Quiet killings in medical facilities: detection & prevention.

• Author: Thunder, James M.

The purpose of this article is to prompt a public discussion concerning the "quiet killings" that have occurred and are occurring in our medical facilities, hopefully leading to a robust debate over improving methods of detecting and preventing such killings. The importance of this subject cannot be overstated, particularly in light of the ever-increasing numbers of people who will be admitted to, or living in, medical facilities as the first of the "baby boom" generation reaches age sixty-five in the year 2011 (1) and the number of employees who have routine access to these patients or residents. In 2000, hospital admissions were over thirty-three million (2) and in 1999 nursing homes had 1.7 million residents. (3) Hospital employees number over four million and nursing home employees another 1.8 million. (4) To these institutions and people having access may be added the residents of homes licensed to dispense medication and all of the visitors to all of the facilities.

The article will provide evidence of these quiet killings, define the scope of the problem they present, discuss some problems in detecting, investigating and prosecuting these killings, and suggest methods for detecting and preventing the killings. (5) Not only will the implementation of methods for detecting and preventing such killings save lives, such activity will save the reputation (and financial resources) of health care professionals and medical facilities by reducing their exposure to civil and criminal liability.

The Evidence of Quiet Killings

First, we begin with the evidence that quiet killings have occurred, and are occurring, in our medical facilities. Quiet killings make headlines, but then they recede from our memory. They do not seem to have prompted any sustained public discussion. Apparently, as a nation we are blithely confident that these cases are fairly idiosyncratic, but there is no justification for this confidence. Consider how the authorities and the public in the United Kingdom regarded Dr. Harold Shipman.

In February, 2000, Shipman was convicted of fifteen murders. Most of his victims were elderly women and his method was lethal injection. His deeds were committed in his suburban office or in his victims' homes. (6) Both the public and the authorities were alarmed. So, an investigation was commenced of this doctor's practice from 1974 to 1998. The results were not at all comforting, particularly to relatives of his deceased patients. The evidence showed Shipman had murdered over two hundred people. The author of the report, styled a Clinical Audit, concluded, however, that the case of Shipman was idiosyncratic: "Everything points to the fact that a doctor with the sinister and macabre motivation of Harold Shipman is a once in a lifetime occurrence;" (7) Shipman, it is said, is in prison; and, in any case, the recommended changes, if implemented, will ensure such a situation will not recur. (8)

Events described as once in a lifetime can occur more often. In 2001 and 2002, Kimball, West Virginia, experienced two one hundred year floods, that is, floods that would occur by definition only once every one hundred years. (9) What can occur with nature can occur with human nature. Whatever the case in the United Kingdom, we in the United States are on constructive notice that this "once in a lifetime" standard does not obtain in the United States. (10) One point of this article is to ensure that our constructive knowledge becomes actual. And here is what we ought actually know about the most recent span of a current lifetime: At least eighteen people in the United States have been charged with quiet killings in medical facilities in the past twenty-five years. Twelve have been convicted of two attempted murders and sixty-six counts of murder or manslaughter, with three more having twenty counts of murder or manslaughter pending against them. The eighteen are suspected of having killed more than 370 others--for a total of about 455. This summary is based on details that follow. The details are given in reverse chronological order by the date of the conviction; if there has been no conviction, by the date charged.

In July, 2002, nurse Vickie Dawn Jackson was charged with killing four elderly patients at Nocona General Hospital, seventy five miles northwest of Dallas, Texas, by injecting them with lethal doses of mivacurium chloride, a muscle relaxant, from December 2000 to February 2001. (11)

In June, 2002, former nurse Richard Williams was charged with ten murders allegedly committed in 1992 at a Veterans Administration hospital in Missouri. He pled innocent. (12)

In February, 2001, Efren Saldivar, a respiratory therapist in California, was charged with six murders. He is suspected of one hundred more in the decade 1989 to 1998. His victims were unconscious with Do Not Resuscitate Orders (DNRs). He would either withhold oxygen or administer a lethal injection of Pavulon, a muscle relaxant. In a confession, he claimed his motive was mercy. (13) Also, two co-workers were fired following the hospital's investigation into his accusation that they had followed his lead in killing patients. (14)

Kristen Gilbert, a mother of two and a nurse in Massachusetts, was convicted in March, 2001, of four murders and two attempted murders at a Veterans Administration hospital. Her method was an overdose injection of adrenaline. Police said her motive was to attract the attention of her boyfriend, an emergency medical technician, by showing him how she could handle an emergency. (15)

Michael Swango was a medical school graduate who interned in Ohio. After being convicted in Illinois of poisoning his fellow health care workers with rat poison and serving two years, he then practiced medicine in South Dakota, New York, and Zimbabwe. In September, 2000, he was convicted of four murders in New York and Ohio. One of his victims was a nineteen year old gymnast. He is suspected of having murdered scores more from 1982 to 1997. He typically used a paralyzing drug in intravenous solution. Police believe his motive was his desire to exercise power over life and death. (16)

In the summer of 2000, Robert Weitzel, a Utah psychiatrist, was convicted on five counts of manslaughter and negligent homicide. His victims were killed in sixteen days' time. Police believe his motive was that he did not want to have his holiday parties and skiing interrupted by having to care for his patients, ages seventy-two through ninety-three. He used psychotic drugs for sedation, then morphine. (17)

In the summer of 1999, nurse Rhea Henson administered morphine to two hospital patients in Virginia. They were comatose with Do Not Resuscitate (DNR) orders. The investigation concluded that the injections had not caused the deaths of the patients, so in May, 2000, Henson was charged with two counts of distributing a controlled substance. She pled guilty to one count and agreed to give up her license. (18)

Orville Lynn Majors was a nurse in Indiana. He was convicted in October, 1999, of six murders. He is suspected of having committed 150 in thirteen months from 1993 to 1995. His method was lethal injection. He claims he is innocent, so he has not revealed any motive. (19)

In 1989, nurse Richard Angelo was convicted in Suffolk County, New York, of killing four patients by injection: two murders, one manslaughter, and one by criminal neglect. In addition, he was convicted of assaulting--three times--a surviving patient. His motive was to bring them near death so he could participate in heroic efforts to save them and overcome feelings of inadequacy and low self-esteem. (20)

Nurses Gwendolyn Graham and Catherine Wood were convicted in 1988 of murdering five elderly women in three months by suffocation at a nursing home in Walker, Michigan. They were lesbian lovers who obtained sexual gratification through their acts. (21)

Orderly Donald Harvey was convicted in 1987 of twenty-five murders committed from 1982 to 1987 at two hospitals in Cincinnati, Ohio. He was suspected of nine more murders. His methods were poison (rat poison, cyanide or arsenic) and suffocation. Most of his victims were incurably ill. He claimed a motive of mercy. (22)

In 1996, nurse Terri Rachals was acquitted of six murders, but the Georgia court found her guilty of one count of aggravated assault for injecting a patient with potassium chloride. She was suspected of having injected twenty patients because they had asked her for help to die. (23)

Robert Diaz, a nurse, was convicted in 1984 of the murder of twelve patients in a twenty-six day period at two California hospitals in 1981. He was not charged with a thirteenth murder that occurred a week earlier at a third hospital nor with a number of attempted murders. He used lidocaine which, when properly used at appropriate levels, is life-saving. He claimed innocence. (24)

Genene Jones, a mother of two and a nurse, was convicted in February, 1984, of murdering a fifteen month old girl in 1982 in the clinic where she worked. She had injected the infant with succinylchlonine chloride, a muscle relaxant typically used during surgery to facilitate intubation. Later in 1984, she was convicted of injuring a child using the same method. Evidence was admitted that in a single month she had injected five other children at the same clinic--in an apparent attempt to persuade the nearby rural hospital in Texas to open a pediatric intensive care unit. All of her victims were too young to talk. In February, 1983, a grand jury convened to investigate forty-seven suspicious deaths of children at Bexar County Medical Center Hospital over the four years that Jones had worked there before being employed at the clinic. An epidemiological assessment pointed to Jones as responsible for twenty. (25)

In the spring of 1979, prosecutors dropped charges for three murders against a Baltimore nurse, Mary Rose Robaczynski. It had been alleged that she had unhooked...