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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)

  • BTW the information which Elizabeth Yardley and David Wilson used to compile the "red flag" checklist for their 16 cases ... came from newspapers. Well, newspapers certainly are an extremely reliable source of information when you are researching Health Care Serial Killers! The Dutch nurse Lucia de Berk scored extremely high, according to newspaper reports. She even had two Stephen King novels about serial killers at home (overdue? stolen???). This is why the original inventor of the red flag checklist, Prof. Katherine Ramsland from the U.S., put "owning books about serial killers" on her list back in 2006 when Lucia was still a convicted serial killer. And they found some medicines at home in the medicine cupboard (aspirins?) which seemed to have come from the hospital. In the past she had had psychotherapy and all that ... like so many of us.

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  • Journal paper is available as mentioned by Richard Gill - and from

    Online peer critique: 1 entry atm:

    Birmingham City University news link to paper:

    'Dr Yardley said: "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."'

    Some people at work might have most of the "most common red flags" but doesn't mean they are serial killers.

    It must also be taken into consideration if areas receives much higher than average sicker patients with higher acuity needs, co-morbidities and long-term conditions.
    We're probably seeing more 'defensive medicine' being practiced by nurses and doctors for fear of litigation, false allegations and adverse publicity. Once mud is thrown, think it sticks, as anecdotal evidence indicates careers have been ruined through false allegations.

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  • opps- Birmingham City Uni's link is:

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  • Nursing people on a daily basis undertaking 12 hour shifts, lack of sleep and nonsense stress from other members of staff and management is enough to make anyone depressed. It's the ones that crave action and fantasise emergency scenarios that worry me. I think every nurses' ideal when going on duty is anticipating that they will inherit a stable case load and to be assured they will receive support when needed. Chronic illness has contributed toward my feeling down in the dumps, which enables me personally, to be more empathetic which seems to be sorely lacking.

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  • Elizabeth Yardley and David Wilson kindly sent me the spreadsheet (16 nurses, 22 red-flags) of their paper.

    Today I computed the Ramsland checklist score for Lucia de Berk. I used the information which was believed to be true in the period 2004-2006 ie before any kind of public movement started claiming a miscarriage of justice, *after* a conviction both at a lower court and at an appeal court. I answered the questions according to the information you would have found in the judges' summing up and in the (quality) newspapers.

    Result: Lucia is the winner with a score of 15, which is 4 bigger than the record-holder Charles Cullen !!!

    This is not entirely surprising, since Ramsland used a previous study by Yorker et al., and one of the "et al" was a Dutch ex-nurse Paula Lampe who wrote a lurid book about Lucia in the early years of the case. There is also connection to the professional FBI profiler Alan Brantley who was an expert for the prosecution and also wrote a paper (in the FBI Law Enforcement bulletin) on his experiences in the Dutch case.

    In other words: a number of the items on the list were *inspired* by the evil witch Lucia.

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