In 2017, Elizabeth Wettlaufer was convicted and sentenced to eight concurrent life terms, with no possibility of parole for 25 years. Wettlaufer was a registered nurse working in long-term care facilities, in Ontario, Canada. She was found unfit to be a nurse due to mental illness and drug addiction and was fired twice, but was still considered “in good standing” with the College of Nurses of Ontario CITATION She18 l 1033 (Sher, 2018) at the time that she confessed. Healthcare professionals, in hospitals and long-term care facilities, are responsible for the most vulnerable in society.
Policies and procedures need to be created and followed to find possible discrepancies in the care that is provided; and to protect patients, families and the staff at these facilities.
Healthcare serial killers are considered the most deadly, and rare, type of serial killer. Nurses are the majority of killers, but physicians and other personnel have been convicted for serial murderer in the healthcare setting. The victims, of these murderers, are predominately very young, very old or critically ill patients.
The murders tend to occur during the evening or late shifts, when there is less oversight and/or supervision of the employees CITATION Bar16 l 1033 (Barros, Rosa, Telles, & Taborda, 2016). It was reported to the Long Term Care Inquiry which is currently being held by the Province of Ontario that as of 2018 there has been 131 prosecutions worldwide, in 25 countries, for murder and/or assault of patients in care since 1970, of which 90 were convicted without appeal. Seventy percent of the murders occurred in a hospital setting, twenty percent in nursing homes/long term care and six percent in home care CITATION Yor18 l 1033 (Yorker, 2018).
Traditional serial killer theoretical models and typologies will not necessarily help predict that a healthcare serial killer is at work in the hospital or long term care facility but there are some similarities that can assist facilities and law enforcement in detecting the killers before they commit more murders. According to strain theorist’s, Durkheim and then expanded by Merton, strain within society and the pressure placed upon an individual to succeed, will eventually force a person to become deviant from the acceptable norms of society CITATION Lin16 l 1033 (Linden, 2016). With a traditional serial killer their struggle with society pushes them into desperation and committing murder is their only release from this struggle while with some healthcare killers the strain to conform to societies expectations, that healthcare workers are beacons of hope and can fix any problem, causes them to create situations where they can diagnose and save the patient, thus receiving the respect and adulation from patients and colleagues.
Control theory, developed by Travis Hirschi, says that people who value instant gratification and only take a short term view of their life and goals will be more likely to act in a deviant way. Those that have low self-control will tend to be associated with other criminal activities and drug and alcohol abuse. CITATION Lin16 l 1033 (Linden, 2016). Serial murders and healthcare killers who lack self-control will give into their murderous impulses to gain control and power over their victims CITATION Chr14 l 1033 (Christine Katharine Lubaszka, 2014).
Doctors and nurse serial killers have different motivations for killing. Doctor’s predominantly kill to feel a god-like sense of power and control over their patients and they feel that they are superior to the patient, patient’s family and fellow co-workers. Nurse killers tend to feel less powerful and undervalued. Their motivations are varied. They may kill to gain attention, pay back towards colleagues or facilities, they overburdening of workload and frustration of difficult patients or they find the killing rush alleviates their depression CITATION Dea15 l 1033 (Dean, 2015).
The healthcare serial killer selects their victims differently than a traditional serial killer, which existing typologies primarily rely on. A traditional killer stalks and kills their victims in areas outside of their comfort zone. Healthcare kills don’t have to stalk or hunt for his or her victim. Their victims, contact site, murder site and the body when it is discovered are all in one location CITATION Chr13 l 1033 (Christine K. Lubaszka, 2013). Law enforcement and healthcare facilities can view healthcare killers as conmen or confidence men. A conman’s ability to manage the impression he gives of himself to others is his most important tool. A healthcare must also give a trustworthy and capable impression to their fellow workers, friends and families of their victims CITATION Chr14 l 1033 (Christine Katharine Lubaszka, 2014). Beverly Allitt, who attacked 13 children, killing four, had the conman’s ability to manage impressions. One of her victim’s was a twin and the parents were so grateful for the care they thought she provided that they asked her to be the other twin’s godmother.
There are many difficulties to detecting healthcare serial killers. They have advantages which traditional killers do not, to help them escape detection. Their training and knowledge of the healthcare system, guidelines and practices helps them immensely, and because of their possession of this knowledge and ability to gain information, can help them evade capture. The majority of killings in healthcare settings are committed using injection and specifically insulin which can take hours or days to induce coma or death in a patient, making it difficult to assess if this is what is occurring in an already elderly patient CITATION Yor18 l 1033 (Yorker, 2018).
Society’s myth that the medical profession is omnipotent and are the only individuals that have the medical know how to give direction in medical situation, can reduce the vigilance of the patient and patient’s family members to question the need for medical procedures or prescribed drugs CITATION Chr13 l 1033 (Christine K. Lubaszka, 2013). The healthcare environment can also challenge detecting healthcare serial killers. Hospitals and Long-term care facilities are places where death can and is expected to occur on occasion. This means that the environments where a death occurs is not usually treated as a possible crime scene and any evidence that may have been available is not preserved CITATION Yor18 l 1033 (Yorker, 2018).
The usage of a 22 point checklist of personality traits and behaviors, can assist law enforcement and administrative levels of healthcare facilities in detecting potential criminal activities that are occurring in their institutions. The most prevalent points that were seen with currently convicted healthcare killers were: higher incidents of death on their shifts, mental illness history, they made colleagues nervous or suspicious, they had drugs at home or in their lockers and they appeared to have a personality disorder and craved attention. It should be noted that just because an employee may have one or two of the points on the checklist, this does not mean there could be a serial killer in the mist.
Focusing on only specific points, such as a history of mental illness or depression, could have detrimental effects on the nurses and doctors at the institution and those individuals that do suffer from mental illness could face the risk of stigmatization CITATION Eli16 l 1033 (Elizabeth Yardley, 2016). Charles Cullen, who convicted of killing 13 patients and attempting to kill 2 others, scored an 11 on the checklist, while Beverly Allitt scored a 7 out of a possible 22 maximum score. While examining news reports, Elizabeth Wettlaufer would have an estimated score of 7, which would be a cause for concern if she had not turned herself in and confessed.
Institutions can help resolve the contributions to healthcare serial killers criminal behavior in many ways. The code of silence that is prevalent in healthcare settings, that is similar to the police force’s blue wall of silence, can lead to longer killing periods on the part of the serial killer. Colleges and others who report suspicions should be protected by administration and the shaming and blaming that occurs when medical errors happen should be discouraged so that more reporting can occur and root cause analysis can happen.
This reporting can also find discrepancies that are not natural occurrences. Drug delivery or dispensing discrepancies can also be caught much more quickly if the usage of electronic dispensing systems are used. These systems can produce usage reports to track if drugs are being diverted to places other than the patients CITATION Yor18 l 1033 (Yorker, 2018). Additional hiring policy changes that could help eliminate a potential serial killer could be social media training, routine background checks and mandatory follow up of references, drug screening all new employees prior to hiring and better communication is required between hospitals, long-term care institutions and employment agencies that are used to fill needed employment vacancies.
The responsibility of protecting patients and residents of all healthcare institutions is not only on the staff but on the public and hospital administrators. Many healthcare serial killers were able to continue the killing with impunity because staff did not speak up, the administrators choose their jobs and institutions over the safety and welfare of their patients and family and friends of patients were not listened to when suspicions were brought to the attention of individuals in charge CITATION Dea15 l 1033 (Dean, 2015). The most vulnerable go into a healthcare institution and it is expected that they will leave healthy and alive.
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