Quiet killings in medical facilities: detection & prevention

Issues in Law & Medicine, Spring, 2003 by James M. Thunder

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)