Killer nurses

The news story of Victorino Chua that holds the UK in its grip is that of the nurse who killed many patients by poisoning the water drip attached to their arm.

Although it is rare, this is not a new phenomenon, and I am not even including nurses who kill one person they know well personally (such as this one or this one with paranoid psychosis). Just search for “killer nurse” or “nurses who kill patients” on the web. It lists several:

2006: Oxfordshire. Benjamin Green, who killed for kicks

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http://news.bbc.co.uk/1/hi/england/oxfordshire/4919520.stm

2007: Crewe. Barbara Salisbury

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http://news.bbc.co.uk/1/hi/wales/north_east/7058722.stm

2009: Leeds. Colin Norris

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http://news.bbc.co.uk/1/hi/england/west_yorkshire/8403614.stm

And this happens in other countries as well, for example in Germany recently (Niels H.), the United States (Charles Cullen), and Italy (Daniela Poggiali). Once you start looking for this on the internet you find more and more. In some cases, nurses seem to have been falsely accused and have become victim of the difficulty distinguishing between murder and illness-related deaths (see the case of Dutch Lucia de Berk).

The motivations behind patient killings might be different. For example, while some might be driven by sick pleasure, some others might be driven by a form of compassion for patients in the last stages of terminal disease (although this does not apply to the ones listed here).

The psychopath

Detectives in the Victorino Chua case described him as a narcissistic psychopath. I am not sure what exactly they base this on, though, although I am sure there will have been a psychological and psychiatric report about Chua (I could not find anything in the news about this, though). It is important to point out that narcissism and psychopathy are two different things. I have described tests for both these states you can try yourself:

Description and test of narcissism

Description and test of psychopathy

One of the similarities between narcissism and psychopathy is a lack or low level of empathy – for which there is a separate test too! But there is more than a lack of empathy here. Several of the above listed cases indeed got a kick out of it. The term psychopath seems more appropriate than narcissist.

Can this be prevented?

Every time when these cases are discovered, we read on how this will bring on a change in the system and so on. The fact that it keeps happening shows to me that this is not preventable. No matter how tragic and horrible these cases are, at least they are still very rare, especially if you think how much medical staff there is. It is just a fact of life that there are some people who will show these terrible traits, and they might even choose to get into the medical profession to have control and cause suffering, just like some paedophiles are attracted to professions where they can have unchecked contact with children (in schools or churches).

Last year, there was a study which proposed a red flag system to help the identification of killer nurses (check here on the BBC). According to this study, the most common red flags are:

  • Makes colleagues anxious
  • Being in possession of drugs at home/in locker
  • Appears to have a personality disorder, depression, history of mental instability
  • Higher incidences of death on his/her shift.

There are difficulties with this too, though. One of the interesting things about psychopaths is there ability to combine charm with scrupulous lying and manipulating! For example, Chua seems to have been faking his documents. If someone is a charming manipulator, they will be very hard to detect, even when working in small groups. This means the red flags might be harder to detect.

And even when it is detected, it will already be too late. In other words, even when it would be more easily detectable, it is not preventable. This is even more so the case with international mobility, where people might be able to leave one place and start at another with a fresh record. In that context, it is surprising how bad the UK is in ensuring enough local nurses are being trained. Something seems really wrong in a country if it has to “import” nurses decade after decade!

In conclusion. Society has an obligation to work hard to prevent this, but unfortunately, it seems that it will happen again, no matter what measures a society puts in place.

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