Healthcare murders as a patient safety issue

How many murders did you have in your hospital last year? Did they involve sporadic or serial killers?

What? You don’t know? You really haven’t thought that much about it?

I’m not surprised.

Chances are you might have had some murders but they were not discovered. I’m not only talking about the angry patient or family member who brings a gun to the ER or a patient room to seek revenge for a bad outcome. Or, bad guys whose assaults just happen to be carried out in hospitals. These are usually obvious, recognized, and widely reported.

Ken Kizer and Beatrice Yorker recently have published a paper in a Joint Commission journal discussing the sometimes overlooked patient safety aspects of what the authors term HealthCare Serial Murder (HCSM).

Since 1975, at least 35 American healthcare workers have been formally charged with serial murder of patients, marking healthcare workers as an overrepresented occupational group among known serial killers.

Some of the worst serial killers of all time have been physicians. Physicians, of course, occupy the uniquely powerful position of enjoying the total trust of patients and their families, easy access to lethal drugs and devices, and the unquestioned authority to sign death certificates.

These authors draw distinctions between healthcare serial murder and euthanasia, assisted suicide, politically motivated assaults, or crimes of passion. Of course, the actual numbers of serial killings are unknown, but more than 1,000 suspicious deaths have been linked to persons charged with HCSM.

Let’s face it. We in healthcare education or practice may select people to work with patients without knowing a great deal about their potential to become killers.

Kizer and Yorker make several proposals of how the healthcare community might do a better job of recognizing and preventing HCSM, naming IOM, NQF, and AHRQ as organizations that could review the subject and recommend good processes.

Meanwhile, in your own setting, I suggest that you raise your institution’s alertness to the potential of healthcare murders as a patient safety issue. One good place to start would be to look at in-hospital deaths.

There is a classic way to do this … it’s called … frequent autopsies.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more hospital news.

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  • http://thedocsquawk.com thedocsquawk

    When I first read the title, I thought this was going to be more a healthcare manslaughter article than murder. I have no idea how many doctors have motive to kill their patients. I’ve seen docs kill people before but that was always by accident.

    • http://www.aneurysmsupport.com/ Mike

      Actually, in the area I grew up, we had a doctor who murdered two of his children, two other people in a drunken driving accident, and likely at least one patient. He got away with all of it till he killed his second son in a neighboring state. He was convicted, sentenced to death but committed suicide while on death row.

      • http://thedocsquawk.com thedocsquawk

        Ugh. Did any murders happen in the hospital?

        • http://www.aneurysmsupport.com/ Mike

          None that are known, at least as far as I am aware. It would not surprise me if there were but at this point, so many years later, I doubt we will find out.

  • Vox Rusticus

    Did someone jusr read “The Devil in the White City?”

    Part of what excites such interest in this rare kind of crime is precisely its extreme rarity. Killers like Dr. Shipman from England and Dr. Swango in the USA follow the usual pattern of serial killers using poisoning. Ordinary serial killers do not have the added curiosity of perversion of an expected professional moral standard.

    I agree that autopsy should be done more often, and M&M and case review should add to the scrutiny. Somehow, I think that patient safety concerns and efforts would be better devoted to investigating microbial killers and human errors.

    • http://www.aneurysmsupport.com/ Mike

      I’ve never read it Vox. Interesting note on our local doctor, while most physicians I suspect usually murder by poison in this case the man shot both of his children. The first he had staged to look like an accident, but did a poor job of it. With the second, I think he wanted it to appear to be a random murder, but as I recall in his trial his lawyer argued it was suicide.

  • Bladedoc

    Hah frequent autopsies. GA runs out of funding for autopsies by mid-year — and that’s for gunfights and car crashes. I haven’t been able to get an autopsy at my institution for learning or interest purposes in my 8 years here. The best bet is to piss off the family and then they’ll pay for one looking for med-mal. Hey there’s an idea “mrs jones I think the optho subspecialst I consulted on your husband may have knocked him off. Want to get an autopsy, it’ll be $2000?”

  • http://useddentalequipment.org/ Jonas

    When reading this article, my mind immediately focused on my experiences. Approximately 9 years ago, my brother died in the hospital and allegedly due to malpractice. My family can not accept this and almost demanding the doctor to court.
    But I’m sure a doctor is humans that can be wrong. Something like this should be a lesson for another doctor to get the trust from all patients.