There's an arsenal of documented cases in which medical professionals kill their patients -- known as serial healthcare killing.
This has taken place at the hands of nurses, nurses' aids, physicians and pharmacists. The topic has grown in attention so much that one nurse presented on nurses who kill to an overflow crowd at a recent national emergency nursing conference. Prisoners on death row are not the only ones who meet their maker via lethal injection. Scores of fatal overdose injection deaths at the hands of nurses who kill come in a variety of delivery methods. From a potassium chloride drip or drastically high doses of diabetes medication given to non-diabetics to the unassuming turkey pot pie or gelatin cup laced with arsenic, cyanide or some other poison du jour, according to news reports. People Magazine and The New York Times covered the topic at length earlier this year.
Raising awareness about nurses who kill
The eerie words read more like a page out of a Stephen King novel, but the truth is nurses who kill are out there and often go undetected for many reasons. They can hide behind fake smiles, professional demeanor and respected medical credentials, making these cases some of the hardest to prove. Nurses get away with these vile acts because they prey on victims likely to die anyway -- elderly patients or the terminally ill -- so it does not raise a red flag to colleagues or the authorities, said Gina Carbino, BSN, RN, CEN, clinical education manager with Champlain Valley Physicians Hospital in Plattsburgh, N.Y.
"Nurses have access to critical-care medications, and when people are very sick it's hard to prove whether it was ill intent to kill or if it was from natural causes," Carbino said. "So when they die, it's not a big surprise and you don't necessarily go investigate the death."
Commonly called "mercy killings," it may not seem as pervasive as mass shootings in the U.S., for example, yet the topic made the cut at the 2019 Emergency Nurses Association annual conference when Carbino suggested it. With more than 4,000 nurses in attendance at the ENA conference, Carbino delivered the chilling historical facts about nurse serial killers. She came up with the idea for ENA after she discovered beta blocker toxicity, which allegedly caused a patient death, she said. Did her presentation strike a chord? In addition to the room where she presented, there was an overflow room packed with eager attendees, according to the ENA, and the event drew a standing-room only audience. Since the presentation, Carbino has received scores of emails and had numerous people approach her with stories and questions.
How common is it?
Keep in mind that we are talking about serial killers who happen to be trained as nurses. In fact, the number of nurses who kill is quite small, said Beatrice Yorker, JD, RN, MS, FAAN, professor emerita of nursing and criminal justice and criminalistics at California State University, Los Angeles.
"Your chances of dying at the hands of serial killer nurses are rare, less than being struck by lightning," Yorker said. "But I want employers to be aware it does exist."
In the U.S., from the 1970s until 2018, there have been 131 prosecutions and 90 convictions of "healthcare serial killers" worldwide, according to Yorker's research, which she presented at the American Academy of Nursing's 2018 conference. The problem is even with a small number of nurse serial killers, they can leave an alarming trail of bodies, especially considering the suspected but unproven cases, a topic well reported, including a story in the National Post. Carbino said some medications are difficult to detect in the postmortem toxicology report.
"A nurse from Indiana killed about 130 patients in less than two years in a four-bed ICU," Carbino said. "They knew something was going on because the death rate at the hospital quadrupled. He was using potassium."
In many cases, the total number of deaths will never be fully known. Yorker said it's far too costly and time consuming to go after all the suspected deaths, plus it would likely involve exhuming bodies. "Prosecutors pick the top two or three [deaths] with smoking gun evidence where they know they will put that person away," Yorker said. "There are far more suspected victims per convicted nurse killer than those for which they were convicted."
Track the numbers
When these cases on nurses who kill turn up from prominent medical institutions and universities to lesser-known small hospitals or the unassuming kidney dialysis center, it can set healthcare facilities on a potentially more deadly path to correct the problem and preserve their reputation.
"The desire to avoid bad publicity may obstruct investigations," Yorker said.
Certain hiring practices, employee reporting and patient death count tracking need to be in place, she added. When patients die, it's important to keep track of which nurses are on duty at the time, said Yorker, using risk management data. "There is nothing libelous or slanderous in reporting the truth about patients," Yorker said. "It's in the hospital's best interest to put it in the employee record. And be forthcoming when they receive reference calls, to say, this nurse was fired and will not be rehired because adverse patient outcomes happened when this nurse was on duty." The Institute of Medicine report "To Err is Human" has helped deter serial healthcare killings, Yorker said.
Take these courses to learn more about patient safety:
National Patient Safety Goals - Nursing (1 contact hr) This course will cover the 2019 National Patient Safety Goals for nursing staff in the hospital setting. Promoting a Culture of Safety to Prevent Medical Errors (1 contact hr) An organization promotes a culture of safety by focusing on how and why a problem occurred rather than on the person whose action or inaction caused the error. Experts refer to healthcare organizations that have a passion for patient safety as high-reliability organizations. In such organizations, being on the alert for how patients can be protected from harm is part of everyday work life. Although high-reliability organizations have few adverse events, they still continually explore risks and ways patient safety may be compromised. This module will offer suggestions for establishing and maintaining a culture of safety. It explains sentinel events and how to avoid them. Drug Interactions With Medications and Food (1 contact hr) According to a 2007 Institute of Medicine report, an astonishing 380,000 to 450,000 preventable adverse drug events take place in hospitals annually, causing patients to suffer injury or death. As much as $3.5 billion is spent annually on treatment of these adverse events. This has become not only a quality issue but a financial issue as well, raising concern in the healthcare community and regulatory organizations. This educational activity will review common drug-drug and drug-food interactions, phases of pharmacokinetics, and interventions to improve patient safety and outcomes.
