. Harold Shipman is one which 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 to 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 1970’s. 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 raise questions and the most common form of killing is through 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. Cases examined included Beverley Allitt, probably the most well known ‘Angel of Death’ nurse serial killer in the UK. Allitt was a healthcare nurse who in April 1993 was convicted of the murder of four children, the attempted murder of three children and inflicting grievous bodily harm on a further six children, all over a 3 month period at Grantham and Kesteven Hospital in Lincolnshire, England.
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 which 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 less 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 towards 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 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 in looking at the data as a whole and not using one such trait or characteristic on its own to implicate one individual.
As highlighted by Professor David Wilson:
“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.”
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 and ordered blood tests which showed lethal doses of insulin in her system. For a patient having no medical condition requiring insulin, 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.
It was believed 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 on 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 on his conviction and his guilt. In December 2014 a BBC Panorama television programme aired which 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 programme 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. 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. It is believed the Criminal Cases Review Commission is currently reviewing the case of Colin Norris with regards to the possibility of an appeal and this is a case which highlights the complexity of medical serial killer cases and the risks of implicating an innocent nurse.
A stay in hospital is a difficult time for anybody and is a time when we are at our most vulnerable. 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 opportunity and resources available to enable them to carry out their crimes.
The more understanding we have and the more we can learn from previous cases, the more measures can be put in place to prevent such crimes occurring in the future. Unfortunately, there will always be people in this world with sinister intentions; trying to spot them before they can do any damage is a challenge we will always face.
- Crocker, L. (2013) ‘The Angel of Death’ and The Hospitals That Put A Serial Killer To Work. The Daily Beast
- Eleftheriou-Smith, L (2015) What Makes A Nurse A Serial Killer? The Five Characteristics That Define Our ‘Angels of Death’. The Independent
- Frieden, J. (2014) Healthcare Serial Killings Down in U.S. but Up Globally. MedPage Today
- Johnston, J.E. (2012) The Medical Murder Club. The Human Equation Blog. Psychology Today
- Protzman, F. (1989) Killing of 49 Patients By 4 Nurse’s Aides Stuns the Austrians. New York Times
- Ramsland, K. (2012) When Nurses Kill. Shadow Boxing Blog. Psychology Today
- Yardley, E., and Wilson, D. (2016) In Search of the ‘Angels of Death’: Conceptualising the Contemporary Nurse Healthcare Serial Killer. J. Investig. Psych. Offender Profil., 13: pp39–55. DOI: 10.1002/jip.1434.
- Yorker, BC., Kizer, K.W., Lampe, P., Forrest, A.R., Lannan, J.M, and Russell, D.A. (2006) Serial Murder By Healthcare Professionals. J. Forensic Sci. 51(6), pp132-71. DOI: 10.1111/j.1556-4029.2006.00273.x
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, 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.