Serial Murder in Hospitals
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Slide 1 :
Preventing Murder in Hospitals Beatrice C. Yorker JD, RN, MS, FAAN Dean, College of Health and Human Services California State University, Los Angeles
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Prevalence 90 prosecutions of healthcare professionals for serial murder of patients in their care since 1970 1970’s 10 1980’s 21 1990’s 23 2000’s 40 and counting (30 not in US)
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Legal Outcomes 53 have been convicted 4 for attempted murder 5 pled guilty to lesser charges 44 of these for serial murder 25 have been indicted and are either awaiting trial or the outcome has not been published 8 were acquitted of murder charges 3 of these were liable for civil damages ranging from $450,000 to $27 million. 4 successfully appealed their convictions
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Geographic locations Country Incidents Country # Cases Austria: 4 Belgium: 3 Brazil: 1 Canada: 1 England/Wales: 12 Egypt: 1 France: 1 Germany: 14 Holland: 3 Hungary: 1 Ireland: 1 Italy 1 Japan: 1 Norway: 1 Poland: 4 Russia: 4 Scotland: 1 Switzerland: 1 United States 36 Zimbabwe: 1 Total (20) 90 State Incidents US State _# Cases Alabama: 2 California: 3 Florida: 3 Georgia: 1 Illinois: 1 Indiana: 3 Maryland: 2 Massachusetts: 1 Michigan: 4 Missouri: 1 New Hampshire 1 New Jersey 1 New York: 2 Oklahoma: 1 Ohio: 1 Oregon: 2 Pennsylvania: 1 Texas: 5 Virginia: 1 Total (19) 36
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High tech environments
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Injection Potassium Chloride Digoxin Respiratory paralyzing agents Epinephrine Insulin Lidocaine Morphine (more prevalent in UK & Europe)
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Other Methods Injection 51 Unknown 25 Suffocation 11 Water in lungs 4 Air embolus 3 Oral med's 3 Equipment tampering 1 Poisoning 1 TOTAL 99 (some used more than 1 method)
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Victims Victim characteristics: Persons who were critically ill or very old, infants and seriously ill children were most likely to be victims of serial murder. Some killers were associated with a specific type of patient (e.g., elderly victims) or with a specific diagnosis.
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Victim numbers There were a total of 307 patient deaths that resulted in convictions for murder. In most of the incidents the caregiver was suspected of being linked to many more deaths than for what were actually prosecuted. The total number of suspicious deaths associated with the 53 convicted healthcare providers was 2,081. This may be a significant undercount. In addition, there were 130 patients who survived an injection and the healthcare provider was convicted for attempted murder or assault.
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Video Segments Serial Murder Video Segment #1 Serial Murder Video Segment #2
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Case studies Georgia Florida New York England Indiana England Europe
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Psychodynamics Factitious Disorder/Munchausen Syndrome by Proxy Attention Euthanasia: Rationalization by some killers. Not authentic euthanasia with full informed consent. Sociopathy: Power and control Hero syndrome Disdain Mother Teresa Syndrome: fine line between aggression and need to be needed, improve self esteem (P. Lampe) Move patients out, overwork (B. Salisbury) Profit: kickbacks from a funeral parlor, payment from organ transplant industry (Poland, Russia)
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Prevention Employment practices Risk Management Medication control Routine data review Encourage reporting Night and evening shift supervision
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Early detection Routine toxicology screens post arrest Save equipment, vials, tubing, syringes Review death, arrest stats monthly by unit, by shift, by total hospital and compare to each other and to selves—monitor trends Strict pharmacy accounting for each dose of medication
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Surveillance (implement at any significant trend) Covert video surveillance Overt video surveillance Chart review Personnel tracking Background checks ?? Behavior documentation Increase data collection in identified unit
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Surveillance(if trend reverses) Track identified personnel Shift from overt to covert surveillance Evaluate data for evidence of criminal activity Once “probable cause” of a crime exists notify law enforcement If necessary notify licensing board
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Staff member resigns Provide information to future references Notify adult protective services?? Consider national licensing board data sets
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Non-surveillance detection Nursing staff report suspicions Patient or patient’s family report getting a drug that made them feel sick/stop breathing/die Autopsy results Caregiver with Munchausen syndrome
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Working with Law Enforcement REASONS WHY DON’T : Negative publicity Fear of Civil Suits by patients for negligence Fear of Civil Suits by nurses for libel/slander Fear investigation will reveal poor record keeping
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REASONS WHY SHOULD : Keep confidentiality Support staff Better outcomes… Patient safety Prosecution Public Relations Working with Law Enforcement
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Burden of Proof Criminal case: Beyond a reasonable doubt Civil case: A preponderance of the evidence
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InterventionRisks if fire Risks if not A law suit for wrongful discharge, slander, libel, etc. $50,000 Wrongful death(s) $500,000 to $8,000,000 (or until maxed out)
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Sensitivity in investigation Gender and race issues Media coverage Entrapment
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Prosecution Good “smoking gun” evidence Documentation Toxicology results Eye-witness testimony Epidemiology questionable Profile evidence not recommended
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Planning Arrest Obtaining a confession Searching the home Health record search Keeping other staff calm Media control
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Covert Video Surveillance For Munchausen Syndrome by Proxy legally permissable under 4th Amendment Arguable for nursing assault Private party Diagnostic Notification posted
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We Can Reduce SERIAL MURDERS in Health Care firstname.lastname@example.org
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PowerPoint Slide Presentation on Since 1970, 90 healthcare professionals have been prosecuted for serial murder of patients in their care. This presentation is a summary of the data presented in the article: Yorker, B.C., Kizer, K.W., Forrest, A.R.W., Lampe, P., Lannan, J., Russell, D. (2006) Serial murder by healthcare professionals. Journal of Forensic Science, 51:6 1362-1372.
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