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Criminologists identify range of 'red flags' for killer nurses

  • 25 Comments

A spike in death rates during shifts should not be the determining factor in identifying hospital nurses that may have murdered patients, researchers have claimed.

They warned that focussing solely on hospital attendance data to establish who was working during a shift when large numbers of deaths occurred could lead to miscarriages of justice.

Instead, they called for a wider range of “red flags” – such as drug possession and whether they made colleagues feel anxious – to be considered alongside high death rates when investigating potential healthcare killers.

“It’s really important to acknowledge it will be a cluster of factors and not one individual element that should identify an ‘Angel of Death’ at work in a hospital setting”

Elizabeth Yardley

The study authors, from Birmingham City University, pointed to Dutch nurse Lucia de Berk who was found guilty in 2003 of murdering seven patients, but was later acquitted after lawyers highlighted the problematic nature of attendance data – which was central to her conviction.

The new study, published in the Journal of Investigative Psychology and Offender Profiling, looked at 16 convicted serial killers in health settings, including Colin Norris who was convicted in 2008 of four murders while working as a nurse at hospitals in Leeds.

Colin Norris

Colin Norris

Criminologists Elizabeth Yardley and David Wilson wanted to establish whether a certain combination of personality traits or behaviours could be used to detect and prevent nurses that set out to murder patients.

The most commonly occurring traits were higher incidences of death on shift (94%), history of mental instability/depression (63%), making colleagues feel anxious (56%), being in possession of drugs (50%) and seeming to have a personality disorder (50%).

However, they concluded focussing solely on one or two red flags was not likely to be an effective way to identify serial killers. They found that in the case of Mr Norris only two of the indicators were present.

The university has passed its research to the legal team representing Mr Norris, whose case is being looked at by the Criminal Cases Review Commission, and to Greater Manchester Police in relation to three 2011 deaths at Stepping Hill Hospital in Stockport.

Nurse Victorino Chua was charged with the Stepping Hill murders in March 2014 and is expected to stand trial early next year.

Birmingham City University

David Wilson

Based on their findings, the authors have called for a reassessment of the approaches used by healthcare and law enforcement groups to prevent and detect murderers working in healthcare professions.

Professor Wilson said: “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.”

Ms Yardley added: “It’s really important to acknowledge it will be a cluster of factors and not one individual element that should identify an ‘Angel of Death’ at work in a hospital setting.”

  • 25 Comments

Readers' comments (25)

  • As much there should be a safe + harm free environment for all our patients and colleagues, imagine working under constant observation pending an imminent CQC inspection. Now multiply that several times with the stress of being under the spotlight with higher mortality rates.
    My anxieties and concerns includes if an unfortunate cascade of events and when things become very stretched takes over, blame may be put onto innocent staff and not directed at the person who caused harm.
    Also death may happen when that person is not be on shift, so again other colleagues would be under the spotlight.

    It assumes the culprit have to be on duty to deliver the fatal 'dose' or neglect key elements of care at a critical time (and eg. wielding a bloody knife).
    In terms of access to patients, think of how many visitors there are in any given area - not just nurses, these can also include non-clinical people as well as external visitors.
    Again who's going to be monitoring the monitors?
    If there's a case of potentially wasting resources, increasing retention problems, with more auditing/monitoring and the feelings of 1984 over us, this will be it.

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  • The report is interesting and definitely relevant to highlight the red flags that may identify those that potentially could be capable or responsible for patients deaths. However particular commonly occurring traits such as depression, mental health problems as this report suggests may increase the risk. Mental health issues/depression can be experienced by lots of the nurse population and others in the wider community, however it doesn't mean that someone may have potential to be a killer.

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  • Might the term "Angel of Death" be removed from our vocabulary please? There is nothing at all remotely angelic about a pompous, murdering pervert.

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  • Oh My Goodness! We are all serial killers now? I am really frightened. Is a Nurse able to continue in practice for X years without a patient dying during or shortly thereafter one's shift?
    At the end of a busy shift I'm glad that I have not killed myself. Trying to fit others in as part of a psychotic compunction would be laborious at best.
    What is really terrifying are the criteria listed in the article itself. Depression, making others anxious, drugs, seeming to have personality disorder. The description matches any overworked Medic/Nurse in the aftermath of a horrendous and protracted shift.
    Depressed - Not had a break and very tired
    Making others anxious - Handover and we can go home.
    Drugs - Energy drinks and strong coffee.
    More importantly, who does not have a personality disorder. Especially when depression, anxiety and drugs/stimulants are considered?
    I hope that my post is taken as the 'tongue n' cheek' as intended?
    Nurses are NOT serial killers. Serial killers could be anyone. Furthermore, there are very, very few of them................

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  • Andy are you trying to make your colleagues feel anxious?? (56%)

    The CQC is so slow moving and charitable that they give those acting in ignorance or making human errors way too much time to put things right.

    Try grounding yourself by putting your service user equal first and I'm sure you'll feel less fearful.

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  • This study identifies the factirs which get a nurse accused of being a serial killer. Note that many are incredibly subjective. Once the scare has started, gossip and fear adds more. Once the dictors too are scared, they go back trawling for "suspicious" incidents at which the scary nurse played a role, reinterpreting and rewriting the medical dossiers. They present an impressive srack of highly suspicious material to hospital management who go to police. The media does the rest.

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  • This study identifies the factors which get a nurse accused of being a serial killer. Note that many are incredibly subjective. Once the scare has started, gossip and fear adds more. Once the doctors too are scared, they go back trawling for "suspicious" incidents at which the scary nurse played a role, reinterpreting and rewriting the medical dossiers. They present an impressive stack of highly suspicious material to hospital management who go to police. The media does the rest.

    The study is methodologically flawed. It shows what leads to successful convictions, but 3 of the 16 convicted HCSK's in the study are innocent.

    Wendy Hesketh: "My view is that the "Establishment" want the public to believe that, since the Shipman case, it is now easier to detect when a health professional kills (or sexually assaults) a patient. It's good if the public think there will never be "another Shipman" and Ben Geen and Colin Norris being jailed for 30 years apiece sent out that message; as has the string of doctors convicted of sexual assault but statistics have shown that a GP would have to have a killing rate to rival Shipman's in order to have any chance of coming to the attention of the criminal justice system. In fact, the case of Northumberland GP, Dr. David Moor, who openly admitted in the media to killing (sorry, "helping to die") around 300 patients in the media (he wasn't "caught") reflects this. I argue in my book that it is not easier to detect a medico-killer now since Shipman, but it is much more difficult for an innocent person to defend themselves once accused of medico-murder."

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  • michael stone

    Richard Gill has already pointed out, that these 'flags' are exactly that: they are things which might imply that something suspicious is going on - that isn't the same as evidence.

    The failure to see the distinction between 'flags' and evidence, is widespread and very problematic - the tendency to resort to accusing the most 'apparently likely' person of a known crime, with no direct evidence, when no direct evidence has come to light, is both common and not very satisfactory.

    But although 'very subjective' [and to an extent unsatisfactory, therefore] I see a lot of 'virtue' in:

    '... and whether they made colleagues feel anxious'

    as a flag.

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  • Yet another article that will give the nurse bashing media an excuse to use nurses as scapegoats for the ills of the NHS. With 3/4 million - give or take a few thousand - or so nurses in the NHS/UK there are bound to be a few incompetent/cruel dodgy nurses who only enter the profession in order to carry out their own perverse agenda.

    How many of the 600+ MP's are self serving narcissists or paedophiles; or the civil servants who 'support them? How many bankers have a social conscience? I think the odds of finding a psychopath amongst this lot, who control all of our lives and often act without impunity, is far higher despite the fewer numbers than registered nurses.

    Agree with the summation of Richard Gill above.

    To me, this is yet another reason for me not to recommend nursing to young people just starting out on the career ladder. They are unlikely to climb very far up the ladder and will be paid peanuts to be bashed by patient groups and the media alike.

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  • Anyone got a link to the actual paper?

    So we can see what it really said, rather than a report of a press release...

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  • michael stone

    BasketPress | 29-Nov-2014 11:16 am

    Anyone got a link to the actual paper?

    So we can see what it really said, rather than a report of a press release...

    You cynic ! You've clearly read too many press reports, which do not reflect the original claims - so, at least two of us are in that particular club !

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  • The Yardley and Wilson paper appears in Journal of Investigative Psychology and Offender Profiling: J. Investig. Psych. Offender Profil. (2014) Published online in Wiley Online Library. DOI: 10.1002/jip.1434
    It's behind a pay-wall. You can read it for 45 hours for $ 6. The research was ultimately paid for by the British tax-payer.

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  • so any nurse feeling dspressed or stressed is likely to be a murderere, so that will be all of us then

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  • The problem is that a bunch of medical specialists at a hospital (looking at patient records of their own patients, in the heat of the moment just after some unexpected event) are not qualified to carry out a forensic investigation, and they are not independent. They should not be allowed to be doing police work. They should even be considered as potential suspects (not of murder, but at least of making mistakes). Yet they have total control over the selected medical information which, after they are done, is handed over to the police, together with their new interpretation of these selected medical dossiers, and with the suspect on a plate. Add a bit of gossip and a media feeding frenzy soon starts. "Justice" takes care of the rest.

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  • The data analysed in the article (N = 16) ... comes from newspaper reports. That's state of the art criminology for you.

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  • michael stone

    Richard Gill | 29-Nov-2014 5:34 pm

    The police are not good at separating evience, from 'motive and opportunity', either: investigating anything 'complex', is challenging for the majority of humans, and people frequently get it wrong. Throw in 'pressure to get a result' and ...

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  • Richard: thanks for the full title! I'll see if I know a friendly internet pixie who could help me.

    But n=16! Seriously? That is poor.

    Michael: I have a long history of cynicism, which in instances like this is enhanced by a science degree and loadsa poor reporting of scientific and medical issues...

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  • michael stone

    BasketPress | 30-Nov-2014 2:20 pm

    I've got a couple of chemistry degrees - perhaps 'scientists' are more prone to this type of cynicism ? I frequently read 'medical stuff', and think 'your conclusion, isn't connected to what you actually measured !'.

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  • Unfortunately, the problem of medico-murderers is believed to exist and a 'higher than expected' death rate is the trigger that starts people looking for them. In an increasingly febrile atmosphere, any action or inaction can be seen as calculated and as part of a pattern. Most evidence in such cases is circumstantial and is seen as 'evidence' only because it has been - seen as 'evidence'. No-one would propose surveillance to catch a perpetrator in the act because of the risk to patients, but there should, at least, be unequivocal evidence of deliberate conduct to found such prosecutions. The legal system is hampered by the fact that it is at one remove - it is the opinion of medics that currently forms the basis of these cases.

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  • Interestingly, the Ben Geen case was triggered by a high rate of respiratory arrests ... that in retrospect was not high at all. It was about the same as last year! See NHS inquiry report into Horton General. And it was inflated by adding "respiratory depression" to "respiratory arrest". ie a patient fainting was another item on the score list. In the Netherlands, the number of deaths on Lucia's ward in her bad year was claimed to be exceptionally high. A year earlier and a year later it was indeed close to zero. But two years earlier and two years later it was larger! That fact was suppressed by the hospital director (he knew it - he had changed the name of the ward so that he could truthfully say that on Lucia's ward deaths were unusual). What really triggered those cases was (a) a notable personality, leading to gossip and suspicion, to polarized feelings of colleagues about Ben /Lucia, (b) both Lucia and Ben remarking to their colleagues that many events happened on their shifts (that was true - probably just chance, but noticeable), (c) and finally medical errors leading to dramatic and unexpected events which were rapidly linked with the "weird nurse".

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