Steve Ford asks if any system could have prevented the murders.
It is more than 10 years since Beverley Allitt, dubbed the ‘Angel of Death’, was found guilty of killing paediatric patients at Grantham and Kesteven Hospital
The case, and that of serial killer and former Hyde GP Harold Shipman, sparked a major overhaul of the way in which health professionals are scrutinised and regulated – changes, however, that are still to be fully implemented.
A government white paper on future regulation of healthcare professionals was published in February 2007, which stated that nurses should undergo regular checks on fitness to practise. Details of these proposals have yet to be finalised.
When Trust, Assurance and Safety was published, the then health secretary Patricia Hewitt said: ‘Rare cases of abuse have reminded us that even members of caring professions can fall away from the high standards to which they commit themselves.’
But, even with these checks in place, question marks remain as to whether or not they could stop a murderer.
Last week former staff nurse Colin Norris was convicted of murdering four orthopaedic patients at Leeds Teaching Hospitals NHS Trust between May and December in 2002.
Newcastle Crown Court convicted Mr Norris, 32, of killing Doris Ludlam, 80, Bridget Bourke, 88, Irene Crookes, 79, and Ethel Hall, 86, by injecting them with insulin.
He was also convicted of the attempted murder of 90-year-old Vera Wilby – the first of his known victims. She suffered an unexpected hypoglycaemic attack but survived.
The RCN feels it cannot officially comment on the details of an individual case. However, Bobbie Chadwick, the college’s deputy president who works at Leeds General Infirmary, has described Mr Norris as ‘one very sick rogue’.
‘It’s inherent in every nurse to be a patient advocate, to protect patients, to safeguard their well-being and to think that one of our own has let us down so badly and somehow dented the trust we have with patients is very sad indeed,’ she said.
But Mr Norris’ actions have echoes of other cases reaching as far back as the 1970s.
Glasgow nurse Jessie McTavish was sentenced to life in 1974 for the murder of a patient at the Ruchill Hospital in Glasgow. It was alleged she administered insulin to patients with an intent to cause harm – she was released two years later after an appeal.
In 1993 Beverley Allitt received life for murdering four children, attempting to murder another three and causing grievous bodily harm with intent to a further six. She also used insulin injections, as well potassium and lignocaine.
More recently, in 2006 Benjamin Geen was convicted of murdering two patients and of causing grievous bodily harm to a further 15 at Horton General Hospital in Oxfordshire.
So, in these cases were there early-warning signs that were missed? Could these nurses have been stopped earlier, how were they finally caught, and will the system ever be able to fully protect patients from such individuals?
A statement from Dundee University, where Mr Norris graduated in 2001 with a diploma in nursing, said that no evidence of any criminal activity had been found while he was training.
‘Other than a poor sickness and absence record, there was nothing out of the ordinary with regards to Mr Norris’ performance during his time at the university,’ the statement said.
All patients are vulnerable. But Norris, like Allitt, chose particularly vulnerable targets – the old and the young – and used insulin, which is both hard to detect in post-mortem and easily accessible on the ward.
Both Norris and Allitt also carefully planned their crimes. Allitt was found to have been the only nurse on duty at the time of all the incidents. Likewise, the police noted that Norris was cunning.
Detective chief superintendent Chris Gregg, who led West Yorkshire Police’s inquiry into the case, said: ‘Norris is not only a dangerous criminal but cunning in his actions, choosing times to commit his crimes carefully being either early in the morning or at weekends, when he knew senior and specialist staff were not routinely on duty.’
It was only vigilance from colleagues that aroused suspicion in the Norris case.
The police cited the ‘prompt actions’ of a health professional following an unexplained hypoglycaemic coma in non-diabetic patient Ethel Hall.
The patient’s blood was tested and found to contain a high level of insulin, consistent with an external administration. The sample was subsequently found to contain around 12 times the normal level of insulin.
Similarly, it was unusual events that aroused suspicion in the Benjamin Geen case. An abnormally high number of respiratory arrests over a two-month period were found to
have all occurred while Geen was on duty.
So what – if any – lessons can be learnt from these incidents?
With regards to the Norris case, Leeds Teaching Hospitals NHS Trust has said that, following the police investigation and its own internal reviews, it has implemented changes to improve patient care and ‘reduce the risk of criminality’.
This has included wider use of CCTV and card entry points to parts of the hospital.
‘However, it is important to stress that none of these actions would have prevented Colin Norris’ crimes,’ admitted Dr Hugo Mascie-Taylor, the trust’s medical director.
The Clothier committee, which investigated the Allitt murders, also concluded that a ‘determined and secret criminal may defeat the best regulated organisation in the pursuit of his or her purpose’.
Allitt was later diagnosed with Munchausen syndrome by proxy. So far, Norris’ motives remain a mystery. However, the court heard that he ‘disliked elderly patients’.
‘We have no idea what motivated Norris to kill, only he knows the answer to that,’ said Detective Gregg.
Thankfully, what gives all of these cases their notoriety is their rarity – and police investigations confirm this.
‘What has shone throughout this investigation and trial is the absolute dedication of nursing and medical professionals,’ Detective Gregg added. ‘Colin Norris is an exception to that.’