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Criminologists identify range of 'red flags' for killer nurses


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.”


Readers' comments (25)

  • 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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