Serial killers in healthcare are not unheard of, including cases involving nurses and doctors. Interestingly, healthcare serial killers (HSKs) do have motives and methods of killing that are in common. This implies that they can be prevented or caught—if the right policies are in place.

How to spot a HSK

Doctors and nurses train for years to support and preserve the lives of the ill. Yet, according to psychiatrist Dr Herbert Kinnell, a notably large proportion of serial killers tend to belong to the very same profession.

Those with a "pathological interest in the power of life and death" may tend toward patient care, he wrote in the BMJ. The combination of the knowledge to kill, as well as the ready access to the vulnerable, are presumably too tempting for the aspiring HSK to resist.

There are several key traits common to HSKs, which contribute to tells that point to their true nature, namely, a tendency towards erratic behaviour and feeling of invulnerability, a lack of empathy to patient deaths, a desire for attention, and a morbid fascination with death.

The most common method of murder involves poison, due to the ease of killing, the access to drugs and the potential for the cause of death to be disguised as some other medical malady.

HSKs either exhibit bad behaviour early, or are too good to be true

One tell in many HSKs is the tendency towards misbehavior; such as records of medical school expulsions, a history of dismissals from employment, and even revocation of medical licenses. This is because many serial killers tend not to be mentally stable and may display irregular behaviour.

Indeed, a study conducted by criminologists from Birmingham City University, which examined 16 convicted male and female nurses who murdered within a hospital, found that 10 had a history of psychological instability or depression while half appeared to have a personality disorder.

The same lack of empathy that allows them to kill could also manifest in a possible mistreatment of patients—leading to a poor employment record. Surprisingly enough, the opposite can be true. HSKs may adopt a mask of affability, to gain the trust of the victims’ families and remain above suspicion. At the same time, the HSK is also able to hold detailed morbid conversations with grieving relatives, allowing them to relieve their killing experience.

HSKs often think they are invulnerable

Another key trait is the exhibition of ‘gallows humour’ and risk-taking behaviour. They have no qualms joking about their patients’ deaths—former nurse’s aide Donald Harvey, who pleaded guilty to 37 counts of murder in 1987, often joked with co-workers about the deaths under his watch. “I got another one today,” he was reported to have said, according to the prosecutor at his trial. Such behaviour allows them to show off and relieve their ‘achievements’ without casting suspicion on themselves—or, so they think.

According to the Federal Bureau of Investigation (FBI), "It is not that serial killers want to get caught; they feel that they can't get caught"—as their confidence grows with each offense.

They often get emboldened after getting away with the first few murders. Consequently, they get more and more careless—escalating their crimes in the pursuit of bigger thrills; or simply, to achieve their goals, which may have nothing to do with their job or even with themselves.

For example, Louay Omar Mohammed al-Taei, an Iraqi doctor and member of Ansar al-Sunna, one of Iraq's most lethal Islamist groups, murdered at least 43 policemen and members of the Iraqi National Guard, because he “hated the Americans and what they'd done to Iraq."

He thought he would get away scot-free, as he "killed without fuss, and there were no facilities at the hospital to perform proper autopsies".

When asked if the thought of stopping his crimes had ever occurred to him prior to his arrest, he replied, “I never considered how terribly brutal my crimes were, and I never thought... I would be so easily captured. I got on so well with all the people at the hospital. They seemed to like me.”

Other key tells include the preference for night shifts or shifts with fewer staff on duty, a tendency to ‘predict’ patients’ deaths, and having many patients die under their care.

How to thwart a HSK

From the common patterns of killing that HSKs display, some preventative measures could be introduced. The first is to watch misbehaving healthcare professionals more closely—such as by having a system of national-level communication among different hospitals—to prevent HSKs who move from hospital to hospital in an effort to stay under the radar. Patients and staff should also be encouraged to report any misbehaviour, which should be taken seriously and investigated.

The second is to have a system which holds HCPs accountable for the amount and type of medicines they administer or take from the hospital, given that the administering of overdoses or poisons is a very common MO for HSKs. Examples include fingerprint access and keeping exact records of the amount of medicine removed from the hospital pharmacy, down to the last milligram.

Lastly, the moral and legal obligations of all HCPs should be reinforced, such as through in-service ethics training—in an effort to curb the perceived untouchability that HSKs often feel. MIMS

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